Here’s wishing all of the readers of Healthcare Interoperability a very Merry Christmas, happiness and joy all around.
An interesting article surfaced in Healthcare IT News that suggested that executives at some healthcare software vendors want to transform themselves from generically being deemed as an EHR vendor and become a Population Health company like Cerner’s CEO Zane Burke told Healthcare IT News.
Being able to access data relevant for patient care should be possible regardless of the format it is presently in or whether it is in an EHR, national database or in pdf format.
The constraints that “EHRs” are presently may not allow for this functionality (yet). The article goes on to state that providers are also moving towards precision medicine, accountable care management, chronic care management and value based reimbursement.
Movement for many on the ground is still in the initial stages and only those provider organizations with deep pockets and the ability to leverage collaborative working relationships with solution vendors can think about moving forward with all of the initiatives mentioned above in a meaningful way.
In a story published on September 13th , 2016 by Healthcare IT News (HIT News), Epic Systems’ founder Judy Faulkner ( just ‘ Judy’ to many in the Healthcare IT world) revealed that Epic invested something like 50% of its operating expenses on research and development, outstripping all organization in and out of the Healthcare IT ecosystem.
HIT News verified through federal filings that Cerner spent 19%, Allscripts spent 34% and athrnahealth was at 10%. Google spent 45% of its operating expenses on R&D (or $12 billion) and seemed to be the closest when it came to a percentage of operating budget.
The thought that ran through my mind was ” Has this translated to better and more efficient and streamlined patient care at Epic’s customers versus provider organizations that have implemented a competing product? I’m all for R&D and believe that it’s really what makes America great (I don’t think we’ve lost the ‘greatness’ since 1776 when the Founding Fathers declared independence, but that’s another story for another day). The technology of the 21st century has indeed been spurred by American innovation and ingenuity (Facebook, Twitter and the entire world of Social Media). R&D brings us medicines that have been life changing to many and previously were inconceivable even in the latter part of the 20th century, but with the cost of patient care rising and many Americans wondering how to get them within reasonable limits anymore, does this only add to our costs in the patient community or will it be the savior of millions and have a lasting impact for the country and the world. Makes you think. …
As always, the opinions expressed here are mine and nobody else’s.
What a wild ride this year has been so far. As my son and I watched the Broncos -Panthers game, it dawned on me that I’ll never hear the famous words from the just retired Peyton Manning anymore. The young next generation QB on the Broncos team though didn’t do too badly though and seemed to keep his cool as he faced the Panthers and end up getting the better of them in the end. Flipping to the wacky Presidential election we’re going through, apparently Vladimir Putin is the new standard of excellence in leadership.
I always look at our nation’s Declaration of Independence and focus on the words “We the people ” in the Constitution therafter, in the 18th century, those were indeed revolutionary words to even think about, let alone write as a declaration.
In our world we need to think ever more about empathy and healthcare as never before. Working at Healthcare Providers for some time now, I see the need for a better more efficient and effective way to care for people and believe truly that a combination of collaborative project management, appropriate resource allocation and technology that enhances patient care and safety has the ability to transform patient care in a positive way.
I’ve also seen of late, the return of racist elements I’m society that were previously kept at bay which disappoints me greatly.
Stay focused on the real substance of the world, the care and empathy that we all should have to better understand the human connection that makes us live a more harmonious existence.
If you’re reading this blog post, just look around you and realize all of the good that is in your life and appreciate the ability to be able to give more of yourself for causes such as better patient care through information technology.
Go get ’em!
Look forward to seeing as many people participating in this all important topic of cyber security and privacy.
Having worked with Revenue Cycle professionals over the last few years, gives me a finer appreciation of the work that provider organizations have to do to get paid. We’ve all received those bills we thought that the insurance company would have taken care of and wondered why are we receiving this? Why can’t I get through to the company that has sent me this? Did I really get disconnected after holding on this phone for 15 minutes? Frustration can certainly mount. I know it does for my family when trying to figure out next steps. According to an article from Healthcare Finance that I recently read, the top 5 medical claim denials that are the most common are:
1) Duplicate claims – When hospital administration resubmit claims when they have not heard back from the payer and end up restarting the clock for that claim and end up mostly with a denial due to re-submission
2) Lack of information on the claim – When a claim is processed but due to human errors, information such as a date of birth or the spelling of a name is incorrect, the claim gets denied.:
3) Expiration of Eligibility – When both the patient and the provider organization are unaware that the insurance eligibility of a patient has expired with that organization. This is a common mistake that can be avoided if the provider does an eligibility verification before and during when the patient comes in for their appointment.
4) Claim not covered by the payer – Providers can easily avoid this by leveraging the ability to use real time verification capabilities.
5) Time limit expiration – Basically, the provider did not send the claim in on time as apparently many times, smaller providers don’t focus on smaller claims, but want to make sure larger claims are paid leaving a lot of smaller claim dollars on the table that eventually add up.
All in all, payer organizations also leverage the system to their benefit as any organization would. It is up to the patient to understand their eligibility options and the provider to recoup the money that they are owed. There are many opportunities for revenue cycle improvements that are more often than not, simple to deduce, but more difficult to achieve.
I look forward to seeing everyone at the Project Management Institute’s Mega Event at the Horseshoe Casino tomorrow for my presentation “ICD-10: The Healthcare Y2K That no one knew was coming!”
See you tomorrow!