Thursday, January 29, 2009

Navigating in the rough waters Part 1: (small practices)

Navigating in the rough waters Part 1: (small practices)

During these difficult times, I find it that the media is more focused on the negative news and the problems that businesses are facing, rather than making recommendations and special reports on how we can become part of the solution. In our group, when we have our weekly brainstorming sessions, we discuss our economy and go around the room asking all individuala to provide feedback in the following format: what can we do to help practices navigate through these rough Waters and be part of the solution not the problem.

This was the mindset that we have been in, even during consulting with clients. As healthcare technologists, when we meet with clients and discuss how we can assist them with their technology needs, we focus on listening to what they are looking to resolve. And more than ever, where are hearing that it is about how we can use technology to “SAVE THEM MONEY, and INCREASE THEIR REVENUE” as well as how is the new administration is going to assist them.

So, in my mind it is two subjects that we need to tackle.

PART 1: Plug the leaks in your practice

When I got married, my wife and I were young and eager to see what it feels like to live on our own house. We chose to rent an older home close to my work for about a year. During that period, we were paying off school loans and such, and trying to save as much money as we could. Things went well during the summer up until the winter time. Living in the Carolinas with 30 degree temperatures had raised our gas bill to over 300 dollars a month. Keeping in mind that we both worked full time and had a relatively small house (1200 sqft), we did not know what to do, and the landlord did not care much. We knew that it was too expensive for us, so we had to do something about it. The only option we had while bound to a lease contract was to find ways to save on our gas bill. So we came up with a good short and effective list of solutions:

Wear thicker clothes and lower the thermostat by an additional 3 degrees.

Request the landlord to put weather stripping in all the cracks and the doors to the outside.

Close the rooms that we don’t go in and close the vents in them.

Perform maintenance on the Heating unit to get it to function efficiently.

While we knew that this was the last time we would live in a home without doing an initial inspection, we were extremely pleased with the results that we saw the next billing cycle. We were able to save over 40% on our gas bill. This was a great solution that had measurable results.

With the similar model, I found that we can apply different solutions to a medical practice that can help cut costs, and especially during this difficult economy. The following are some examples of things that can benefit a practice through the use of technology:

Review the clearinghouse services you are getting and add more functionality

Things to consider:

Patient eligibility: Get your money upfront when a patient does not have valid insurance, and eliminate the need to waste resources in filling an already denied claim, in that this will be saving precious staff time and money.

Automatic Electronic Remits Posting: if you thought about it in the past , and were too afraid to try it, well this is the best time to make the jump. Eliminate the time spent on data entry for the payments by allowing the system to do it automatically for you. This will give your billing staff enough time to allow them to focus on getting the AR where it needs to be.

Claim Submission: There are still practices out there that send claims via paper. This is the time for the switch. You are wasting your dollars if you are paying someone to print, folder and mail a claim. You can save on stamps and staff pays to do it electronically.

Practice trends: Getting the right reports to help you realign your practices goals is critical. Since you are still a business, it is important to see how you are doing and not wait for a phone call from the accountant at the end of the year. Some clearinghouses offer dashboard that give you a snapshot of where you stand, and what are certain services that are more financially beneficial to you than others

Working your collections and statements

Things to consider:

Outsource Statements: It is nice to see how we can have an assembly line when working on statements. One person prints, the other folds and stamps, however having a company that will reduce your costs and errors is far more beneficial in the long ran. You can start to see saving right away with this method, by uploading your electronic statements and letting them print them and mail them for you.

Outsource Collections: While it is nice to get a third party collection agency to call and try to get your money back, it is critical to choose the right company. One that will not make you loses your patients by scaring them off. These services will help you get more of your money, and allow your staff to be more efficient.

Revisit your IT support and maintenance contracts

Things to consider:

SLA contract and flat fee support package: This is the one thing that motivates an IT company to do the best job they can, by preventing problems. Having an SLA (Service Level Agreement) forces the IT Company to try to minimize the time spent on a problem as they want to ensure that they would need to spend less time on fixing things they can prevent to keep the margins up.

Get a good lite Preventative maintenance package “lite managed Services”: While it is a common practice for an IT shop to recommend monitoring the workstations, the servers, and even the temperature in the room, you only need to have monitoring done on critical equipment in your building. The front desk computers, or the ones in the break room are not important devices, you can save yourself money by buying some spare ones and keeping them in the back ready. Your main goal here is to prevent major downtime and loss of revenue by focusing on monitoring Backups, servers, server room temperature, and logs of critical applications such as RIS/HIS/EMR/PMS/Exchange... The provider’s tablets can be skipped as long as there is a good policy and training around saving important files or personal documents to the local computer disck drive, which would jeopardize data.

Get that EMR you have always wanted today

Things to consider:

Gethe best package for the best price: Because of the tough times and some good old competition, we finally have affordable EMR/PMS packages, and plenty of room for negotiations. We are seeing 20 to 30% off some of the top EHR packages out there. This would be a huge savings that might not last for long.

How About Free EMR: If you haven’t heard this yet, well it is true. You can get a free EMR and the only cost is the maintenance and support. OpenVista is the OpenSource (developed by a comunity of developers) EMR product developed and currently used by the V.A. in many hospitals. There is a commercial version of the product that medical offices can use and its Free!

Get Free Money from the government

Things to consider:

Grant money: whether you are a Community Health center or a private practice, the new administration is working on some great packages to offer as part of the healthcare modernization push and Stimulus package. Our president Obama is looking to get Healthcare IT some much needed financial assistance to get us where we should be. So, you have to start looking at the details of the stimulus package and how you can get approved for that assistance.

Free or low cost e-RX: Take advantage of the bonus that Medicare is currently offering. If you are seeing a large volume of patients from Medicare, then you should highly consider implement e-prescribing (e-Rx). This 2% bonus based on your anual reimbursments will last up until 2011 and then it will be reduced to 1% bonus, and by 2013 you will start losing about 0.5% of your total reimbursements from Medicare.

Remove the paper based tasks

Things to consider:

Low end scanning solution: Get with your IT Company or Copier machine guy and see what you can do about those paper EOBs that you have to keep in the back. While most of us think that we can shred them, it is critical to keep them around if you ever get I.R.S. knocking on your door, or one of the payers decides to take back some money and you need to have some supporting documentation for a claim or two. Turing your EOB into electronic documents will save your staff a lot of time as they will not have to spend a lot of time looking in boxes and such for 10 minutes or more for a single EOB.

Hybrid document management system: This is by far the most cost effective EMR and paperless solution. It offers the best of both worlds. Having all the benefits of an EMR while still keeping it simple to use for the clinical staff, and still maintain the same amount of patients and workflow.

eFax: Implement an eFax solution. You only have to spend just few hundred dollars and get a complete eFax solution. Believe it or not, you can get a complete eFax application for free as part of your windows Server 2003. All you need is a modem. This will save your nurses from having to chase paper lab results, and other faxed patient documents. One other advantage is to eliminate the need to spend time scanning, filing them, or the toner when printing them.

Consider refurbished workstations

Things to consider:

Refurbished workstations: As the computer prices have dropped, there is potential saving in buying refurbished workstations. They still hold the same warrantees, and would still run just as good as the new ones.

Free software

Things to consider:

Free office tools: Many practices thing of Microsoft Office suite when you mention word processor. In reality, you spend over 299 on to get those applications. I highly recommend looking at the free OpenOffice.Org OpenSource product. It does everything that word, excel and PowerPoint do. Except it will cost you 0 dollar.

Lower your electric bill

Things to consider:

Turn off the switch: Turn off PC, speakers, calculators and monitors automatically. Many of us underestimate the power consumed by PCs even when we don’t use it. During the night time when a PC is in standby, it is still running up your bill. So, if you want to save 30% or more on your energy consumption then buy a smart power surge for your workstations. A power surge like “Power-Saving Essential Surge Arrest 7 Outlet with TEL 120V” for as little as 20 dollars. This surge protector is smart enough to sense when the computer goes to stand by, and then it shuts off power to the PC, Speakers, calculators, digital picture frame, and last but not least monitor. This is truly a great out of the box idea that will save you tremendously on your electric bill.


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