Tom Furr

"Today's realities are that managing a practice is more complicated than ever…"

That's how an assessment begins on what it takes to successfully run a medical group in 2017 by Triple Tree, a merchant bank focused on healthcare. In a recent 

, the bank also looked at the forces driving mergers of specialty groups. Chief among them is the realization by administrators and their physicians that the healthcare business isn't what they hoped it would be.

The mounting pressures are affecting medical groups' top and bottom lines. The bank's report suggests that while opting to be part of a larger group might sound attractive to an independent practice, the non-clinical demands are the same, just more complex..

And that is why all medical group administrators must realize the way to manage their group should sync with the business environments in which they operate. According to TripleTree, a critical success factor is administrative and operational efficiency, due to the significant burden created by government regulation. It also noted that groups need to support and keep pace with changing consumer preference.

Those two aspects have combined to force medical groups to work "more for less." Between the CMS and commercial payers, one might think that is plenty to focus on. However, there is a third payer with which to contend, the patient. The rise of high deductible health plans (HDHP) has created a third payer group, your patients.

The patients who you see in your office everyday could also be its undoing. Because patient financial responsibility has gone from about 10 percent of your bill to 50 percent or more, bringing greater efficiency to the billing and collection of patient bills is a necessity. It demands that administrators take a less lackadaisical attitude across their groups, from how the front desk greets the patients, to the people in the back office who often call about past due balances. It also requires understanding how patients handle their bill-paying activities.

Among the observations made by TripleTree is that efficiency starts before the patient comes to the office. It suggests that "it is critical to drive highly efficient scheduling and reminders to ensure repeat volume is consistent and reliable."

Related to that is the need to realize a growing number of patients, or the parents of pediatric patients, manage much of their lives from their smartphones. The calling, texting or emailing of appointment and care reminders is reaching the level of ubiquity.

Interestingly, the Pew Charitable Trust reports nearly a 

 of smartphone users have paid a bill from their mobile devices. It's interesting because nearly 9 out of 10 healthcare bills sent to American consumers arrive in 

To make your medical practice more efficient, today's new approach to management demands that financial management and operations -including billing and collections, accounting, analytics and budgets -get done differently.

Most medical groups run their business offices the same way as the day they opened their doors. No matter how many years ago your medical group opened, maintaining the status quo can be harmful to its financial health.

Let me repeat a harsh fact of life for a medical group, half of your revenue will soon come from patients. Unlike insurers who, even if challenging at times, pay like clockwork every couple of weeks on approved claims, it takes longer and costs more to collect from patients. The paper-based billing process results in a dangerous 90 to 120 day payment cycle, according to the MGMA, who suggests consumers don't pay anything until at least three paper statements have been issued.

If your group is still paper-centric, grasp the findings of a 

 conducted by Aite Group, a global research and advisory firm, which looked into how consumers pay their healthcare bills. The researchers learned that use of the USPS to pay bills declines with each younger generation. The study found that 40 percent of bills paid by seniors went through the mail. By contrast, 44 percent of payments by millennials were made electronically.

There's much attention paid to finding ways to enhance the patient experience. In virtually all instances of such initiatives, this experience focuses solely on the time spent by a patient in the office, and largely while in an exam room.

If you send a bill in a way your patient doesn't prefer and, to add insult to injury, the statement is utterly confusing, whatever goodwill you built up through the efforts of your healthcare professionals vanishes in the moment the bill is opened.

In my dealings with medical group executives, I hear all sorts of excuses not to take simple, easy steps to improve their collection rates. It's as if they've turned a deaf ear to the challenging environment in which their practices exist and the shifts in the preferences of their patients.

Those who choose not to hear the signal for change will likely falter and fail. It's your practice. Manage it the way it needs to be so you can have a future.

Tom Furr founded Durham, N.C-based PatientPay, the patient payment solutions company that offers a patented online billing, collection and reconciliation services that can be embedded in all current popular management and healthcare information systems, to enhance the productivity and profitability of medical practices, ambulatory networks and hospital systems.  His experience in electronic payments and online services for small businesses is reflected in the innovative, easy to use PatientPay solutions. 

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Today's practice must be in tune with the reality of healthcare consumer demands, including using electronic billing services.

Paper-Based Billing is Ancient History in Healthcare 

Reports have splashed across the pages and screens of media outlets with frightening regularity about security breaches at healthcare provider organizations as well as patient data being held for ransom by opportunistic 

The Ponemon Institute, an independent research firm, noted in its 2016 "

Benchmark Study on Privacy & Security of Healthcare Data

 that breaches of information systems at hospitals are occuring with increased frequency, and will likely continue at an unabated rate as cyber threats evolve and cybercriminals become even more audacious.

The survey provides the viewpoints of people responsible for, or involved with, digital security at hospitals and hospitals' partners. As a leader of a medical group, you cannot say, "'That's not me or my problem." If anything, a medical group has more to worry about.

Interestingly, 95 percent of businesses that experience a breach are 

. While hackers are not discerning when it comes to size, healthcare is at the top of the list. The reason healthcare is such a "high-value target" is that not only is it relatively easy to gain access to this information, the data has great value to the cybercriminals..

If your group is hacked and patients' credit card information, social security numbers, and/or birthdates are taken, the Ponemon Institute estimates the cost of recovery to be more than $200 per record. Along with that cost of complying with state and federal mandates, while notifying all affected patients and covering an assortment of high-priced liabilities. There's also the price a group pays for eroded reputation. 

reports that as much as 60 percent of small and medium-sized businesses that experience a data breach go out of business after six months.

 for data breaches among most healthcare organizations is a criminal attack. It's the digital era's equivalent of Willie Sutton's response to the question, "Why do you rob banks?" Back then it was where the money was. Today it's in data stores at healthcare providers.  In fact, 65 percent of respondents to the Ponemon survey indicated successful attacks targeted medical files and billing and insurance records.

On the deep web, the hard to get to, dangerous part of the Internet, one can find a virtual bazaar for credit card account information and other valuable data that quickly gets sold to the highest bidder.

To address this "what can I possibly do!?" circumstance, there's cybersecurity insurance. Not surprisingly it's one of the fastest growing forms of insurance, expected to grow 

over the next decade. Like most such forms of protection, this insurance transfers some of the financial risk of a breach to the insurer. However because it's a new insurance form, premiums are steep and the extent of a medical group's liability is often not crystal clear. Also this insurance doesn't begin to touch the loss of revenue due to the damage done to your medical groups' reputation.

There is something simpler and appreciably less expensive a medical group can do. Medical groups can transfer and change where and how they house their patients' credit card information. If it's not on your system, it won't be stolen if you're hacked.

By working with a firm that can present statements and collect payments electronically, you remove the risk those credit card numbers represent from being your responsibility. Unlike your group, these services operates under industry-recognized security standards for storing, processing and transmitting credit card information. .

All of this can be summed up with words you often hear being said to a patient at your group: "Let's take care of this now before it becomes something much worse."

Tom Furr founded Durham, North Carolina-based PatientPay, the patient payment solutions company that offers a patented online patient billing, collection and reconciliation services that can be embedded in all current popular management and healthcare information systems, to enhance the productivity and profitability of medical practices, ambulatory networks and hospital systems.  His experience in electronic payments and online services for small businesses is reflected in the innovative, easy to use PatientPay solutions.

Cybercriminals are increasingly going after healthcare providers. Make sure you put protections in place to keep your information safe. 

Don't Let Cybercriminals Infiltrate Your Practice

President Barack Obama called upon America to apply all its innovation to create a moonshot-like initiative to rid the scourge of cancer during his final State of the Union Address, Jan. 12, 2016.

The term "moonshot" comes from a speech given on May 25, 1961 by President John F. Kennedy. He asked America to undertake a space exploration program; landing men on the moon by the end of the decade. Interestingly, President Richard M. Nixon first used the imagery of a moonshot for healthcare in a 1971 speech where he too talked about finding a cure for cancer

Clearly, we're better able to meet the challenge than when Nixon put it before us. . Howeer, the  point I wish to make with this blend of history and optimism is as fast and far as healthcare goes in research, discovery, procedures, treatments, and cures, that's how slow it moves with to make its operational side more efficient, easy and equitable.Take a stroll through the business office of group practice and you’ll see what I mean. The level of inefficiency, in terms of process and cost-effectiveness, is disturbing.

Twenty million more Americans now have health insurance than before the Affordable Care Act (ACA). And with that the high deductible health plan has altered the arrangement of financial responsibility from the old 90/10 percent insurance company/consumer to a near 60/40 percent split. The result is consumer out-of-pocket will be more than $600 billion by 2019, according to Kalorama Information

Healthcare costs are hard to swallow. It's why medical bills are the number one cause for personal bankruptcy in this country. We are not a nation of savers, especially as it relates to healthcare bills. A Federal Reserve 

 found 46 percent of Americans did not have enough money to handle a $400 emergency expense.

The clinical side of healthcare is driven to do things better and faster, whereas the operational side of healthcare does nothing to be efficient unless the government pays for, or worse, forces it. 

In this day of chatbots handling purchase and payment for goods and services, medical practices manage to exist by sending claims to insurers. This is a process that takes days to process by clearinghouses or waiting up to 120 days for patients to mail back paper statements with a payment.

Clearly, as insurance payments are slow to process and patient balances rise, the ability of a practice to maintain financial success, let alone sustainability gets really tough.

Some group practices have realized billing and collections are not core competencies. So they've outsourced the process to revenue cycle management (RCM) firms. However, many RCM firms replicate the processes and, thus, the cycle continues.

Unlike the cable company, a healthcare provider can't prevent you from watching "Sunday Night Football." As such, there isn't much of a reason to pay a medical bill on time, if at all. The 60/40 split means doctors have to get a lot more of their revenue from sources that take more time and expense from which to collect.

Patients aren't deadbeats, per se. However, a study 

 by Citibank that looked at the correlation between understanding a bill and willingness to pay it points to a big reason why patients are slow to pay. The research found that if the bill can be understood, there is no hesitance to pay it.

Even those with fine educations or who work in healthcare don't fully understand what they see on a medical bill. Case in point, me. My daughter had a couple of sport-related injuries. The bill the followed caused my blood pressure to rise. To give me some assurance it was the bill and not me, I showed it to friends. No one got the amount due correct.

Since the bill was not understandable and, more importantly, a payment I had sent in was not showing up, I resorted to placing a call to the billing office. After more than two hours on the phone with a billing clerk the mystery was solved or so I thought. Instead of applying my payment to what was thought to be the current owed amount, a prior balance was covered. Another month, another bill, creating more confusion and frustration.

If the business of healthcare does not become more efficient, easier to understand and deal with quickly, funding the much needed "Cancer Moonshot" will likely be impossible. The clinical and operational sides of healthcare must work hand-in-hand.

Tom Furr founded Durham, North Carolina-based PatientPay, the patient payment solutions company that offers a patented online billing, collection and reconciliation services that can be embedded in all current popular management and healthcare information systems, to enhance the productivity and profitability of medical practices, ambulatory networks and hospital systems.  His experience in electronic payments and online services for small businesses is reflected in the innovative, easy to use PatientPay solutions. 

In order for there to be a "Cancer Moonshot," healthcare needs to see advancements in the operational side of the industry, too. 

Healthcare Needs More than One Moonshot

It astounds me on a daily basis how the healthcare industry takes pride in how smart it is about managing patient clinical care. Compared to other countries, the quality of care delivered by American healthcare providers, from an individual physician to our country’s major hospital systems, is second to none. But if you look at how medical practices in the United States handle their finances, particularly revenue cycle management, it looks like something out of the 1980s.

View the typical business office in a medical group and you’d think your eyes were playing tricks. Piles of paper, ledger books, pencils, and the like are far more common than what I call paperlessness: The use of digital systems and communications to prepare, issue, and reconcile bills.

When I talk with practice administrators to learn why they continue to go through the time-sucking, error-prone process of producing paper bills and post payments manually, the most often heard answer is: “It works for us.” Well, I’ll accept that if we were still in 1980, but we’re not.

The healthcare industry is undergoing a set of tsunamis in terms of change; not only in how, when, and where care is provided but how it’s managed as a business. Gone are the days of insurance companies assuring cash flow by way of covering up to 90 percent of the cost. High Deductible Health Plans (HDHP) have obliterated that pleasant experience. The payer will fork over just 50 percent. The rest sits with the healthcare consumer.

And that healthcare consumer isn’t happy about that and won’t necessarily be in a big hurry to pay. The aspect that inhibits prompt payment more than anything has to do with that paper bill. It makes no sense to them and the patient won’t pay something she doesn’t understand.

When I explain that there’s a simpler, less costly way to bill patients, which provides statements they can readily understand electronically, the practice executive sheepishly says something about people being unwilling to provide their email addresses.

A recent study by Kaiser-Permanente (KP) looked at email encounters between patient and provider. It found that most like to communicate directly with their providers online. It makes sense. Email is the most common mode people use to communicate. It is by far the function people use most often on their smartphones, the device that’s with them at all times.

Medical business managers point to arduous policy-driven shifts that might not be in the best interest of patients or providers.   A poor reason at best not to embrace electronic communications and paperless billing.

The KP study also found 42 percent of those surveyed with higher out-of-pocket costs reported that email reduced their phone contacts, 36 percent reduced in-person office visits, and 32 percent said emailing improved their overall health. Email helps to keep receptionists off the phone so they can spend more time with patients in the office. Email helps reduce “crazy days” at the office or clinic because it eliminates the “need” to handle things in person.

In the new healthcare world we’re living in, patients are making health decisions as consumers. Hence the use of email to determine if they ought to make an appointment and see the doctor. There’s no point in making a judgement good or bad on this. It’s our reality.

Asking for email addresses doesn’t violate patients’ privacy or security, assuming safeguards are in place. Asking for email addresses means you build better relationships with your patients and be better able to hold them over time. Asking for email addresses will save time and money, increase cash flow, and lower A/R. Because with emails you can communicate with patients more easily, more efficiently and bill in half the time and at half the cost using a paperless payment solution.

Asking for email addresses is the first step. There’s no reason at all not to ask.

Tom Furr founded Durham, North Carolina-based PatientPay, the healthcare payment solutions company that offers a patented online billing, collection and reconciliation services that can be embedded in all current popular management systems, to enhance the productivity and profitability of medical practices, ambulatory networks and hospital systems.  His experience in electronic payments and online services for small businesses is reflected in the innovative, easy to use PatientPay solutions. 

Email is a simple way for physicians to improve care and lower costs for their patients. Yet, most claim that patients don't want to interact this way. 

Author | Tom Furr

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