Physicians can prevent revenue cycle leakage, even in age of MACRA

More physicians are leveraging that data to prevent money from slipping through the cracks of their revenue cycles, especially as the Medicare Access and CHIP Reauthorization Act ties doctor payment to outcomes.

The problem for many physicians, especially those in small- to mid-sized practices, is that delving into the data can often take their attention away from providing care, threatening to thwart their efforts at improving clinical outcomes. Some of them outsource their data analytics or revenue cycle functions. But those who can't are increasingly turning to technology to ensure they're capturing as much revenue as possible.

Thom Schildmeyer, vice president of revenue cycle management, strategy and development at Modernizing Medicine, sees this happening increasingly among physicians who might not otherwise be comfortable taking on these kinds of roles.

"As you look at the overall picture on how physicians are affected, you have to look at how they take in information," said Schildmeyer. "They look at it like a match equation -- they take information such as demographics, medical information -- and they take that information and they make a diagnosis, which is solving the equation and in turn leads to prescribing something," he said.

"When they look at the financial side of the business, they aren't comfortable with this area," he said. "They don't have a lot of expertise, so they're uncomfortable. They're insecure. The MIPS/MACRA situation has created some uneasiness, and with that uneasiness, some people are going to avoid it. Some people are going to go into full-bore."

Tom Schaal, director of product management at Medeanalytics, sees physician discomfort over this situation as a potential stumbling block, though it's one that can be overcome.

"It is a challenge," said Schaal. "In an ideal world you have physicians focused solely on providing care, but there are business-type things that get in the way. … If you give them too much, or make it a second job they have to focus on, that takes away from their primarily responsibility of delivering care. That's a problem."

Yet physicians' larger role in managing their revenue cycle picture is largely unavoidable these days, which is why many are clinging to the life rafts of technology and data. And the data helps. If a physician is using a stent that fives times more expensive than a similar stent that offers similar outcomes, that's valuable information, said Schaal.

"Technology is one of the most critical areas," said Schildmeyer. "A lot of physicians perceive technology as a necessary evil because of the cost, but the reality is that if you look at the cost -- $500 a month, $1,000 a month, whatever -- when you look at how that technology helps the physician -- checking the patients, gathering information, financial reporting, analytics -- that alone has a tremendous value that frees up a physician from having to pay people to do that for them. It brings it all into a system. It allows you to have the templates to put the information in in an easy way."

"You can be reimbursed or coded for what you actually did, and then that helps not only with the reimbursement but the organization of the information," he said. "Technology saves on so many of those areas. When you bring the information together, and you can operationalize the information, it allows you to diagnose and prescribe financial and strategic resourcing. Technology is actually critical to all those areas. To me, it's one of the greatest gifts you can give to a business."

The first step for a physician in deciding which technology to use is to determine what's available in his/her speciality. If there are solutions that are specific to a certain specialty, said Schildmeyer, it's possible to navigate information in a way that's more natural and seamless otherwise, making it easier to achieve the desired outcome.

"As we look toward patient satisfaction and payment structures around things like lack of readmissions, physician quality really becomes a focal point in terms of maximizing revenue," said Schaal. "The quality of a physician is really going to be a cornerstone when it comes to any enterprise's health. … Making data meaningful is really where you move the needle. As you draw insights from the data to drive business initiatives and business decisions, that's where it gets really powerful."

It also makes it easier to spot that ever-pesky revenue cycle leakage. Each stage of the revenue cycle -- the patient check-in, the gathering of information, the diagnosis, the copay and insurance verification, the billing, the payment processing -- represents a potential point of leakage. If there are no appointment reminders in place and a patient no-shows, for example, that's lost money. Ditto for expending resources on following up on a claim that could have been avoided to begin with. 

"The doc thinks they have control of this," said Schildmeyer, "but there can be a 20 percent difference in what they're taking home because they're bleeding in so many places."

That's what data solutions can address, he said, and this approach should only continue as the spread of MACRA continues. Doctors, after all, want to focus on care.

"Physicians aren't business people," said Schildmeyer. "They want to see their patients and go home."

Twitter: @JELagasse