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HMT1005 Thought Leaders

A quick visit to any online practice-management buying guide reveals dozens of alternatives from companies whose products are designed to streamline the operations of today’s healthcare practices. Whether single-tenant installed or multitenant systems built on a software-as-a-service (SaaS) platform, the technology space has grown increasingly crowded as insurers and practitioners strive to operate more efficiently and deliver better patient care.
Technology has already allowed those practices who use it to improve cash flow, expedite claims filing, simplify office and patient scheduling, and synchronize schedules and patient information across office locations. Technology has enabled office staff and providers to spend more time with patients. The future is primed to offer even more advanced technologies; the most-frequently discussed being the capture and transference of electronic medical records (EMRs).
Those who are using available technology understand its value and have embraced the efficiencies that result from it. Interestingly, though, the topic of efficiency has been surprisingly absent from the national debate on healthcare reform.
Consider this. A study conducted by Milliman indicated the nation’s healthcare system could save an estimated $86 billion annually if it were to adopt only one procedural change: utilizing existing technology to automate claim filing, claim status inquiries, referrals, pre-authorizations and eligibility. Eleven billion of the $86 billion would come just from converting paper-filing physicians to electronic healthcare claim-filing offices, estimated to save more than $42,000 per healthcare provider. These dollar savings do not even take into account the extra benefits that would accrue from faster payments, faster turnaround on claim errors, improved cash flow and patient satisfaction.
In addition, the adoption of EMR technology holds the promise of adding efficiencies in processing times, patient care, information redundancy and records integrity. With so many benefits, why has the adoption of electronic filing been so slow? Change rarely occurs overnight. Just look at electronic claims.
According to the American Medical Association, approximately 25 percent of all healthcare claims are still submitted on paper. The majority of these 3 million annual paper claims are being submitted by practices with five or fewer physicians. Their reluctance is costing insurance
companies billions of dollars in unnecessary expenses, while driving up billions in unnecessary costs for the providers, as well.
In the infancy of electronic filing, there were plenty of reasons why providers were slow to implement. Today, most of those challenges have been addressed, leaving habit as the biggest reason for not converting to electronic submission. Habits are hard to break unless one has no choice or is given an incentive to do so.
Minnesota has taken the “no choice” approach, having made the decision to no longer allow paper claims to be filed in the state. Other insurers are beginning to do something similar in their new provider contracts. While such a move carries some slight risk for the insurers, many providers would likely not risk losing patients in favor of working only with insurers who continue to accept paper claims.
The U.S. government, by comparison, has generally taken the incentive approach, providing incentives to lead to desired outcomes. In fact, the government is planning to make more than $40,000 available per physician over a multiyear period to offset the costs of EMR technology, beginning in 2011. Yet, a stimulus of only $100 per paper-submitting provider is all that would be needed to cover the cost of software to get a practice up and running with electronic claims capabilities.
Electronic connectivity is moving from a cost-savings opportunity to a healthcare necessity. If the healthcare system hopes to accommodate new innovations, emerging technologies and planned changes in healthcare, connectivity becomes ground zero.
EMRs, new diagnostic codes and changes in standardized forms are all planned over the next two years. How can the system expect a provider to participate in the electronic transfer of medical records if that provider has not yet become comfortable with the electronic transmission of medical claims – the simplest and most rudimentary function they could perform?
How do insurers help to effect the kind of change that has the ability to increase their own ROI, while improving the people, process and procedural operations of their providers? How does the industry demonstrate its own willingness to reduce costs and meet the changing demands of a U.S. marketplace that is seeking benefits without increases in premiums? How do we help providers to take the first step so that they can embrace the technologies to come?
First, we have to work together. Insurers with insurers. Insurers with providers. As providers work with multiple insurers, every provider that is converted to the efficiency of electronic processes benefits every other insurer and the industry as a whole.
Second, we have to recognize that providers will not do anything that they do not want to do unless they are engaged in the benefits of that action. To that end, there are countless ways to effect change, ranging from stimulus money to incentives to mandatory compliance.
Third, we need to make efficiency part of the dialogue. A dollar spent properly yields a much-different value than one spent foolishly. Imagine how much healthcare reform could be funded by just helping the industry to operate more efficiently. HMT

Bill Bartzak is founder, president and CEO of MD
On-Line, a provider of electronic data interchange solutions that facilitate the connection between doctors and payers.
For more information on MD On-Line solutions:

May 2010


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