Patient Benefits of an Advanced Automated Answering Service Solution

Patient experience is the most important factor when it comes to patient retention at any medical practice. An essential touchpoint to optimize in modern medical practices is to standardize the way your patient calls are handled. The right 24/7 answering service solution can free up valuable provider and staff resources to focus on patient care while reducing unnecessary interruptions and ensuring urgent messages reach the right provider at the right time—every time.

Removing human error and delivering an automated and reliable service for both providers and patients, advanced answering service solutions are being implemented by more and more practices to enhance both patient and provider satisfaction.

Here are just a few key patient benefits of an ideal automated answering service solution:

Less Frustration

Your patients have busy lives but your practice is busy, too. If your practice experiences call volume congestion, your patients still need to be able to reach you without being put on hold. The right answering service solution will differentiate messages based on urgency and use your on-call schedules to accurately route communication to the right provider based on escalation policies set by your practice, speeding time to treatment.

Timely Communication

Efficient practice operations help decrease the time patients spend waiting during appointments and on hold when they call your practice. Automation allows patients to reach your practice at any time, during any circumstances to get the answers and help they need. The best answering service solutions offer smart routing that ensures providers are only interrupted to address urgent requests that require responses in a timely manner.

24/7 Care Access

Although many answering services are only used for after-hours coverage, an automated answering service solution delivers around-the-clock coverage as needed. Just because you don’t see your patients on a 24-hour basis does not mean it shouldn’t be easy for them to manage their appointments and make routine requests such as medication refills whenever they think of them, which might not be during regular office hours. An automated answering service solution can support call volume overflow when the main line at your practice is busy and serve as a 24/7 backup during emergency events when your practice is closed.

Better Onsite Service

Your staff need to be able to do their jobs, but when they face constant interruptions and take on the additional task of call filtering, concentration is broken, efficiency is lost, and providers can become unable to best care for their patients. Implementing the right automated answering service solution can free up your team to focus more on what they do best—patient care.

If providing an excellent patient experience and running an efficient medical practice are priorities for you, an advanced automated answering service solution might be just what the doctor ordered.

Let’s discuss more about how the ideal automated answering service solution can benefit your patients.

 

4 Simple Steps for Reducing Third-Party Vendor Costs

In the era of nonstop mergers and acquisitions, healthcare organizations are taking on immeasurable costs in the form of third-party services. When a health system acquires a private or independent group practice, the health system inherits all the practice’s employed third-party services and systems, including:

  • Electronic Health Record (EHR)
  • Practice Management
  • Revenue Cycle Management
  • Medical Answering Service
  • Security, Maintenance, and More

When healthcare organizations merge, issues with purchased services compound as the health system takes on all existing service contracts from the practices affiliated with the previous organizations. Purchased services represent as much as 20% to 25% of an organization’s annual spend,1 so consolidating services is a valuable opportunity to save on spending.

Standardizing third-party processes and technology can be an untapped source of savings across the healthcare supply chain. To help you identify areas in need of improvement, here are four steps that can help successfully lower your organization’s purchased services costs:

Step One: Mine the data.

For many healthcare organizations, simply gaining visibility into third-party contracts and expenses can be challenging. Contracts are often managed by various people throughout healthcare organizations, or even services outside organizations, such as group purchasing organizations (GPOs).

Start gathering the actualities by creating an inventory of all third-party vendors used throughout your organization, as well as the associated stakeholders and contracts. It’s important to speak with each stakeholder and review each contract thoroughly.

Next, collect all financial data for your vendors. Check with your accounts payable department and take a look at current and past purchase orders. While purchase orders won’t tell the whole story, they are a good place to start to get an idea of total cost. Many third-party vendors have variable costs that make it difficult to get an accurate account of how much they’re really costing. Reviewing your general ledger will help you uncover variable costs.

There are a few key questions to consider when reviewing your service contracts:

  • What rate is this vendor currently charging me and how often?
  • Is there an auto-renewal in place? If so, when?
  • What are the scaling terms and are there fees associated with scaling?
  • Are there termination clauses? If so, what are they?

Place vendors into categories to get a more accurate picture of how much your organization is spending in specific areas. You may find that the individual costs of many of your third-party vendors are relatively small, but when aggregated by category, the numbers compound quickly.

Step Two: Gain Executive Buy-In

Equipped with your data, it’s time to engage your decision makers. Engaging organizational leadership early in the process is a great way to build a case to move forward. Speaking with executives can help you understand the different viewpoints and situational nuances in your organization, which helps you navigate roadblocks and build the business case to make changes.

Step Three: Evaluate Performance

Analyze vendor and service performance in three key areas:

  1. Comparing Spend
  2. Assessing Utilization
  3. Evaluating the Quality and Effectiveness

Some vendors charge hidden or variable fees, so looking at one month’s service charges can be misleading. Look at each vendor’s historical cost, trends, and variability. Then, consider local benchmarks: What prices are other vendors in your area offering for a similar service?

Another important aspect to consider is utilization. Here are a few simple questions that can help you assess your organization’s use of a particular service or vendor:

  • Who is actively using the service/vendor?
  • How is the service/vendor being used?
  • Could the service/vendor be used more efficiently?

Finally, do some digging to find out your staff’s level of satisfaction with the third-party service/vendor:

  • What level of results is the service or provider currently delivering?
  • Are your stakeholders satisfied with the performance?
  • What kinds of performance metrics can the service or vendor provide?
  • Does the service or vendor meet your organization’s performance metric needs?
  • Does the service or vendor make your staff’s job easier?

Step Four: Consider Standardization Options

Completing steps one through three will give you a firm grasp on the types of vendors you have and the services you’re paying for, how they’re being used throughout your organization, and your staff’s readiness to try new solutions.

If you consider replacing multiple similar vendors with a single standardized solution, make sure the solution you select does the following:

  • Addresses all stakeholder needs and goals.
  • Decreases (and if possible, helps to standardize) your organization’s overall spend.
  • Contributes to your organization’s strategic objectives.

When your organization undergoes a merger or acquisition, it’s more important than ever to conduct a high-level review of the spending and operating efficiency of the larger organization. At the end of your evaluation, you should be better prepared to make specific service and vendor selections based on your analysis and your organization’s strategic priorities.

1Vizient, 2020

5 Warning Signs Your Answering Service Might Be Hurting Your Practice

Medical answering services are essential to modern practices for triaging patient calls, delivering urgent messages at night, and allowing receptionists to focus on imperative tasks during business hours. An effective answering service solution can help practice managers, providers, and staff improve the overall patient experience and increase patient satisfaction.

Unfortunately, some medical answering services are susceptible to manual errors and environmental challenges. Routing mistakes and connectivity issues can negatively impact both patient and provider satisfaction.

Here are five warning signs your medical answering service might be negatively impacting your practice:

1. Poor Provider Satisfaction

Your providers’ wellbeing is essential to their satisfaction, livelihood, and ability to best care for patients—yet provider burnout is on the rise. Key contributors to burnout include receiving non-urgent calls after hours, getting unnecessary interruptions while caring for patients, and dealing with other communication challenges that interfere with providers’ daily workflows.

Contacting providers at the wrong time is a common mistake. When an answering service makes an error and contacts your provider at midnight on their Saturday off or interrupts their time with a patient for a non-urgent or routine message, it brings down the provider’s satisfaction and makes it more difficult for your practice to retain top talent.

Providers who are unable to work at their best due to unnecessary interruptions and complicated communication workflows may experience burnout and decide to leave your practice. Losing providers reduces patient satisfaction, lowers revenue, and increases your recruitment and onboarding costs.

2. Declining Patient Experience

It’s important to let patients know they are being heard and cared for, not ignored, yet missed and lost messages are another common issue with medical answering services.

If your answering service loses patient messages, fails to take thorough notes during a call, delays sending urgent messages, or sends messages to the wrong provider, your patients will begin to feel frustrated and undervalued.

3. Negative Impacts on Your Practice’s Reputation

To your patients, your answering service is a representative of your medical practice. Errors and poor patient encounters with your practice answering service can be harmful, and even detrimental, to your practice’s reputation in providing quality patient care.

It is imperative to ensure that your answering service—which many patients do not know is a third-party service—is delivering the quality of care and experience you want your patients to expect from you. Keeping your patients satisfied and confident in their care is the key to patient retention.

4. Fluctuation of Practice Operating Costs

Your medical answering service may be costing you much more than you originally intended. Many answering services have hidden fees and charges based on call volume and duration, causing practices to spend much more on the service than was budgeted. For a more accurate account of how much your medical answering service is really costing you, look at your month-over-month charges and take note of the fluctuations. Hidden fees can add up quickly when practices don’t pay close attention and consistently follow up on billing.

5. Inability to Support Patients During Emergencies

Healthcare can’t stop when inclement weather, natural disasters, pandemics, or other emergencies happen. Keeping lines of communication open between your providers and your patients is essential, especially during times of uncertainty. Your medical answering service must be available and connected to take patient calls and route messages correctly and quickly at all times.

You can learn more about identifying risk to prepare for unprecedented circumstances from our related blog post and our Medical Practice Disaster & Emergency Preparedness Checklist.

Not all medical answering services provide the same level of service and support.

Use the factors above to assess your current medical answering service vendor and decide if it’s time to look for another solution that can better protect your medical practice.

Consider how an automated medical answering service solution can help strengthen your practice.

The right answering service solution will provide a consistent patient experience, reliable connectivity, accurate message routing, and appropriate escalation while supporting work-life balance for your providers and eliminating variable costs.

Let’s discuss how your practice can benefit from the right answering service solution.

How much is your answering service costing you?

medical answering service warning

Sometimes, traditional medical answering services come with hidden costs that could be undercutting the success of your practice. Costs associated with human error—such as lost and delayed messages, negative patient interactions, inaccurate symptom descriptions, and more—carry significant risk for your patients and your practice.

Mistakes that were once par for the course with answering services have become largely avoidable in a modern healthcare environment. Since quality communication between patients and providers (before, during, and after business hours) is a fundamental pillar of patient care, it would be wise for any organization using a live medical answering service to ask yourself the following questions:

Are your patients being served a positive experience with your practice?

Any negative encounters with your practice (including over the phone) can begin to erode the trust and positive relationships you have built with your patients. Many patients perceive the answering service as an extension of your practice—not a separate, third-party service. That makes live call agents a contributing factor to your overall patient experience, a factor you have limited control over.

If a patient feels at any time as though their medical needs are not met with the level of urgency they feel is necessary, their trust in your practice quickly dissolves into frustration, fear, and motivation to seek care elsewhere. Whether or not a patient leaving costs you any recurring revenue, word of mouth can impact your organization’s reputation for care quality and, therefore, your ability to bring in new patients.

Is your staff empowered to use their time as efficiently as possible?
It’s tough to assign a dollar amount to the frustration of having to resolve a breakdown in patient care caused by miscommunication. It’s impossible to quantify the impact of anxiety your staff can develop when they feel unable to deliver the best patient care due to issues with the clinical communication process. But if your communication process isn’t optimized to help providers focus on delivering proper patient care, you may wind up calculating costs in terms of turnover and other negative effects of low provider satisfaction and burnout.

Are you legally or financially at risk?

Some unlucky practices have discovered a best-kept secret of certain deceptive answering services: subcontracting. In some cases, live “medical” answering services turn out to be subcontracting their work out to other answering services that don’t always have a medical focus or adhere to HIPAA compliance standards.

Few medical practice leaders would knowingly risk placing subpar answering services between their patients and their providers or practice. In fact, a practice in this situation is at risk for fines and penalties associated with breaches involving PHI and unsecure communications.

Another scenario in which a practice using a live answering service may be at risk includes one where the answering service is referencing an outdated provider shift schedule.

Consider this worst-case scenario A patient, unknowingly suffering from a stroke, calls your practice after hours to report blurred vision and confusion. The medical answering service, operating off of an inaccurate on-call schedule, fails to deliver the patient’s message to the correct on-call provider for another hour. Due to the time-sensitivity of this ailment, your practice could be at risk for a malpractice suit.

An unforeseeable and adverse incident like the one above could become a substantial loss for your practice.

Are you safeguarding your reputation?

Imagine another unfortunate scenarioA critical care surgeon with his own practice routinely performed emergent consults for a local hospital. But then, the hospital stopped calling. They felt the surgeon’s medical answering service was unable to deliver messages in a timely, efficient manner. The hospital now works with other providers instead.

Don’t let the above scenario happen to you. Your credibility and reputation in the healthcare community can be negatively affected if outside consultants and hospitals cannot reach you quickly in times of emergency. The impact of an unreliable reputation can be detrimental to your providers and your practice. It may seem easier to stick to the status quo with a live answering service, but is it worth letting avoidable lapses in communication tarnish your reputation?

Have you uncovered all hidden fees?

Most medical answering services are upfront about their fees, but practice leaders and managers seldom realize how many fee-based events they’re actually being charged for on each single after-hours call or message. Varying types of hidden fee-incurring events include:

  • Taking the call or message.
  • Relaying that message to the right clinician.
  • Relaying the clinician’s instructions back to the patient.
  • Recording and logging the conversation as a whole.
  • Recording and logging each communication.

These events can incur minute fees that can account for an unexpectedly substantial amount of overtime.

What is the real cost of your answering service?

Take a skeptical look at your answering service’s monthly invoice to understand the hard costs. Think through how your current answering service effects patient safety and satisfaction, as well as your providers’ satisfaction. Is your answering service a compliance risk? Can it harm your professional reputation? At the end of the day, these are the costs that put your practice, providers, and patients at risk.

What is the best solution to eliminate the costs and risks of your answering service?

In the age of digital communication, automated tools are commonly used to eliminate human error, simplify communication processes, and streamline accurate connections. These advantages are perhaps most valuable in a clinical environment. An ideal medical answering service solution can sync with the most up-to-date shift schedules, protect providers’ caller IDs, escalate urgent messages, and save non-urgent messages for regular business hours.


Let’s discuss how your practice can benefit from the right answering service solution.

4 reasons why patient education should be a priority

physician patient education

As providers continue to evolve away from fee-for-service healthcare and towards a value-based care system, patient education is becoming more important than ever.

Value-based healthcare’s focus on outcomes and, consequently, what happens outside the “four walls” of the healthcare organization, requires a renewed focus on patient education to help combat chronic illnesses, increase preventative care, reduce readmissions and lower expenses.

When it comes down to it, an informed patient who understands their condition and corresponding treatment plan is one of the most important factors in achieving the goals of value-based healthcare.

Here are four reasons why patient education should be a strategic priority for healthcare organizations across the nation.

Reimbursements

Last year, the U.S. Department of Health and Human Services (HSS) noted that by 2018, 50 percent of all Medicare reimbursements should be tied to value-based care. The HSS also wants value-based reimbursements for 2016 to come to 30 percent—in other words, the HSS plans for healthcare organizations throughout the country to begin transitioning away from fee-for-service and towards value-based care.

With the traditional fee-for-service model, providers received compensation based on volume: they’d see as many patients as possible, and order tests and procedures without regard to cost. With value-based care, alternatively, providers will begin to focus more so on evidence-based medicine, preventative and tailored treatments, and, of course, patient education, in order to increase quality of care while also keeping expenses down.

Increasing patient education efforts through social media campaigns, text-based outreach platforms, informative web videos, email marketing, podcasts, community lectures, and brochures are examples of inexpensive means for a provider to adapt to the new value-based model without having to completely restructure their organization.

Preventing chronic illness

Back in 2012, roughly half of American adults—or approximately 117 million people—were diagnosed with one or more chronic illnesses or health conditions. In fact, that year, one out of every four adults had two or more chronic conditions.

Currently, approximately 133 million Americans suffer from one or more chronic illnesses like diabetes, depression, or asthma—and the numbers are only increasing. Seventy to 80 percent of total health care costs are directly tied to the treatment of chronic illnesses. In short, the treatment of chronic illnesses is a major concern for the American medical community.

One of the most successful means of combating chronic illnesses is through patient education. Certain diseases, such as diabetes, can’t be treated through medical attention alone; patients require self-management, such as proper diet, to treat these illnesses as well. Studies have shown that patient education delivers results.

review of over 40 studies on diabetes patients noted that when providers encouraged “patient-oriented interventions,” patients’ health improved, and some even established positive glycemic control. Patient education should be viewed as a strategic weapon in the fight against the progression of chronic diseases in the United States.

Reducing costs

Unnecessary patient readmission is a costly issue that currently plagues our nation’s healthcare system. In fact, it’s estimated that these readmissions cost the U.S. government roughly $17 billion each year.

Additionally, it’s estimated that one out of every five Medicare patients will be readmitted into a hospital within a month following treatment. Readmissions, either due to over-cautiousness, carelessness, or patients relapsing, are a sizable expense that healthcare providers need to avoid.

But how can providers cut down on readmissions while also avoiding additional expenses?

Patient education can help providers to inform patients on the proper self-managed care needed to avoid readmissions. Additionally, with increased patient education efforts, providers can help patients understand the care setting most appropriate for their condition.

Uninformed patients sometimes seek treatment in the Emergency Room (ER) for minor issues when an Urgent Care Center, for example, would be much more appropriate. The ER is one of the most expensive healthcare settings, and patients should only seek it out when necessary—and not for minor concerns. But patients continue to seek ER treatment in ever-increasing numbers. In fact, ER visits have risen steadily over the last few years. According to a survey of 2,098 ER physicians by the American College of Emergency Physicians, three-quarters of the doctors surveyed noted that visits rose steadily from January 2014 to March 2015. Additionally, one-quarter of doctors noted a “significant increases in all emergency patients” since 2014.

Educating patients on when and where they should seek treatment will help to streamline the overall healthcare process and lower overall ER visits.

Saving time

Primary care doctors are increasingly short on time. Since fee-for-service care is structured around the concept of treating as many patients as possible, doctors usually try to squeeze in a high volume of patients during their workday.

In fact, in 2014, general practitioners and family physicians reported seeing an average of roughly 90 patients each week. It’s typical for doctors to also schedule short, 15-minute appointments, but some physicians try to keep appointments to no longer than 11 minutes. These short appointments not only make it difficult for patients to communicate with their doctors, but doctors are becoming burned-out with the rapid-paced appointments: A 2012 study noted that 30 percent of doctors between the ages of 35 and 49 plan to retire within the next five years.

With value-based care, doctors will begin to treat fewer patients, focusing more so on achieving positive results as opposed to booking a steady stream of appointments. However, in order to help doctors free up their time and avoid burnout, healthcare providers should focus on increased patient education. Informed patients will ask fewer and more pointed questions, and they’ll have a better idea of what’s ailing them, which will help to keep appointments short.

Lastly, relapses and readmissions should decline, helping to free up doctors’ schedules.

Higher quality of life

Lastly, patient education delivers results, and after becoming educated about their conditions and required treatments, patients generally have a higher quality of life. For example, Gallup polled a group of patients who received medical device implantation.

For the patients who “knew what to expect after surgery” (i.e. they received effective patient education), 72 percent were satisfied with their results, and only 8 percent reported problems after the device implantation. For the patients who didn’t know what to expect, only 39 percent were satisfied with their results, and 27 percent reported issues.

Informing a patient—or, in other words, educating them properly regarding their treatments or illnesses—helps to improve their overall quality of life.

As the nation’s healthcare reorients towards value-based care, patient education will become especially critical. When used correctly by providers, patient education can be a valuable tool, helping to increase efficiency and boost quality of care. Educating patients doesn’t have to take a great deal of additional time or effort.

A thoughtful, patient-centered strategy coupled with the application of innovative technologies can make a significant impact. Patient education, thanks to the push towards value-based care, is taking its place as a strategic imperative for healthcare providers throughout the nation.

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Managing the surprisingly troublesome impact of real-time healthcare on clinical decision-making

We live in an age of instant gratification. From the texts we send friends and family to the orders we place on Amazon.com, we’ve come to expect immediate results: instant responses, next-day shipping, etc.

The idea of immediacy in healthcare communications is not new. In fact, in 2015, healthcare analyst Gartner outlined a vision for what it dubbed the “real-time health system”—a landscape where healthcare professionals will be constantly aware of what’s happening within their systems and with their patients.

As a person living in the digital age, you’ve probably experienced real-time awareness in other parts of your life: the repetitive dings of received text messages, the intermittent beeps of calendar alerts, the near-constant hum as your smartphone vibrates over and over to let you know your mother, children and cousins have uploaded photos to Facebook, Instagram and Snapchat. In fact, as I’m typing this piece, I’ve heard alerts for two personal text messages that I’ve yet to look at (the temptation is maddening), four work-related emails (that I did have to stop and look at), a notification that someone commented on a thread I replied to on Facebook and more.

While there’s definitely a benefit to each of us knowing what’s happening in our expanded universe in real time—and we can easily draw a direct line to the benefits that doctors, nurses and patients would experience if they could communicate instantaneously while coordinating care—the influx of information is simply overwhelming.

And when alarm fatigue sets in, important messages get missed, the communication cycle breaks down and what was once a valuable resource becomes a liability. Overwhelmed and inundated clinicians cannot optimally use their invaluable expertise to make effective clinical decisions that deliver great health outcomes.

Aggregating, analyzing and managing the distribution of clinical information

Managing the flow of data and alert fatigue is a real challenge that clinicians and the IT teams that support them need to understand. Clinicians need “just the facts, ma’am,” so to speak, and they need to know which set of facts pertain directly to them and the patients for whom they are caring. Receiving more than enough information is not always a good thing, especially when the situation calls for fast thinking and quick decisions.

Investments made in technologies implemented over the past several years have enabled healthcare as an industry to generate very large amounts of digitized clinical information. The challenge is to aggregate this patient data in real time to generate new knowledge about a patient and distribute it in a way that does not inundate the clinician recipients with unnecessary information. Physicians and nurses should receive information they need in order to act in that moment. Everything else is noise.


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Implementing communication-driven workflows

Once new knowledge is made available and deemed relevant to a given clinical situation, it’s important to enable workflows that drive this information to the right care team members, who can take action in that moment. Hospital-based communication workflows must encompass all modalities, adhere to strict security mandates and facilitate reliable exchanges among clinicians across boundaries (e.g., acute, pre-acute and post-acute care settings). This kind of clinical integration is the future of healthcare communications.

If clinicians are inundated with unnecessary information, messages and alerts, combined with a communication workflow that creates barriers to a) finding the right care team member to contact, b) finding the contact method that the clinician prefers and c) knowing whether the intended recipient received the message, the workflow is flawed and is inhibiting the decision-making that leads to higher standards of patient care.

Leveraging clinical expertise

The personal judgment of experienced healthcare professionals is irreplaceable in effective, real-time decision-making. Technological advances are no doubt improving healthcare, but human intuition can never be replaced by a new device or software. However, that intuition can be inhibited by technologies if they are not strategically implemented and managed. In this sense, real-time healthcare could, ironically, be eroding quality.

To truly leverage the hundreds of collective years of clinical expertise housed in the minds of your hospital’s medical staff—the expertise that yields great outcomes—you must remove the barriers to effective communication. Collecting patient data in real time is an important part of that. But analyzing and aggregating that data into digestible, valuable pieces of information that can be easily shared and collaborated on is the follow-through that is often overlooked.

The gravitation toward instant gratification isn’t going away. And it’s important to understand that the concept doesn’t apply simply to generating patient data as healthcare events are occurring, but also to the ability to extract the significant portions and begin collaborating with the broader care team to interpret the data and derive a plan to deliver high-value care.

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The Important Role Nurses Play in Care Transition and Reducing Readmissions

In its simplest form, “care transition” is defined as a hospital discharge or movement from one care setting to another. The risk that readmissions pose to patient safety requires that transitional care processes are under constant evaluation.

Nurses are the linchpin in clinical communication and coordination of patient care and thus are best equipped to coordinate a successful transition. The bedside nurse, for example, may understand a great deal more about the patient’s needs as they travel through the care continuum than other care team members. And when those needs are communicated effectively, the nurse is given the opportunity to extend to the patient high-value care beyond organizational boundaries through clinical communication.

Nurses create transitional care plans by compiling all the pertinent patient information and creating instructions to be followed. Then they share the plan in detail with all members of the new care team so that the handoff is seamless for both the patient and the new unit or facility.

The most important factor in transition of care is communication during the handoff process.

What to communicate and when

The goal of the handoff is to safely transfer the patient from one care setting to another (or to discharge the patient from the hospital completely) by exchanging the necessary information with, and by effectively transferring the responsibility of care to, either a new care team or the patient’s family.

It’s a lot to put on any nurse’s plate, but by standardizing and implementing an effective and comprehensive transition communication process, nurses can elevate patient safety, avoid adverse events that lead to costly readmissions and decrease patient anxiety during the transfer process.

It’s important to remember that the transfer process doesn’t apply only to moving a patient from an acute setting to the home or a post-acute environment. There are many different handoff scenarios within the same organization, unit and floor that need your close attention.

For example, nurses should be prepared to provide handoff communication:

  • At shift change
  • During a break
  • When patients are transferred within the hospital (e.g., from the ER to ICU, from radiology to the OR, etc.)

It’s extremely important for the purposes of continuity of care that the communication between the nurse and either the new team of clinicians or the family prepares them in such a way that they’re able to anticipate the patient’s needs and make timely decisions.

At a high level, to adequately prepare the new care team, the following should be included in the handoff communication:

  • Patient care instructions
  • Treatment description
  • Medication history
  • Services received
  • Any recent or anticipated changes

More specifically, and especially in the case of transfers to a new care team or facility, an effective care transition communication plan will include:

  • Patient’s name and age
  • Reason for admission
  • Pertinent co-morbidities
  • Code status
  • Current isolation or precautions
  • Elopement risk
  • Lab results—including any pending and/or abnormal findings
  • Relevant diagnostic studies
  • Fall risk assessment
  • Any assessment findings that are appropriate to the patient’s current health

Many times, nurses on the receiving team care for patients for whom they lack pertinent health data. For example, EKG results are often left out of the transition communication between hospitals and subacute rehabilitation facilities. In this case, if a patient has an episode of chest pain, the receiving team could conduct an EKG on their own, but without prior results to compare with, they can’t successfully rule out something dangerous, such as angina. So, they may err on the side of patient safety and send the patient back to the hospital, resulting in a readmission. However, if an EKG result is included in the transition communication, the receiving team can conduct an EKG on their own, compare the results with the EKG performed at the hospital, and determine whether there is an emergent need for a readmission or the issue is something they can safely handle in their own setting.

Pay extra close attention to medication communications

While including all pertinent test results in the handoff communication is extremely important, there’s another area that needs special attention, because it causes more admissions than any other factor: medication.

It’s estimated that 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Communicating medication details is an area that poses the greatest risk for error as well as the greatest opportunity to effect a positive outcome. In fact, over 66% of emergency readmissions for patients over 65 years old are due to adverse medication events.

Breaches in handoff, such as failure to include specific details of the patient’s medication history and future dosage needs, have dire consequences.

However, defective handoffs are also known to cause problems beyond adverse events. Issues such as delays in care, inappropriate treatment, and increased length of stay arise when transition communication is not strategically planned and delivered.

There are many root causes of a defective handoff, but since nurses play the most important role in the transition communication process, you must strategically develop and communicate the transitional care plan—not only by considering what information you believe should be communicated, but by extending a dialogue to the receiving team and understanding what information they feel is necessary to provide the best follow-up care possible.

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What to expect from MACRA: The early years

MACRA legislation passed in April 2015. When the initial version of the rule came down, the industry collectively braced for declining revenues, the avalanche of administrative paperwork and the increase in overhead costs that would be required to comply.

When the final rule was issued in October 2016, the tempered requirements seemed to point toward fewer projected negative payment adjustments in 2019, the target year for MACRA’s first Quality Payment Program distributions, and the tension subsided a little.

Even with the new allowances in reporting and threshold scores, the MACRA structure makes clear that there’s an abundance of work to be done, especially around efforts to promote care coordination and communication.

Year 1: 2017-2018

Now that we’re already into 2017, the first official reporting year, tensions are rising again because, even though most physicians acknowledge they are going to participate, the majority have not yet plotted their course or defined a compliance strategy.

And if you’re in the group that hasn’t figured it all out yet, the good news is you’re not alone.

According to a recent poll conducted by The Health Management Academy, almost half of the physician and practice leaders who participated are not moving very quickly toward adopting value-based payment models. In fact, only 4% claimed to be moving “very quickly” while almost 40% admitted to moving “very slowly” toward value-based care.

Somewhat surprisingly, the same is true even for large hospital systems. These organizations are perceived to be the driving force, the ones moving the fastest toward the end goal of value-based care, and yet, per a similar poll, few of the large systems are moving very quickly.

Only 8% of large hospital systems polled are moving swiftly toward implementing value-based payment models. – The Health Management Academy, 2017

The Quality Payment Program, however, is going to be the catalyst for healthcare organizations, both large and small, moving more aggressively toward these models in the next couple of years.

The MACRA structure and how you fit in

By now, you know that reimbursements are going to be variable based on performance, even if you’re still practicing in a fee-for-service structure and, like most, have not yet begun practicing in the more advanced tracks.

There are four participation categories, which fall underneath two broad tracks—the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) track.

The four MACRA Quality Payment Program participation categories. – The Health Management Academy, 2017

The two categories in the middle of the chart are bridge areas, and won’t apply to many providers right now, but they can be considered as stepping stones from MIPS to the Advanced APM track.

The MIPS track equates to fee‑for‑service, and most physicians will, at least initially, fall into this track. They’ll balance their steps toward embracing more downside risk by continuing to practice fee-for-service medicine, and so they must prepare to report performance metrics and have payments adjusted based on those metrics in 2019.

On the other end of the spectrum is the Advanced APM track. To reach “Advanced APM Qualifying Clinician” status, physicians must engage significantly in certain downside risk-bearing payment models. In this track, participating physicians will enjoy fewer reporting requirements and more financial incentives, while still being held accountable for delivering high-value care. The only way to sustain a profitable practice in this track is to eliminate wasteful workflows that result in inefficient and unreliable communication processes among all members of the broader care team, even if they are not directly affiliated with your practice.

Year 2: 2018-2019

In the first months of 2018, physicians practicing in the MIPS track—again, that will be most of you—will be required to report metrics in three performance categories based on at least 90 consecutive days of work. This should come as more good news, because if you haven’t started measuring yet, or you’re not impressed by your initial metrics, you still have time to pivot before the data is due in early 2018.

CMS will use that data to give each physician a composite score, which will determine the payment adjustment he or she receives in 2019.

The Quality Payment Program’s initially proposed rule was accompanied by disheartening projections in terms of payment adjustments, particularly for solo physicians and small practices. While the finalized October 2016-issued rule basically guaranteed that all physicians who submit any performance data will receive at least a neutral payment adjustment, physicians are still bracing themselves for less-than-average profit margins.

As MIPS is largely a budget-neutral program, less risk equals less reward. Since fewer physicians will be subject to negative payment adjustments in 2019 (see Image 3 below), fewer dollars will be available to distribute to those who perform well.

Only 20%—versus 87%—of physicians in smaller practices are projected to experience negative payment adjustments in 2019. – The Health Management Academy, 2017

Simply put, the best way to ensure your adjustment is as high as possible is to garner a high composite score.

Effectively coordinating care with your patients’ broader care teams as accurately and efficiently as possible to reduce waste and unnecessary overhead costs is a good first step toward achieving high scores in all four MIPS performance categories.

Back to the present

One of the goals of MACRA is to drive the costs out of treatment while still providing high-value care. Physicians will be in a much better position to deliver this dichotomy, and advance to a more rewarding reporting track, when the barriers to real-time care coordination have been broken down.

Seamless care team communication and collaboration among interdisciplinary, and often disparate, providers will be a foundation on which you can lay the groundwork for improved care coordination, which leads to less waste, improved efficiencies, and ultimately better outcomes, all of which underlie value-based care and the successful reduction of healthcare costs.

Source: “Making Sense of MACRA” webinar. The Health Management Academy and PerfectServe. March 2017. 

Watch the full webinar to learn even more about MACRA and how it applies to your practice.

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Mobile charge capture: A simple change to your business practices with significant outcomes

While there are conflicting perspectives on the physician shortage, there is resolute agreement that the demand for primary and specialty care is growing due to the expanding older population. Concurrently, the challenges for physician practices, which are needed to provide that care, are also increasing. Older patients require 2–3 times the amount of specialty and primary care to treat and manage chronic conditions and age-related illnesses. Unfortunately, in today’s ever-changing healthcare environment, many practices are struggling to survive.

As has never been experienced previously, practices are facing daunting obstacles to care delivery due to rising operating costs, regulatory burdens and barriers to receiving pay/reimbursement. The cost to operate a practice has increased at twice the rate as the consumer index due to increasing rent, malpractice insurance, liability coverage, health insurance and personnel expenses. Mounting regulatory requirements have not only served to increase overhead, but have also consumed valuable patient care time with oppressive documentation and administrative requirements for HIPAA, Meaningful Use, prior authorization and quality mandates.

Now in the wake of the time-consuming and costly protracted transition to ICD-10 and EHR implementation, physicians are struggling to get paid. In part, this is due to the ACA which has introduced reimbursement cuts and increased penalties. Last year, the Centers for Medicare & Medicaid Services (CMS) began to apply the value-based payment modifier to adjust reimbursement amounts to reflect the quality and cost of care provided. Those practices not meeting performance standards will receive less reimbursement. In addition, this year, the penalty for non-participation in the Physician Quality Reporting System (PQRS) increased to a 2% reduction in the CMS market basket update. Further, the increased number of patients with insurance provided through state exchanges or the Federal marketplace has exacerbated the payment problem. These patients typically have very high deductibles, along with a 90-day window to pay premiums, posing more obstacles to the collection of co-pays and out-of-pocket expenses. Notoriously, it should be noted that the CMS also takes longer to reimburse physicians as compared to private payers. Moreover, the ICD-10 transition has resulted in increased claims denials, resulting in labor-intensive, time-consuming efforts to overturn the same.

Confronted with these challenges, paradoxically, many physicians have had to reduce the number of patients they see, further eroding financial return. However, for those struggling practices, indiscriminate cost slashing is not the answer as physicians must finely balance improved operational efficiency with the achievement of the aims of quality patient care. This is where innovative technology can play a key role. Smart investment needs to target technology that is able to:

  • Reduce operational expenses
  • Ease regulatory compliance and the documentation demand
  • Facilitate physician workflow
  • Increase patient care time
  • Generate more revenue

One such technology that meets the above criteria is mobile charge capture functionality within a secure messaging application. This would enable physicians to quickly and easily capture charges at the point of care and automatically and securely communicate this information to billing staff or a billing application.

To ensure there is no increased burden to physicians, this process must only take a couple “clicks” or a matter of seconds. For example, the application must have immediate accessible “favorite” codes composed of those services and diagnoses used most frequently and denoted by the terms most familiar to that particular practice, rather than formal codes and code definitions. Additionally, when needing to find a rarely used code not contained within favorites, the application should provide decision-support enabling the easy selection of the right ICD-10 code to be associated with the CPT code. Also, there should be code bundles available so multiple code combinations can be assigned to a patient in a single click.

This prompt and speedy process replaces the manual paper-and-pencil method in which physicians retrospectively attempt to make a note of the procedures performed —sometimes days or even weeks after the encounter. Consequently, quite often, not all services that were provided are recalled. These “notes” were then provided to the practice billing team who then must interpret the right procedure and identify the correct codes for billing purposes. Often because of the lack of detail within the notes, the specific details of the procedure are lost, reducing the amount of reimbursement received on top of the lost charges due to poor memory.

These issues could be virtually eliminated with smart mobile charge capture functionality. Additionally, this functionality enables the ability to easily add and document PQRS codes while facilitating patient rounding, with a customized patient list and direct access to previous charges, and with the ability to rapidly “clone” them for the day’s visit. This information would also be visible across the entire group of physicians, if desired.

By automating and expediting the charge capture process, there is a direct impact on the practice’s financial homeostasis:

  • The elimination of lost charges and improved coding specificity directly translates into higher revenue.
  • The coding decision support and the inability to mismatch CPT and ICD-10 codes mean reduced potential for costly and time-consuming audits and claims denials.
  • The easy documentation of PQRS avoids the 2% CMS penalty and facilitates compliance.
  • The immediate transmission of charges to billing staff speeds the time to billing, reducing the amount of time to payment received.
  • The number of FTEs required to support the coding and billing process can be dramatically reduced markedly decreasing operational expenses.

Most importantly, such technology can allow physicians to spend more time doing what they want to do and what we need them to do—caring for and treating patients.

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Building an effective care team collaboration strategy: 4 focal points

Part 2 of a 3-part series in conjunction with our nurse leadership webinar series.

The need to unify physicians, nurses and other care team members through effective communication at the point of care is growing in significance. According to a 2015 Gartner report, 80 percent of providers report deploying fragmented communication technologies, which results in degraded care team communication and collaboration.

Collaboration is both a process and an outcome. It affects the patient experience, outcomes and care occurring across a variety of settings in an increasingly complex and mobile environment.

To resolve the fragmented and non-secure communication encountered in healthcare, true care team collaboration is dependent on consolidating disparate technologies into a single solution capable of directly addressing the communication obstacles degrading patient care today.

To some, this may sound like an unachievable goal, but with a strategic plan focused in areas that facilitate workflow processes and communication leading to improved patient care, it is attainable.

You may wonder, where do I even begin? Many organizations, in response to specific challenges, have deployed single-point technologies that provide only incremental gains. True clinical communication and collaboration requires a comprehensive strategy, and to begin you must carefully evaluate your entire communication landscape. You’ll need to assess your current technologies, HIPAA compliance plan, near miss or sentinel event occurrences, nursing time to reach providers and consult notifications procedures – all of which will highlight your clinical communication strengths and weaknesses.

Developing a comprehensive care team collaboration strategy spans four major areas of consideration. Failure to address any one of these areas may leave you with an incomplete solution. Each organization is unique, certainly, but departments and organizations must work together to create an environment ripe for collaboration.

  • Clinical – Mobile technologies are becoming more prevalent in healthcare settings, thus the need to leverage these technologies to facilitate secure communication amongst the care team is becoming increasingly important. A clinical communications solution should enable communication-driven workflows to facilitate timely care team communication. The solution should facilitate direct conversations among nurses and physicians via the preferred mode of contact – be it a mobile phone, pager, email or office land line. By triaging incoming calls and applying personalized algorithms for call placement, care team members reach the correct physician without searching through call schedules.
  • Operational – Once your plan is in place, bringing it to life warrants consideration and considerable forethought. A well-defined adoption strategy will be key to a successful implementation. Clinical champions help drive decisions and engage end users. Leadership engagement is often the most essential driver of adoption of any initiative, plan or policy. You should also consider and plan around timelines, specific tasks and resource requirements.
  • Technical – To achieve success, understanding and addressing technical infrastructure is a must. The strength of your Wi-Fi and cellular networks should be evaluated. Does your organization have a device strategy or do you have a BYOD policy? Do you desire integration with clinical systems and is the solution you are considering interoperable?
  • Financial – In any financial consideration, ultimate ROI and total cost of ownership are needed to justify approaches. When you close communication gaps across the extended care team to facilitate patient care collaboration, you can potentially improve referral revenue, decrease readmissions and avoid penalty costs. The ability to do mobile charge capture at the bedside, and to quickly and fully document exam and procedure details at the point of care will result in revenue recognition and improved cash flow for physicians.

There is no short list of considerations when it comes to building an effective care team collaboration strategy. However, if you focus on these four areas, gain support of leadership and identify a solution that hits these marks, you will be well on your way to effectively addressing your communication and collaboration needs.


Interested in learning more? Read part 1 and part 3 of this series on nurse leadership in care team collaboration.

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