The Ten Commandments Of Patient Engagement In The Doctor’s Office

Here is a list of things that physicians, hospitals, along with concerned stake holder partners, etc. need to do to increase patient engagement:

  1. Regardless of how busy you are, act like you are glad to see them (patients).
  2. Say something to hint that you actually remember who they are – this one is crucial.
  3. Enquire about their health after the last appointment and the reason for them coming today. Remember what they say and come back to it later.
  4. Seek for the patient’s idea related to the reason behind the complaints and ask them what they would like you to do for them.
  5. When the patient describes their problem, avoid interrupting them. Ask questions that would further clarify the problem. Show interest in them. They need to be invited to speak up.
  6. Let the patient know your recommendations about the tests, treatments and new medications. Give the reason behind your recommendation. Make sure to check if the patient is okay with it. If not, ask why.
  7. Pay attention to the cues initiated by the patient. Oft times, they are a call for help.
  8. 8.   Show empathy towards them and try to support the patient as best possible.
  9. Try to figure out their health goals and find out the steps they believe can be taken in order to achieve them.
  10. 10.  Suggest ways by which you and your team can support the patients’ long-term care plans.

Most physicians do not face the challenge of “How to engage patients?” since most patients are already engaged to the extent that:

  • They bothered to call your staff and made the appointment (which seldom is a pleasant experience).
  • Took time off work to come to your office.
  • Waited a while before seeing you.
  • Thought about what they wanted to talk to you and how you are too busy to listen.

Rather, the challenge for the providers is “How to be engaging to the patients?” Healthcare always has been the intensely personal and social interaction between human beings.

Health IT professionals will have you believe that EMRs, web portals and smart phone health apps are the best way to engage patients. Which they are not. People would be more engaged in the care only if the providers were more engaging.

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Empowering patients to ensure their physician does not miss-out on opportunities to be a better provider

It is observed that on a normal day in the office, the average physician misses an ample of opportunities to engage with their patients. The reason behind this being their busy schedules. Research indicates that this happens because physicians do not have the proper patient-centered communication skills and awareness.

On a typical visit, patients provide their physicians with a number of verbal and non-verbal cues, indicating their thoughts and feelings. This is done to pose a question or just to show concern. The value of the cue is directly dependent on the physician understanding it.

Let’s break down a typical day in the office to better analyze the opportunities involved. On an average, a physician receives 3-4 Patient complaints, 2-3 requests and there are around 4-5 patient expectations.   Add them together and we have 9-12 opportunities, per visit. This is a substantial amount. Hence, it is of utmost importance that attention needs to be paid to those cues.

The cues may be apparent; like a patient complaining of depression, but more often, those cues are not clearly stated and the doctor needs to observe the patient’s body language, facial expressions, etc. to get the hint. Regardless of how a patient expresses them, these cues are opportunities to engage the patient.

Let us take an example to understand this better. Following is a brief conversation about the patient’s knee, and there are 4 cues that the patient expressed verbally.

Doctor: So, how is your exercise regimen since your last visit?

Patient: I’ve haven’t been feeling so great ever since I slipped on the ice and my knee hasn’t been as cooperative. I’ve been missing the exercise.

Doctor: How about the diet? Are you still sticking to it?

Patient: Yes, but…

Doctor: Well, now that the weather is warmer, you could get back to the jogging that we talked about before.

Patient: How about doing an MRI of the knee to check if I have torn something. A similar thing happened to my friend and she got an MRI. Turns out, she had torn her cartilage.

Doctor: If your knee continues to bother you after a month, come and see me.

The 4 cues actually represent 5 opportunities for the doctor. Those opportunities could be utilized to:

1.   Demonstrate that the doctor was paying attention and listening to the patient.

2.   Show comprehension of the patient’s expectations

3.   Relate and empathize with the patient.

4.   Explain why MRI isn’t a necessary procedure at this point of time.

5.   To integrate a diagnosis and a treatment plan in a way that the patient can buy into it.

The reason for a potential “fall-out” due to the response of the doctor to those cues would be:

·         Feeling of mistrust

·         Feeling that the concerns were dismissed easily

·         Feeling that the whole visit was a waste of time

·         Problem not resolved

Long-term potential outcomes might include:

·         Patient acting against the doctor which could cause the problem to worsen.

·         Dissatisfaction

·         Patient doesn’t share potentially relevant health information in future visits.

·         Patient decides to visit the ER instead of seeing the physician

Let’s estimate that the average patient visit generates around 10 such cues, which is a conservative number. If the physician identifies and addresses 50% of those cues, it would leave 5 missed opportunities per visit. This analysis would add up to a 110 missed opportunities on a typical business day. Which makes 440 missed opportunities a week and a staggering 22,880 opportunities a year for just one physician.

Think about the impact the physicians in your provider network could make if they were made aware about some basic communication skills which would enable them to be mindful of, acknowledge and properly respond to these cues in a way that the patient would appreciate.   Investing in improving these skills would no doubt have a significant impact.

Asking Insurers to Deviate from Medical Necessity Clinical Guidelines

Insurance carriers routinely cite evidence-based clinical guidelines when denying treatment authorization. However, a number of insurance industry resources confirm that insurance medical decision makers must consider the patient’s unique medical condition and should deviate from the clinical guidelines when appropriate.

Requesting deviation from the guidelines will typically require an appeal focusing on the patient’s unique medical needs and why application of the guideline is not appropriate. Some of the specific factors to address in such an appeal include the following:

  • Patient’s previous treatments and discussion of failed treatment attempts and unwanted side effects
  • Patient’s secondary diagnoses which potentially complicate treatment
  • Any anatomical anomalies or age-related factors (pre-natal or geriatric challenges)
  • Ongoing diagnostic assessment for unexplained symptoms/atypical disease/disorder presentation

Further, the guideline itself can be called into question if it does not appear to adhere to current industry quality care standards and incorporate the latest treatment options. Some of the specific questions useful for assessing the quality of the guideline include the following:

  • How frequently the guideline is updated to incorporate recent medical developments
  • Patient demographic used to develop standards, ie, did the guideline development include studies involving a diverse patient population inclusive of prenatal patients, geriatrics and minorities to ensure appropriate application across a diverse population.

A study of medical necessity decisions made by private health plans discusses the widespread adoption of clinical guidelines for use in medical necessity decision making. According to this study entitled “Medical Necessity in Private Health Plans: Implications for Behavioral Health Care“, several insurer medical directors acknowledged that clinical guidelines are simply a decision making tool and should allow for flexible implementation.

“Interviewees stated that guidelines are not mandates or absolute protocols; rather, they are considered ‘guideposts’ to be informed by, and adapted to, individual circumstances and psychosocial needs of patients. Ongoing audits, performance measurement of in-house care managers and contracted providers, and member and provider satisfaction surveys are used to monitor the appropriate use of treatment guidelines in medical necessity decisions and to build in quality improvements at all levels of decision making,” states the study, available online at  http://download.ncadi.samhsa.gov/ken/pdf/SMA03-3790/SMA03-3790.PDF.

Practice Revenue Growth Case Study

CASE STUDY: Medical Group, Union NJ (2 Providers)

An Internal  Medicine/Primary Care office located in Union, NJ was quite overwhelmed with the overbearing costs, administrative hassles, staff issues and gross collection deficits.  An administrative decision to sell the group was earnestly deliberated.  With an average monthly collections between the 2 providers totaling less than $60,000 while estimated hospital based physician salary is nearly $220,000, a quick resolution was necessary.  In 2011, in an attempt to save the group, ClinicSpectrum was hired by the administrative team.  Immediately, imperative key issues were discovered, and a revenue maximization strategy for cost efficiency was implemented.

Step 1: Operational Restructure through Hybrid Workflow Model

ClinicSpectrum immediately identified all the office tasks including inventory management, cleaning of exam rooms, scanning of documents, appointment confirmation, eligibility services, preparing patient in exam room before physician walks in, and many others.  We assigned those tasks/activities between LOCAL EMPLOYEES in the office and OFFSHORE employees in our back-office operation.  Our back-office employees took over eligibility verification, indexing of scanned documents; follow up on outstanding claims, transcription services, appointment confirmation, missed appointments management and procedure recalls. The group’s local team members were then separated into an administrative team, billing team and clinical team combined with DAILY REPORTING to build self-accountability.

RESULT: With the above planning in place the practice is running smoothly and seeing 55+ patients’ on a daily basis without depending on an “Individual Team” member to run the office.  Step 1 took care of operational efficiency and cost reduction through our back office team members.

Step 2:  Medically Necessary Tests/Procedures for better Outcomes and Risk Management

ClinicSpectrum introduced a concept of collaborative medicine by joining an IPA (Independent Physician Association) which has turned into an ACO now. By joining an IPA, we participated in several incentive programs for Risk Management and reducing cost of care for payers. We created a clinical team that went through each patient’s clinical notes. Based on medical necessity and evidence based medicine we recommended TESTS/Procedures that were urgently needed. This resulted into better care for patients.  Utilization of clinical resources/teams and diagnostic equipment made a difference in patients’ lives and saved money for Insurance companies.

RESULT: The implementation of Step 2 has resulted in significant revenue growth averaging an additional $30,000 per month over the last 4 years.  At present the practice collects $1.1M per year.

Step 3: Monthly Audit

Nothing is taken for granted. Every task/office function gets audited randomly across the practice. A knowledgeable audit team focuses on the following areas: End of week supplies inventory check, daily closing report for copay/co-Insurance/deductibles, outstanding balances, patient clinical non-compliance, reminders for tests/procedures, follow up with insurance companies with outstanding claims, medical necessity compliances, proper documentation, complaint resolution and voice message tracking.

RESULT: Efficient checks and balances mechanism in place lessened errors, and improved efficiency.

Outsourced Claim Creation for Physician Practices

A great deal of expertise goes into running a successful physician practice – from the skilled clinicians who deliver patient care, to the front- and back-office staff who manages the business aspects of the practice. Yet, after focusing on the care delivery aspects of the business, many practices often don’t have enough time to properly focus on their billing tasks. This prevents practices from earning the maximum reimbursement for the services they performed.

In these situations, outsourcing billing tasks – such as claim creation –  is worth consideration. Claim creation services are able to devote their entire attention to the practice’s revenue cycle management (RCM) process, and are focused on keeping up to date with ongoing regulatory changes to reduce claim denials and maximize reimbursement.

Once a practice outsources its claim creation, the process is initiated with one of two options to begin claim creation:

  1. The practice scans superbills and patient demographics to electronically send to the claim creation team. This may also include scanning the billing data and consult information from hospitalists to send to the claim creation team.
  2. The practice ships superbills, patient demographics, and other relevant billing information to the claim creation team.

Once documents are received by the claim creation service, there are typically two ways to generate a claim:

  1. Manual Claim Entry: Before any claim is generated, patient insurance verification is done. Claims are then created from a route slip, superbill and other billing information. Claims are then scrubbed for errors that may cause denials. Once claims are created, they can be either sent back to the practice for submission, or the claim creation service can electronically submit the claims.
  2. Electronically Generated Claims: This process is sometimes known as Autogeneration. These claims are created using the evaluation and management (E&M) coding engine within the practice’s EHR interface. Additionally, these claims can be created by using the electronic superbill within the practice’s EHR system, or can use the charge capture system within the practice management system. Auditing of the newly created claims can still be done before submission by either the practice or the claim creation service.

Outsourcing the claim creation process benefits practices on multiple levels. It enables them to remain focused on care delivery, while also ensuring that they receive maximum reimbursement for the services they deliver.

Show Me The Money

“Show me the money!” The famous phrase uttered by Tom Cruise in his role as Jerry Maguire, the fast talking sports agent in the 1996 hit film, has been echoed countless times. And when it comes to running your medical practice, seeing the money is an absolute necessity. You provide services to your patients, and you need to collect for them.

All too frequently practices pull their aging reports and 30,60,90—even 120 days out, there are unpaid claims. When added together, these claims are costing practices tens of thousands of dollars. On top of recouping these payments, then there is also the extra legwork that goes into denials management.

It’s inevitable that you don’t have a 100% clean claims ratio. It’s virtually impossible due to the fact that claims can be rejected for any number of reasons, ranging from lack of pre-certification or prior authorization, to diagnosis and procedure coding errors and omissions, to complicated workers’ compensation issues. In fact, according to the AARP, 200 million claims are rejected every year, and 60 percent are never resubmitted, resulting in a financial loss for the practice.

Imagine this:

– Shorter collection time

– Your staff freed for other office activities

– More money collected

It’s a reality. We can show you the money. Why continue to suffer with the burden of difficult-to-manage accounts receivable when you can rely on an outsourced staff that is tenacious and will relentlessly work to recoup your hard earned dollars. It costs $25 to $30 for you to manage the average denial, according to the Medical Group Management Association (MGMA). For a fraction of that cost, a devoted, experienced team can follow-up on your report. And in the event of the claims denials, our experts won’t stop till they have identified the reason for the denial, helped correct the issue, and gotten you your money—faster.

Clinicspectrum is a healthcare services company providing outsourcing/back office and technology solutions for 17+ medical billing companies, 600+ medical groups/healthcare facilities including hospitals, and hospital medical records departments.

Outsourcing Provider Credentialing = Gaining Specialization

It makes so much sense that doctors do this all the time. So, why then, isn’t it best practice to provide specialization for the critical tasks in physician offices, such as provider credentialing? It seems as if such a necessary task so vital to protecting a practice doesn’t get the respect or staff resources that it deserves. Instead, credentialing work is simply absorbed by various members of the back-office staff. As a result, the accuracy of credentialing work is often compromised, exposing the organization to financial and patient safety risks.

But rest assured, credentialing specialization does exist, and can be obtained. The answer: Outsourcing. By outsourcing an organization’s credentialing function, physician offices can better focus their staff on revenue-generating tasks, such as billing and collections.

A primary benefit of outsourcing is that it allows provider organizations to access industry-leading expertise on the nuances of physician credentialing, enabling them to get the work done, quicker, better, faster. Experienced credentialing professionals have spent years learning about information resources to verify credentials, which helps them avoid potential pitfalls, and enhance their work through best practices.

Working in harmony: It’s important to note that outsourcing doesn’t necessarily mean that provider organizations have to completely relinquish their control over the function. Rely on the specialization, while keeping the tasks that are easier to manage within the office. This also keeps costs in check. For instance, many organizations choose to retain control over certain aspects, while outsourcing the labor-intensive processes of conducting background and reference checks, or the tedious processes of verifying schools, licensure, employment, malpractice carriers, and more. Experienced outsourcing professionals have the tools, resources and knowledge to perform these tasks faster and more accurately.

With the right outsourcing arrangement and leveraging specialized experts, organizations can remain better focused on their core competencies to improve performance and profitability.

How to Select Credentialing Software

Whether you’ve done it just once, or hundreds of times, you know that physician credentialing is a labor- and time-intensive task. On the flip side, it’s also mandatory if you want to earn reimbursement from payers while also minimizing risks for your practice. Fortunately, there is a silver lining. Software solutions are available to help manage the process. Here are some key features to look for when selecting physician credentialing software.

Cloud-Based. It’s important to look for a cloud-based solution as opposed to traditional software that must be physically purchased on a disc, manually installed and then maintained. Cloud-based solutions can be easily accessed via a browser, are available on a pay-as-you-go subscription basis, and upgrades can be done quickly and nearly effortlessly from any location.

Automated reminders and alerts. Reminders and alerts are critical to notify users when tasks need to be completed. For example, credentialing software can remind users in advance when physicians require re-credentialing. Alerts help notify of important upcoming dates, such as when physician certifications and licenses are about to expire. These reminders and alerts, combined with reports listing upcoming tasks, help facilitate greater efficiency so organizations can always stay on top workloads.

Convenience features. Credentialing software solutions should also provide numerous other conveniences. Once physician demographic and other information is entered, the system should be able to reuse that information to pre-populate forms and other materials. In other instances, some software can also remove the need for data entry by pre-populating the physician data. Look for a system with import tools that allow for the seamless extraction of provider information from various forms, including insurance company forms and the PDF documents from the Council for Affordable Quality Healthcare (CAQH). Then, once imported, this information can be used auto-populate other forms. This eliminates the lengthy and time consuming process of re-entering information.

Document management. Systems should include document management capabilities to store forms, correspondence, credential verification materials, and more. This saves time by properly organizing documents into a logical order that can be easily navigated for quick reference, and rids office staff of the stacks of folders with hard copies.

With the right software solution, credentialing can be a more streamlined and consistent effort throughout any organization. With the right software, you just might welcome the new staff physician who needs to be credentialed.