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coding rules, medical necessity and even coverage limits. And when they followed these rules, the payments came. These payments sustained the medical practice’s business. But that’s all changing now.

It is anticipated that almost one-third – about 30 percent – of medical practice revenue this year will not come from insurance payments, but instead from the pockets of patients. With the increase in high-deductible, consumer-driven health plans and an increase in patients that do not have medical insurance, a larger percentage of medical care is the patient’s responsibility. What does this mean for the medical practice? First, this revenue trend requires medical practices to view patients as paying customers. They should closely watch and manage patient-due receivables and implement plans to collect money from patients. Patients will need to be edu- cated on how much the office visit may cost and have the expectation set that a payment will be required either before or at the time of service. Those experts researching patient payment habits have concluded that the odds of collecting patient payments before or at the time of visit are pretty good. But, if a medical practice takes the “bill the patient later” philosophy, they will likely face less than a 40 percent chance of ever seeing that money. Secondly, medical practice managers need to understand their patients’ financial situations. They need to answer ques- tions such as “Is the patient covered by insurance today?” or “Is there a copay?” and “Has his or her deductible been met?” Luckily, today’s cloud-based technology tools help answer those questions in seconds and better equip medical practice staff to proactively collect payments immediately. It is cheaper and it improves cash flow if a practice collects money ASAP versus chasing it down after the fact. Lastly, successful medical practices will closely monitor patient accounts receivable. Perhaps it doesn’t need to be said, but a growing patient accounts-receivable bucket is not good for the practice. It often results in taking earned revenue and giving up on ever collecting it. And no longer is it acceptable to rationalize that writing off bad debt is a charitable thing to do because the patients don’t have insurance. The majority of them do have insurance and elect not to pay or don’t fully understand their responsibility for paying. In the end, closely monitoring this revenue stream is vital. Defining acceptable aging thresholds and setting goals – even incentivizing staff based upon those goals – will help practices receive the money they are due. Admittedly, collecting money from patients is a sensi- tive undertaking. After all, most medical practices are in business to help people. However, it is still a business and it is unwise to gamble with neglecting the changing busi- ness realities. Paying attention to the details – and now the growing patient responsibility trend – will yield a good return and create a strong, sustainable platform from which to deliver patient care.


The largest change occurred in the time nurses spent documenting outside patient rooms one year post-imple- mentation. The data showed a 6 percent decrease, which based on 12-hour shifts equates to a 44-minute decrease in time spent documenting outside patient rooms. Other substantial findings include a 21-minute decrease in overall documentation time.

Nursing time in patient direct care increased 4 percent (p<.001), while indirect patient care also decreased 4 percent (p<.001) for an 8 percent tradeoff (p<.001), see Figure 4.

Figure 4 – Post-implementation, more time is devoted to direct patient care.

Analyzing data from the year preceding and following electronic documentation revealed a significant upward trend in the documentation of skin-risk assessments within 24 hours of admission. More importantly, a significant downward trend in the percentage of patients with hospital-acquired pressure ulcers was found. PIH also earned a successful Joint Com- mission survey eight months following implementation, with the surveyors commenting specifically on the comprehensive care plan evident in the electronic records. Additionally, the hospital saw a significant positive trend in some patient experience scores.

The myth is busted

Studies that have documented nurses’ dissatisfaction with implementing EHRs are likely outdated. As the benefits of electronic documentation and automated systems prove themselves over time, nursing professionals can see the posi- tive outcomes for patients and how they perform their own duties. The three studies outlined above underscore that, no matter how you measure the improvements enabled by EHRs, nurses are better care givers when armed with the right automated systems.

The views expressed herein are the authors’ own and don’t necessarily represent their employers’ position, opinion or strategies.


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