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Patient outstanding balances are on the rise. Patient A/R is at its highest ever. I am not talking about self-pay patients. Sometimes self-pay patients can be good at paying.
One of the main reasons why patients owe you money is because of healthcare plans in force.

There are two main reasons why this situation arises. Both have to do with insurance plans that may be provided by employers.

1. Increasing deductibles and
2. Increasing ‘per-visit’ co-pay amounts

You would think practices have a collection plan in place, but you will be surprised. I have seen established practices that just ‘wing’ it and leave it to the whims of staff and providers to tackle patient balance receivables.

In a recent conversation with a provider whose patient A/R over 90 days was 46% of all outstanding, he was afraid of pursuing ‘collections’ for the fear of losing patients.

It does not have to be an all-or-nothing approach. You need a well-thought-out and effective collections plan and process in place that involves your entire staff.

Here are 5 effective steps you can consider.

1. At the time of scheduling appointments for patients on the phone, make it a practice to check that patient’s outstanding balance. Of course, this task becomes easy if your integrated EHR/Billing systems allow you to quickly look it up. If patients owe money, they should be politely reminded to pay at that time with a credit card or bring payment at the time of the visit.
2. When patients check in, check for outstanding balances again and try to collect past balances along with the co-pay for that visit.
3. If available, take advantage of an automated system of sending patient statements. Good systems allow you to set up ‘rules’ for sending statements. For example, send statements to patients with a balance of $25 or more. Send statements on a monthly basis automatically and monitor how many statements have been sent.
4. If you have a very large over 90-day A/R, set up a plan including making phone calls to collect the money. This can be a short-term focused campaign to bring down the aging.
5. Send patients to external collections. This is one of the toughest decisions for a provider. One reason why it is difficult is because there is no plan and system in place. A well-thought-out plan removes subjectivity.

A good internal process coupled with an integrated EHR / Practice Management system can make it seamless to pursue patient collections and reduce A/R.

“If you want a job well done, do it yourself”

I lived most of my life with this simple saying. He further said you should have all the skills to be in control. I endeavored to live up to this and excel at what I did. I strove to excel not only in doing everything myself but even in finding my weaknesses and trying to overcome and excel at them.

Just over two years ago I realized I was wrong. Not my Dad, I was wrong. In my interpretation of the words ‘job well done’.

I thought of ‘Job’ as each task, each activity, and each detail. So wrong I was. I have excelled when it came to Strategy and Processes – seeing the big picture and finding solutions that are most apt. My weakness has been details – micro-managing.

I wanted to improve. I Read books, and took coaching classes. Time management and details management.

It hit me when I turned 50. 3 words = 1 simple word. The words ‘job well done’ meant just one word – Goal. My focus was on individual tasks rather than the Goal or big picture.

What did I do about it?

Once I realized this, I decided to take action. I did two simple things:

1. I hired a Personal Assistant
2. I outsourced simple tasks that I used to do including my own bookkeeping, accounting, etc.

That changed my life in two ways:

1. My quality of life improved. I now have more time for myself and I am happy and stress-free.
2. My revenue has actually increased by 45% in the last two years. This is something that came as a bonus because I am able to focus on and amplify my strengths. (see my previous blog post on ‘amplification of strengths‘)

If you think letting go and outsourcing tasks is expensive, think again. I am a living example of this false thinking.

Dr. Lawrence Gordon, an ENT Surgeon in NY provided a unique perspective on why EHR dissatisfaction pervades among Providers.

Theory of Amplification

Dr. Gordon talks about EHR as a tool that can be used to amplify the intrinsic talent that Doctors possess. It can be likened to the explanation Archimedes gave to the principle of Lever. While Archimedes did not invent the lever, he gave an explanation of the principle involved in his work On the Equilibrium of Planes. The principle of lever was used to design block-and-tackle pulley systems. The goal was to lift objects that would otherwise have been too heavy to move.

In today’s terms, we see increasing use of Robotics in the manufacturing sector that does the ‘heavy lifting’, allowing people to be creative.

In both instances, these are tools that amplify intrinsic talent.

What are you trying to amplify?

Doctors and Clinical Providers want to amplify their experience and empathy. Unfortunately, they seek out EHR to directly amplify these. This is precisely where it breaks down.

The goal must be to use the lever of EHR to create processes and an environment that allows amplification of inherent talent.

To be precise, we must use EHR to:

• Visualize data that allows better clinical decision-making
• Automate health maintenance rules for better patient care and interaction
• Provide focused educational content based on diagnosis and assessment

In other words, strengthen the processes outside of the exam room so that Providers can Amplify their experience and empathy using the data provided by surrounding systems, inside the exam room.

The goal should not be to ‘master’ a tool, but to use tools to help providers function at high efficiency. Efficiency does not mean clicking buttons and a mouse, it means amplifying strengths.

When I was in Dr. Gordon’s clinic on a Monday during his lunch break, it suddenly became obvious why his practice looked calm on his busiest day when he typically saw 45 patients.

We all love bargains. Now we can look for them from the comfort and privacy of our home or office. Comparative websites allow us to do that. Competition makes it good for us (bad for vendors).

We want everything in short steps. A quick way to lose weight, lotteries, an easy and fast way to make money and even looking for systems and tools that can help with our practice such as EHR. Sometimes one of these shortcuts pays off and it reinforces our belief that there is always a shortcut.

The problem is, that these shortcuts don’t always pay off. We spend too much time looking for money-saving shortcuts.

But when it comes to EHR / EMR software, there are no shortcuts. This is one reason why so many providers are looking to switch. They made a decision initially in haste, looking for shortcuts; soon to realize that there is a lot of effort needed by all stakeholders.

By all stakeholders, I mean all members of your staff as well as your vendors. Vendors are really partners in your success. If either stakeholder does not come into this as a partner, pause and question why.

Strive to fix it – internally or externally. Change staff, or change vendor, sometimes both.

I re-read an article in Fast Company that was written 4 years ago to see if it is still relevant given that there is so much emphasis on mHealth software and applications these days. (Here is that article)

This article lists a few iPhone apps that are recommended for Doctors and Providers. Some of these are still around. At that time very few electronic health record systems (EHR systems) were robust enough.

I have seen an evolution of EHR systems that incorporate a lot of functionality that required separate ‘apps’.

With the majority of them now on the Cloud, you can access not just one or two mHealth apps, but the entire system on your mobile device with a browser.

How times have changed?

Kyle wrote a very precise article related to Medicare’s refusal to pay for readmission within 30 days of discharge from a hospital.

He summarizes it well – ‘But this is intrinsically a superficial strategy, not a strategy that addresses the underlying cost problems in healthcare delivery.’

The second problem I see is not addressing the issue from a patient’s perspective. The <30 readmission rule can potentially put patients in harm’s way, just as I have found in my case, it was so difficult to get approval for an MRI when my back hurt.

Reducing costs must be addressed, but not at the expense of patients.

I’m sitting at the Las Vegas McCarran airport returning from a fantastic Healthcare IT Marketing and PR Conference hosted by John Lynn. This is also one of the rare airports that has free wifi.

That’s not what I want to talk about though. I am sitting at the gate waiting for my flight. A young lady sat right next to me. I thought she limped a bit. As soon as she sat down, she plugged in her laptop to charge it, connected to the free wifi, and within 5 minutes, she was on the phone.

‘Hi, is this Dr. Podiatrist? I am looking for an appointment next week. Ok, thank you. This went on for 7 calls. She mentioned on one of the calls that she was looking up her Insurance company’s website for participating podiatrists, and she wanted to see someone close to her office.

Finally, on the 8th call, she did find someone who had an availability.

As each call was made, I could sense her frustration grow and her sighs get louder.

Why is it so difficult to find a doctor and get an appointment? We can book flights, find, review, and book dinner at restaurants without talking to anyone.

Is this the last bastion?