Covid19, the deadly and highly contagious disease caused by the novel coronavirus that was first reported late last year, has already tested our country’s healthcare delivery system, and it is almost certainly not even close to peaking yet. Here at Fast Layne Solutions, we are, as always, focused on how to help small- to medium-sized independent medical practices, so today’s blog post is about how technology can assist these vital players (and the patients who rely on them) in this crisis in their tireless efforts to serve patients, while also helping them keep their offices operationally and financially viable. We will conclude with some specific additional measures that Fast Layne Solutions will be taking to help out.
Let’s start with social distancing. It is absolutely vital that we minimize human-to-human contact to stem the spread of the virus. For any medical procedure that does not require in-person consultation, we strongly recommend e-visits, aka telehealth. If your office is not already equipped to do telehealth visits, please contact us. For the duration of the Covid19 pandemic, we are waiving much of the implementation cost for our clients and, for qualifying practices, will amortize the rest over one year. We will work to get you set up on telehealth extremely quickly, as it is embedded into the patient portal that we provide with our EMRx and Revenue Cycle Management offering (see iClaim below). With just a few clicks, you can be seeing a patient anywhere in the world in a secure, HIPAA-compliant environment. (Because Apple will not sign a BAA, FaceTime, for example, is not compliant. Do not make that risky and potentially expensive mistake.) In the same portal, your patients can make appointments and even pay for their visits, as well as message your office, review their records, and check lab results.
Another way your office can facilitate social distancing is to get rid of the old practice of having patients arrive early to fill out paperwork. Using our portal, patients fill in their paperwork online in advance, and your office staff see it as highlighted entries ready for them to check and confirm before making them permanent entries into the patients’ records. As noted above, that same portal can also minimize face-to-face interactions by facilitating online payments, scheduling, records and results retrievals, and messaging.
Now we need to discuss an unpleasant topic, doctors and practice administrators. The insurance companies have waived certain co-pays related directly to testing, but this will not impact any other costs to patients, including actual treatment. Independent doctors already struggle with denials, claim rejections, and outstanding patient debt even at the best of times. During this crisis, those problems will only grow. So let’s look at how we can use technology to help minimize the impact on your practice so that you can continue serving your patients:
By ensuring that every single one of your patients who is covered by insurance has their claims properly submitted and paid by the insurance companies, you can not only survive but thrive in this challenging time.
Technology has an important role to play in this crisis, and we are ready to help you implement it quickly and efficiently to minimize negative outcomes for both you and your patients.
To further assist doctors and their patients at this difficult time, Fast Layne Solutions is also offering a monthly 5% rebate to any of our clients who are in a position to offer medical care to uninsured patients, in order to help them defer those costs. This offer remains in effect until the pandemic is declared over by the WHO.
For the duration of the crisis, we will also be donating 5% of our clients’ monthly invoices to the Center for Disaster Philanthropy’s Covid19 Response Fund.
We want to close by thanking our tireless and brave healthcare workers who will be on the front line in the battle against Covid19. You are our heroes and America’s best hope.
Last week, we talked about the challenges facing a fictional doctor, Dr. Janelle Smith, a young endocrinologist trying to serve the South Side of Chicago as an independent practitioner. When we left off, she was facing an impossible choice: stay in her private practice but barely scrape by, or join a large hospital and let go of her dream to serve her community. But it's a false choice, because all those problems we described actually have solutions.
Let’s take her EHR. Her total annual costs, including maintenance, updates, and training, for her current system exceed $25,000 for the practice. And that’s just what she pays to her provider. What she’s not capturing in that figure is the value of the time wasted by her and her PA due to how complicated and user-unfriendly her system is. So she sits down and runs the numbers: she and her PA are averaging 10 minutes per patient encounter and they see 40 patients a day. To her horror, she realizes that almost an entire headcount is dedicated just to charting. But a tablet-optimized, Cloud-based EHR like NextGen’s EMRx costs a fraction of that, and because it was designed by doctors, it’s intended to get doctors through the charting process as quickly as possible, in an average of just two minutes per encounter. Her first year savings alone are going to be almost $10,000 just for the software, and it leads to productivity gains equating to getting ⅔ of a new headcount for free. She almost has enough to add a second PA and expand her practice. And she’s just getting started.
Now let’s look at her overhead. She has a staff of five, including herself. Of those, three produce no revenue whatsoever and are not involved in providing care to her patients. They spend their days in purely administrative tasks, as noted above. But how much of that work is even necessary? Very little of it. With a full-feature practice and revenue cycle management suite, claims are generated automatically based on the integrated EHR, and reviewed by experts who handle claims for many offices, getting her practice out of the billing and claims business. (Any self-pay bills can be printed with a push of a button.) And because those claims are scrubbed by the advanced iClaim claims management system, the rejection rate is under 2%, and the payments hit Dr. Smith’s account within just a few days, thanks to the separate clearinghouse the system uses.
Patients can now fill out their paperwork in advance through the patient portal. They can also submit their medical records requests there, make appointments, and even pay their bills. And all benefits verifications are now automated and executed with the push of a single button when the patient checks in. And denials? A thing of the past thanks to a rigorous and automated verification system.
So the work of three staff who had been working 45-50 hours a week can now be done by two staff members working 40 hours a week. Now Dr. Smith has a receptionist/admin working no overtime and a far less stressed-out office manager working a normal schedule. Including overhead, salaries, and overtime, she is saving over $50,000 a year. That’s the rest of the money she needs to add that second PA or a nurse practitioner!
She also implements ChoicePay, cutting her credit card transaction fees to 1.79%, saving her money, allowing her to take payments online, and giving her a fully HIPAA-compliant merchant services solution that is seamlessly integrated with her billing system.
Her overall financial situation starts to improve dramatically as her AR days fall and she all but eliminates write-offs and bad patient debt caused by denials. Cash flow is excellent, with payments coming in within days of service provision. She’s no longer worried about making payroll. Her staff of five is now three healthcare providers, all of whom are caring for patients and generating revenue. She’s thriving. She’s able to dedicate more hours to her free clinic. She’s no longer living month to month; on the contrary, she’s making bold plans to expand to a second location.
As you look back through this scenario and consider the impact on the South Side, you can see the obvious benefits in terms of keeping quality care in the area and helping a local practice thrive. But you might have one concern. What about that biller? Yes, the practice still employs five people, but that biller is out of a job, and that isn’t good for the community. That’s why Fast Layne Solutions is proud to announce an initiative to create jobs in the communities we serve by training and equipping claims handlers in those neighborhoods. For example, we are committed to adding one new job for every five providers we serve on the South Side of Chicago. Note we’re saying providers, not clients, here. So a single office with, say, three doctors, one physician’s assistant, and one nurse practitioner would lead to a new job on the South Side. We will provide the training and the equipment, and the claims handlers can not only work from home, but also set their own hours, since we require only that a certain number of claims be processed within a given week. Think about what that means for, say, a single mother. Single mothers in economically vulnerable neighborhoods often struggle to find sustainable employment because working outside the home simply doesn’t pay once you account for childcare. But if you have a job that can be done from anywhere and at any time of day, you have the flexibility to earn a good living while still caring for your children.
The term “win/win” is thrown around a lot, but that’s truly what this is. We are giving practices the tools they need not just to survive but thrive in a challenging environment, while also creating new jobs in the community, jobs that involve highly valued, transferable skills.
Want to learn more? Email us today and let’s set up a free, no-obligation practice analysis. If we can’t prove that we’ll save you more than we will charge you, we just won’t ask for your business. It really is that simple.
We often hear about so-called ‘food deserts,’ areas where it is difficult to impossible to purchase healthy, nutritious foods. But did you know there are also healthcare deserts? These sections of both rural and urban America have a shortage of doctors and healthcare facilities, and the impacts are deadly. And the effects disproportionately fall on minority communities. For example, on Chicago’s South Side, the death rate from diabetes is twice that of other neighborhoods in the same city. The result, when compounded by other factors such as poverty and poor access to nutrition, is that America has a huge life expectancy disparity, and it’s getting worse, not better. In fact, the gap is now 20 years when comparing the wealthiest zip codes to the poorest.
Fast Layne Solutions is dedicated to fighting this trend by helping doctors in these areas to become more financially viable and to thrive in these environments, even as we also develop plans to help these communities in other ways. Today’s blog is an introduction to how our solutions can help, and next month's installment will reveal exciting news about how we plan to do so while keeping jobs in the community.
First of all, why is it so hard for independent doctors to thrive in these communities? Mainly it’s a question of economics. It is extremely expensive to be an independent doctor these days. Quite aside from the fact that new doctors are starting their careers hundreds of thousands of dollars in debt, it is also financially burdensome to practice in the current regulatory and competitive environment.
This month and next, we are going to be looking at the journey of a fictional doctor, Dr. Janelle Smith, a young endocrinologist determined to make a difference in her South Side neighborhood, but who’s struggling to overcome the obstacles facing so many independent doctors, especially in the more economically-challenged areas of America’s cities.
Dr. Smith has just finished medical school and residency and is now ready to dedicate her life to fight diabetes among the area’s poorer residents. Dr. Smith is already in debt from medical school. She owes $200,000 in student loans. But she’s determined to help fight the diabetes epidemic that is cutting so many lives short in her neighborhood. So she raises some money and opens her clinic. She plans to stay viable by serving a wide range of patients: those who have private insurance, a few who are self-pay, some Medicare, and a very large portion of Medicaid patients. She also hopes to do a free clinic session every Saturday for four hours. She hires a biller, a receptionist, an office manager, and a physician’s assistant.
Once she is up and running, she quickly builds a large patient base. Yet she’s not thriving, and her cash flow is terrible, with her average accounts receivable days at around 75. Reimbursements are slow, expenses are high. Her biller spends all day fighting the insurance companies over rejected claims. She’s paying over 3% on credit card transactions for co-pays and self-pays. Her staff seems to spend endless hours on mundane, unproductive tasks like setting up appointments and doing reminders by phone, calling insurance companies for verifications, reworking the hundreds of claims that get kicked back from insurance for seemingly pointless reasons, dealing with write-offs over unexpected denials, going through mountains of paperwork for patient forms that the receptionist must then manually enter…...the list is endless. And Dr. Smith herself has no life. If she isn’t seeing patients, she’s catching up on charting in her tortuously cumbersome EHR (that she can barely afford). And it’s not like she has a choice: as a doctor taking Medicare, she has to start reporting her MIPS performance by her second year, and her state Medicaid program also has reporting requirements. She MUST use an EHR.
Dr. Smith is getting by, but she’s frustrated. She thinks of the stereotypes she grew up with: rich doctors driving Mercedes, taking off Wednesday afternoons, living in mansions. Not that she became a doctor for those reasons: if she had, she could have taken a cushy job with one of the large hospital systems. But still, it would be nice not to feel that her practice and her own financial situation was a month-to-month crisis waiting to happen.
One evening, after yet another 14 hour day, she gets a phone call. It’s a recruiter from the large hospital system in town. He’s familiar with her work, knows her impressive education and residency history. He throws out a number. A number that would mean no more stressing out about student loan payments. No more worrying about making payroll next month.
And no more independence. And no more serving the community she grew up in. In fact, no more living or practicing in her old neighborhood at all. To avoid an excessive commute, she’d have to move to the north side of town. And it means working as an employee for a corporate provider. No more being her own boss. No more serving the South Side.
Is this really what it comes down to? A choice between doing what’s right and barely scraping by on the one hand versus giving up her independence and her dream of serving the community where she grew up on the other?
Absolutely not. She’s facing a false choice, because, like so many doctors in America, she simply does not know that there are solutions to all her problems. Tune in next week and we’ll see how Dr. Smith can turn her practice around and live her dream of serving the South Side as a thriving, independent doctor.
What are the top challenges facing small- to medium-sized, independent physicians as they fight to maintain their independence and compete with the large, corporate providers? Over coming weeks, we are going to look at the top 10 challenges, so please join us for this informative series and tune back in every Tuesday!
First of all, why should independent physicians even try to maintain their freedom? Isn’t the corporate takeover of our healthcare system inevitable? In 2018, employed physicians outnumbered independent physicians for the first time ever, according to Medical Economics. Many independent physicians are despairing that selling out is just a question of when, not if. That’s especially true in the era of Obamacare and MACRA, when the increased rules and regulations are making it more and more challenging for physicians to operate confidently and profitably while complying with all the Byzantine rules.
But it’s a fight worth fighting! Studies show patients of small- to medium-sized independent physicians fare better. Medscape recently highlighted several studies that bear this out. Smaller practices have “ambulatory care-sensitive admission rates fully 33% lower” and lower overall costs for care for diabetes, for example.
So we need to win this battle for our patients. But how? Let’s look at the biggest issues the independent doctors face.
1) High insurance claim rejection rates. On average, 34% of all insurance claims submitted to the insurance companies are initially rejected. Many are eventually paid out, but only after resubmitting, often multiple times. When you consider that each reworked claim adds an average of $25 in cost to the practice, you can see how this is one of the biggest burdens for small providers. But isn’t that just how the game is played? You submit, they reject, you resubmit? Many practices, even smaller ones, have entire headcounts dedicated to nothing but fighting this battle. But they don’t have to! In fact, it makes no sense to. Doing your own claims, especially if you are doing them manually, makes zero financial sense for providers with under 25 staff. The math simply doesn’t add up. Using a resource like Fast Layne Solutions solves this in two ways: it brings advanced Revenue Cycle Management technology to bear on the problem (thus slashing that rejection rate to under 2%) and brings economies of scale to bear to cut your claims management costs by on average 60%.
2) Slow reimbursements. Even when you do get paid, it is often taking far too long. The solution: use a provider that has an independent clearinghouse connected to all insurance companies and that gets your claims paid the first time. That’s why our doctors get paid in days, not months.
3) Clunky, user-unfriendly, slow, overpriced EMR/EHR systems. It is the shame of our industry. Talk to any doctor pretty much anywhere in the United States and they will tell you the same story: I HATE MY EMR! There is even a popular parody account on Twitter dedicated entirely to how awful the leading EHR system in the US is perceived to be by the doctors and other healthcare professionals forced to use it. And to add insult to injury, these systems are incredibly expensive. And on top of all that, most are PC- or laptop-based, which interferes with the doctor-patient interaction. And many are so complicated that even a smaller practice often has to have a full-time IT headcount to maintain their systems. The solution: EMRx, a Cloud-based (read “zero maintenance and no IT staff needed”), software-as-a-service EMR designed by doctors, for doctors, and currently used by thousands of doctors nationwide. EMRx is tablet-optimized, meaning you can maintain eye contact with the patient. It is so user-friendly that our average documentation time per patient encounter is just two minutes for general practitioners, somewhat greater for certain specialists. (And yes, everyone always thinks that’s a lie….right until they see the demo.) And because it is software-as-a-service, the start-up costs are far more reasonable, there is zero maintenance for you, you have access to award-winning support, and the ongoing costs are reasonable. Also, you aren’t stuck in multi-year contracts.
Tune in next week for challenges 4 to 7!