Wondering what books to catch up on during the holidays? Here’s a list of healthcare/medical best sellers and a few hidden gems that are trending in the healthcare industry now.
1. When Breath Becomes Air – by Paul Kalanithi. A powerful look at a stage IV lung cancer diagnosis through the eyes of a neurosurgeon.
2. The Gene: An Intimate History – by Siddhartha Mukherjee. Insightful book on how the science has grown so much more advanced and complicated that we are developing the capacity to directly manipulate the human genome.
The New Year is the time for retrospection and re-evaluating business choices made over in the past. Here are 11 ideas that you could choose to apply to your medical practice for consistent growth and fulfillment.
Nurture your referrals network:
Identify the top 10% of your referrals that contribute to over 80% of your business. Build meaningful relationships with this referral network of doctors who send you patients.
Submit claims everyday:
We can’t stress enough the importance of submitting clean claims every day. Your reimbursement and its predictability depends on the frequency of correct claims submissions.
Take prior-authorizations 5 days in advance:
Denials for pre-authorizations constituted 17% of total denials for a surgery center we closely worked with in the past. Don’t let this happen to your business, take prior authorizations at least 5 days in advance.
Perform eligibility and benefits check for all your patients:
Despite your good intensions of providing timely services, you would lose money if the patient’s insurance is inactive. Check eligibility and coverage benefits for all patients at least 2 days prior to the date of service.
Engage patients through your medical record:
Patients are your most underutilized brand advocates for new patient volume, which leads to downstream revenues. Engage patients by sending them a professional looking electronic medical record file right after you see them.
Check your fees schedule annually:
Review your reimbursements on procedures and consults with the agreed upon rates as per contracts. Appeal on instances where you do not get reimbursed accurately. Negotiate for better rates.
Work on denials within 24 hours:
Take action on denials as soon as they occur, often within 24 hours. This will not only keep your accounts clean but also ensure timely collection of your claims. Do better than industry standards by keeping your AR 90+ days below 10%.
Promote your services online:
As of 2015, 85% of American adults were online. Most patients look up their doctors online before their appointments. Getting online will help your business gain visibility, connections and get more patients. Also consider signing up for local listing services such as Google My Business.
Explore expansion avenues:
Consider starting new procedures that are unique to your region to gain access to bigger patient population. Moreover, look for opportunities to add a new physician or physician assistant to distribute work and improve financials.
Use better analytics:
Instead of just tracking your reimbursements month on month or quarter on quarter, give a thought about the broader metrics that influence your performance. Analytics such as, top payor mix, physician wise cases to reimbursements (for practices with more than one physician), established vs. new patient volume, first pass clean claims ratio, lag days analysis, etc. prove to be essential benchmarks that give up a complete picture of your practice health.
As per PwC report, 85% of large healthcare organizations experienced a data breach in 2014. Educate your staff and deploy precise HIPAA policy in your practice. Apart for security compliance also be in sync with regulatory, quality and coding compliances such as ICD-10, MACRA, SPARCS and HCRA (for state of New York), PQRS reporting and Meaningful Use compliance.
There you have it – an extensive list of easy and necessary changes that will help you control the business side of medicine, thereby giving you better work-life balance.
During one summer in the southeast of US, I shadowed a doctor who was treating an obese woman in her early 50s. She was out from a colonoscopy that also involved removing a piece of chicken that was stuck in her gut. Such a procedure costs $1,185 on an average depending on where you get it done – money that she or her employer or the taxpayer has to bear because she never learnt to chew her food sufficiently and not gulp it down while watching TV.
Having closely observed medical operations in many parts of the world, I see an industry whose primary concern has become that of sick-care and not of healthcare. But the healthcare business proposition fails to remain exciting when we ourselves become its customer. It is then that we realize that we are stuck in self-defeating quicksand that doesn’t give us the confidence to entrust our bodies to the system and expect to be fixed. Trust amongst patients and their providers is at its lowest in almost every part of the world.
Despite our concerns, we seem to have taken to sick-care well as a society. Most patients are happy absolving the responsibility of staying healthy when an entire industry promises to find a fix for all evils.
Bizarrely, it’s the patient with a piece of stuck chicken that fuels our industry. It’s she whom doctors routinely see after spending a decade or more in pursuing medical education. It’s she who chokes our tertiary care system because she checks in too late. From the imaging equipment needed to see her gut to insurance that covers her procedures to a legal trade that encourages her to blame the undissolved chicken, we depend on her to gulp her food down so that she can continue being our customer.
Healthcare, get your mojo back
Every time a patient seeks care, we have an opportunity to change how we function as an industry. Instead of merely prescribing a fix, we can begin by asking questions that take us deeper into the process of care. Is her environment causing her to fall sick? What’s her genetic data indicating? What does her microbiome reveal about her gut? What role does stress play in her condition? How can she be educated to help herself? How do you reach more patients using her data?
Surely certain conditions require fixing but there are several others that require healing. For example, a broken hand needs fixing but hypertension takes better to longterm healing. Chronic conditions, which seem to be the plague of our times, are managed better through lifestyle changes than through medications alone.
We need changes in healthcare policy to support an ecosystem that keeps its population healthy and not just fixes the sick. An industry that gets paid based on medical transactions cannot be expected to reduce those encounters. When we flip the equation to make hospitals into control-towers that track disease before people fall sick, we begin to depend less on patient volumes.
Technology is key in reversing how we change our focus from sickness to health. Until now, we’ve used technology as a means to complete our billing, conduct clinical examinations or store medical records. But we need to go further by using technology to connect the dots that influence our health.
Through environmental information, a patient could be forewarned about “asthma hotspots” that she traverses during a commute. Devices that prompt us to breathe when our heart rate goes up might help us manage stress as it occurs. Diabetes can be better controlled when we see a continuous graph of glucose levels captured through sensors. Electronic health records could become pathways that connect patients to doctors remotely, extending access to care at the time of need. A zip code map of patients whose vital signs are out of line could help providers address symptoms even as they manifest. Elderly care can be monitored through homes with sensors that track movement. Smartphone-based lab tests can control early conditions of heart disease through primary care rather than expensive specialized care. We could utilize drones routinely as a part of emergency medicine. 3D printing could change how patients understand their condition by touching and holding diseased organs.
The technology we need to nurture an industry that improves health is already here. All we need is imagination.
Praveen Suthrum is co-founder and President of NextServices, a healthcare technology and management company with offices in Ann Arbor, Michigan and Mumbai, India. Not coincidentally, he is a passionate alumni of the University of Michigan Ross School of Business.