Medical management in today’s world is not as simple as it was decades ago. Many practitioners believe they need to extend their education in order to properly manage their clinic. Nitin Chhoda defines medical management practice in the 21st century.
Clinicians and other healthcare practice management professionals spend a lot of time getting a thorough education. Unfortunately, their medical knowledge is not supplemented with quite enough business and medical management study.
Private Practice Trends
Some clinicians opt to get an additional degree in business or medical management so they can comfortably run a private practice. However, that is the exception and not the rule.
There has been a recent trend in private practices where clinicians are finding themselves in financial trouble due to mismanagement of expenses, billing, and health insurance companies refusing to pay for the provided care.
In some ways, the problems of private practice physicians in medical management are not their own fault at all. Insurance companies change their policies frequently, and what was billable one week may not be billable the next.
In response, new degrees and a new career path have been forged so clinicians or their staff can be educated about dealing with the particular challenges of running a medical practice. A medical manager is also often called the healthcare administrator, health services manager, or healthcare executive.
For those interested in medical management careers, you must complete at least a bachelor’s degree in business or a related field, and a master’s degree is highly recommended. The Bureau of Labor Statistics estimates that medical management is growing more rapidly than many other fields due to projections of an increase in demand for medical services over the next decade.
Medical management combines strategy, information management, and leadership for building and managing a successful health care practice.
One of the major components of being able to manage a medical practice is having an understanding of the laws and requirements that health care providers must adhere to, such as HIPAA and the HITECH Act.
Clinicians are usually concerned with being able to do their job and take care of their patients as best they can.
What a medical managementprofessional can bring to a private practice should include everything else, from understanding how to implement an EMR and EHR system to reporting to government agencies and ensuring that the practice is eligible for tax breaks and HITECH Act incentives.
The health care industry is changing rapidly and clinicians who run a private practice are starting to pay for inattention to administrative and management duties which they do not really have the time to handle.
There are medical management systems that attempt to streamline the way that medical clinics handle administrative tasks, such as billing, scheduling, and health insurance filing.
In fact, most EMR systems are equipped to handle medical management tasks as well as medical records. EMR and EHR systems will include scheduling and billing organization and reminders so that the clinic can be more efficient.
They can also ensure that the proper paperwork is filed for Medicare, Medicaid, and health insurance companies. Claims are often rejected due to illegibility or errors in the paperwork, and EMRs attempt to do away with those kinds of mistakes and rejections.
Nitin Chhoda shares the state of health care practice management from the past and how it will affect the future. He shows how the role of management and its staff are evolving as technology enters the physical therapy business.
Even though the tasks assigned to health care practice management staff have been around for as long as hospitals have existed, the job of health care administrators is relatively new and is constantly changing.
Handling medical records and medical billing is a big job. For very small practices, these jobs used to be the tasks of the health care practice management, usually in the form of an office manager.
But today, health care practice management involves so much more, and tasks like medical billing and coding are handled by specialists.
The current role of the health care practice management staff involves a lot more analysis and efficiency management than ever before, largely due to changes and improvements in technology.
The role of electronic medical records (EMR) in this change cannot be emphasized enough. Electronic health care practice management technology has allowed health care management to take advantage of data that was previously too time consuming to extract.
Health Care Management Focuses on Patients
Of course, all these technological improvements might lead health care practice management consulting professionals to spend more time with charts and graphs than dealing with patient concerns. But that is not entirely the case. In fact, analyzing performance of the clinic will serve two purposes.
Firstly, identifying problems with efficiency will provide many advantages to the doctors, nurses, clinicians, and entire staff of a hospital or practice. Many health care practice management professionals will be quick to look for ways to save money, which is another advantage of EMRs and using the technology that is available today. But most of the changes that help the practice’s bottom line have other benefits, too.
The second purpose of looking for inefficiencies by using data on outcomes, re-scheduling rates, and visits per patient is to identify where patients can be better served. This is the tangible benefit that technology can bring when used the right way.
Number of Patient Visits
As an example, imagine that some clinicians only see a patient three times before the patient can go back to life as usual but other clinicians spend at least five visits with each patient.
Usually, in a busy office, you would never even notice a pattern of health care practice management like that.
Clinicians tend to know just how often they need to see patients, based on past experiences and what they were taught.
But if you could see that patients with the same complaint were given a more effective treatment or series of treatments, you could find out what it is that efficient clinician is doing.
Health Care Practice Management, a Delicate Balance
It’s easy enough to see how this kind of information could be misused. And it is likely that we’ll see plenty of cases of disgruntled staff members who are frustrated by statistical analysis and being treated as if they aren’t doing a good job.
Health care practice management in the future is going to be more and more a job focused on efficiency. But there are important human elements that must always be kept in mind so a practice is really running the best it can. Unhappy staff are not the way to make things better.
Before deciding what type of physical therapy software to use in your practice, you first need to determine where your practice needs help. Nitin Chhoda shares the different healthcare practice management tools, and the ways it help to increase productivity and efficiency.
Improvements seem to be made from day to day, so should you invest now or is it too early?
Should you spend a lot of money up front for the best solution, or find something more reasonably priced and add features as you benefit from the change?
What are the risks of choosing the wrong health care practice management tool? Rather than focus on which are the best tools, first it is important to distinguish between the different kinds of health care practice management tools and what they can do for your practice.
Electronic Medical Records
At their simplest, EMRs are systems that allow you to keep detailed records of each patient without using a lot of papers and pens. There are plenty of other benefits, such as the fact that information is faster to enter, review, and communicate with others.
This can improve efficiency within the office as well as the health care practice management, and when communicating with other clinics or hospitals.
Medical Billing Software and Medical Accounting Software
For big steps toward improved efficiency, most health care practice management consulting teams will look for an integrated EMR and medical billing software solution. Medical billing software will improve the speed and accuracy of claim submissions, reviews of rejected or denied claims, and re-submittal of claims.
A well designed medical billing software system will incorporate medical coding, as well, increasing the opportunities for staff to catch their own errors before claims are sent to insurance companies.
With an incorporated system, EMRs can be shared with medical billing staff instantly. Filing and sharing of files will no longer hold up the important processes that health care practice management want the staff to focus on.
Staff may also find that their jobs become more streamlined and flexible as a result of a good EMR and medical billing system.
Staff are often thrown off balance by cancellations or re-scheduled appointments at the last minute. An improvement in scheduling can also result in improved billing and collections.
And naturally, if patient scheduling software is included in the health care practice management tool you purchase, the results can be pretty exciting. For example, if a clinician needs to be informed of a change in schedule, they can get a notification instantly.
Reminders can be set for scheduling tasks and priorities so open appointments can be filled rather than overlooked. And each patient visit can be channeled through the system via their electronic medical record, triggering the medical billing cycle, and new appointment scheduling.
There are many other perks that some EMR and health care practice management solutions provide, including radiology information systems and picture archiving systems. To determine which health care practice management tool is best for any practice, the first step should be the detection of inefficiencies that exist and goals that the practice has.
Healthcare practice management tools already exist in the market today, but you must choose wisely. Nitin Chhoda points out that the tools you selected should meet the needs and requirements of your physical therapy practice.
Once you have settled on goals for the practice, you can start to explore your options for health care practice management tools.
Many of these tools will offer basic EMR and EHR systems, but there are also features to consider for the future, or that might make sense to implement right now to reach your goals.
No matter which health care practice management solution you select, remember to set your goals first. The wrong system may not improve efficiency as expected and can cause problems instead of offer solutions.
The final decision should also be determined by the size of the practice, your specific needs, and the flexibility of the system as balanced by your budget; if you don’t have the finances to purchase an all-encompassing, health care practice management system, find one that can be expanded upon with other features as you feel ready.
Top 10 Most Popular Health Care Practice Management Tools
While popularity isn’t necessarily the best measure of a good health care practice management tool, companies that have done more installations are going to have worked out more bugs and inefficiencies. You can at least count on them to have evolved to suit their clients. Below is a list of the top ten companies and their market share as of 2011. Data may change in the near future.
Epic Systems (8.7%)
Siemens Healthcare (8.4%)
Healthcare Management Systems (7.3%)
Self-developed systems (5.8%)
Eclipsys, now part of Allscripts (3.9%)
The first three in the list above account for over 50% of market share, but that may be because they are used in large hospitals; for that reason it makes sense to review the experiences of practices of a similar size to yours, that have actually installed a health care practice management system you are considering.
Meditech is generally used in large applications of health care practice management, such as in hospitals and medical facilities that see hundreds of patients and have specialists of all kinds on staff. The program is considered very stable and consistent, but users do have some trouble with the interface. The majority of applications are used for medical accounting and lab documentation, but less by physicians and clinicians.
Cerner also ranks fairly low with users for functionality and is used by large hospitals and clinics. But there are quite a large portion of users who find Cerner to be quite useful.
It may be that for the right practice, this is the right health care practice management solution.
Amazing Charts, SOAPware, and e-MDs Chart also rank highly with small practices, although Amazing Charts ranks fairly low for functionality.
Praxis EMR is also highest ranked for satisfaction with support and training, which may be the most important ranking.
For small practices, with between one and five physicians, there are other options which rank very highly with practices that currently use the system. The top user ranked health care practice management consulting tool for small practices is Praxis EMR.
Nitin Chhoda emphasizes that a physical therapy practice should be aware of all the regulations and laws that are connected within the practice. Not everyone can be an expert, but assigning a dedicated staff member to focus on regulations, laws and the changes that are made will be helpful to your practice.
For a large hospital or clinic to keep a lawyer on staff is not uncommon, and in many ways it makes sense to always have a legal specialist available to answer questions about the rights of the hospital and their patients.
However, for a small practice it is much harder to justify having legal representation on staff. There are many horror stories of legal problems causing bankruptcy for a medical practice.
Health care practice management should include some basics about the dangers of making legal decisions for which the outcome is unclear. However, because of the focus on patient lawsuits, health care practice management teams often forget to think about regulatory legal blunders.
Understanding HIPAA regulations is one of the most important jobs of health care practice management. While mistakes in following HIPAA regulations can be damaging, they are also some of the easiest mistakes to avoid, if the health care practice management team is aware of common mistakes that are made.
The most common problems that health care practice management run into focus around liability for fraud, mishandling overpayments, violations of privacy, and not responding to Medicare inquiries. Third-party payer audits and certificate-of-need process should also be comfortable topics for health care practice management consulting professionals.
HIPAA violations can be avoided if at least one member of the health care practice management within your practice understands HIPAA thoroughly. It may seem like a very big and ominous law, so expecting everyone to know everything will be challenging.
But at least one person should be or become a HIPAA specialist so the practice has someone to ask before procedures and standards are set that will violate HIPAA regulations.
Legal blunders relating to contracts are also very common. Naturally, health care practice management professionals are on high alert about any contracts, especially with staff, physicians, and clinicians.
You can also run into trouble with non-compete clauses if you work with physicians who are providing services for more than one practice, especially in-office ancillary services.
To avoid legal problems, it is best to negotiate all contracts in full, taking the time to review all aspects that may introduce conflicts within the practice.
At the first sign of a problem, make sure that communication is open and honest so that changes can be made before a problem becomes a legal issue.
The HITECH Act will also pose a lot of risk for health care practice management, as the punishments for not following HIPAA regulations are more severe as a result of the HITECH Act.
Additionally, funding through the HITECH Act is expected to increased oversight so that infractions are more likely to be discovered.
Regulatory oversight can be the least of your worries if you have focused on improving your knowledge of the regulations.
Managing a health care practice can include complex facets, and being aware of risks to the practice should be a high priority. The best way to avoid a risk is to understand what constitutes risky behavior.
The first priority of physical therapy management is to give 100% patient care while obeying the law. Nitin Chhoda explains why avoiding legal suits is important, as this will affect the standing of your physical therapy business.
Even if the case is eventually decided in favor of the practice and it is determined that you did nothing wrong, the legal cost of defending the practice can be devastating.
On top of financial fears due to legal expenses, there is a very good chance that your other patients will hear about the lawsuit and some patients may leave your practice for less tarnished options. Potential new clients may learn about the lawsuit as their introduction to your practice.
Needless to say, avoiding legal action from patients is a very big priority for health care practice management.
Steps to Avoid a Lawsuit
With so many opportunities for patients to accuse a health care practice management systems of negligence or malpractice, it may seem impossible to avoid a lawsuit if it’s coming at you. But there are some steps you can take to ensure that patients are heard before they start thinking about legal action.
Most importantly, clinicians and all staff of the health care practice management should be educated about the risks of legal action.
Criminal and civil lawsuit examples should be discussed among the staff so that everyone understands their role in avoiding a lawsuit. This should include not just patient-staff relations but also the employee-employer responsibilities.
When a situation does arise where a patient or employee feels they are being taken advantage of or mistreated, the action that health care practice management takes may determine how far things escalate. Never underestimate a claim, even if it is totally unfounded.
Be sure to spend time listening to the complaints, as it may be enough for the patient to be heard and acknowledged. However, rather than giving in and being apologetic, be sure to stand firmly on your policies and avoid saying things that could incriminate your health care practice management.
The first step in any litigation will include mediation. In some ways, you should consider mediation as your first option when a serious complaint of your health care practice management is filed.
There should be an easy-to-use complaint filing system and ways for patients to give feedback, so that they feel confident they are being heard. If a patient is frustrated while simply trying to file a complaint, their estimation of your practice will only diminish further.
Introducing a third party mediator or legal consultant for the health care practice management can be the right step for many situations. Especially if you have legal advice that suggests you are not in the wrong, bringing a third opinion into the conversation may help you to avoid an actual lawsuit.
And just like in any legal situation, it will probably be less expensive to work things out before things escalate, even if you win your case in the end.
Bigger Picture Thinking
Avoiding legal mistakes will be a challenge for any health care practice management team, but most especially for small practices that do not have significant resources.
Remember to focus on the big picture and consider how each step and each action your practice takes will reflect on the community’s perception of the practice.
But don’t be afraid to stand up for what you know is correct and to hear out complaints in an effort to reduce the potential for damage.