How has medical practice management evolved since you started your career?
I started my career in 1976 in a small rural community in Southwestern Kansas so it has extensively evolved since then. I even included childhood vaccinations in the Office Call. In a large practice it is impossible to function without a dedicated support team to deal with all the legal and insurance requirements. Originally, when I started practicing, if a patient came to see me we treated them – now, we have to make sure we are their PCP and God forbid if not then we certainly will not be paid.
What are the major challenges of managing medical practices today?
Personnel – staffing an office correctly is still a major challenge. From administration to billing to scheduling to the MA’s the attitude still has to be that the patient comes first. Hiring providers is a challenging proposition today as they all want to be the chief without putting in the hours in developing a bedside manner that is appropriate for patient care. A provider can be the smartest ever and fail at patient care because of how they interact with the patient.
What are you doing now to prepare for the future of healthcare?
We started a long time ago promoting wellness and have continued to meet the HEDIS Markers, which will go a long way towards how we are reimbursed in the future. We continue to encourage all of our staff to treat the patient with respect they deserve since the patient perception will also come into play for reimbursement.
What healthcare trends interest you most today?
Heart Attack and Stroke prevention are my hot buttons. I feel it is a totally preventable problem and yet as providers our hands are tied with not being able to fully utilize all the services available in testing such as the advance lipid testing.
What have you found are the biggest benefits of the transition to EHR?
I have been on the same EHR since November of 2001 so I was a very early adaptor. The biggest benefit is the ability to organize the chart without having to flip through page after page looking for a particular result. Also, we aggressively use the EHR as a profit center in our wellness department.
Part of the EHR – through a series of questions, previous diagnosis, ethnicity and when previous tests were done – allows us to simply hit a button and a SQL statement will then order all the tests that we as a group have decided constitute a wellness exam. This way it is very uniform in our approach to patient care.
What would you love to change about EHR? What improvements would you like to see made?
Interactive and able to exchange data with all the systems that are available – specialist, hospital, x-ray facilities, etc.
How has EHR impacted practice management?
Simply in the ability to organize the information available. With a click of a mouse I am able to see what my practice average A1c is for our diabetic population of patients or the average diastolic or systolic blood pressure numbers are. This is an immense help in managing our outliers.
What has been the reception of your patients to patient portals?
Most patients have embraced the portal but a few are still resistant. Surprisingly, the older generation seems to accept it better.
What have you found are the most effective ways to get patients to use portals?
Offering to let them view their test results seems to be an incentive.
How do you envision these portals being used in the future?
I suspect as Telemedicine becomes more mainstream it will be used more in that manner.
What are some of the challenges you are facing with billing today?
Low re-imbursement is always an issue. With the health plans not increasing re-imbursement and yet the cost of doing business continues to increase it becomes difficult to attract and keep well-trained employees.
What types of tools have you found to be the most useful when managing billing?
Accurate coding tools. If it is not coded correctly with the correct ICD-10 code then that will impact billing.
In a perfect world, what features would your medical billing software include?
Instant access to deductible information with the insurance companies. It is available through third-party vendors but there’s usually some delay in the information.
How do you manage your relationship with insurance companies?
We meet as often as possible with the insurance representatives and attempt to cultivate a positive working environment.
Where do you have the biggest struggles with reimbursement?
It has been over five years since we received an increase in reimbursement from the insurance companies and yet inflation continues. We are constantly looking for new revenue streams.
What have you found improves your practice’s ability to be reimbursed?
Again, I go back to accurate diagnosing and accurate coding. We have three certified coders that look at each encounter before it is submitted to the insurance company.
What would you love to change about working with insurance companies?
Encourage insurance companies to be more sensitive to our needs as well as to the needs of the patient. The outrageously high salaries of the corporate executives with the insurance companies is ridiculous.