Health Technology, Digital Healthcare
Article | September 8, 2023
As competition for patients intensifies, more hospitals and health systems are embracing a consolidated, single-bill approach for services rendered. Creating a single bill for the patient’s portion of inpatient or outpatient services can help eliminate confusion and reduce the ill will that frequently results when patients receive multiple invoices for a single care event. Yet incorporating anesthesia charges into a consolidated invoice is often problematic due to the unique nature of the anesthesia billing compliance.
Anesthesia Billing Service Hurdles
A few weeks ago, I met with the CEO of a 300-bed hospital. We discussed anesthesia billing, and he explained that his hospital traditionally outsourced this portion of its billing due to the more complex nature of anesthesia coding and the need to collect anesthesia minutes for billing. Unlike most inpatient services, anesthesia charges are not directly derived from CPT codes but instead utilize minutes and modifiers unique to the specialty.
That means coders must use a CPT crosswalk to account for ASA codes, base and time units, emergency- and physical-status monitors, split anesthesia units reflecting CRNA involvement, and other specialty-specific nuances. Most coders and hospital billing staff are not trained in these complexities, and hiring and retaining capable staff in today’s competitive market can be difficult. Moreover, many billing platforms are simply not equipped to incorporate all the variables necessary to produce an accurate anesthesia bill.
As a result, producing a consolidated patient bill that includes anesthesia is tricky. Yet leaving anesthesia off a single bill can undercut its value since, after facility and surgical charges, anesthesia often is one of the largest cost items patients incur. Fortunately, we at Change Healthcare know how to roll anesthesia charges into existing hospital billing systems to produce an accurate and timely single patient bill.
Helping to Reduce Costs
The benefits of consolidated billing extend beyond an improved patient experience. Producing just one bill reduces costs and repetition at both the front and back end of the revenue cycle management process. It can also ease staff burden when collecting on self-pay accounts, since there’s only one bill per patient. Finally, consolidated bills can help increase revenue by simplifying collections when patients present for follow-up care.
Here’s an example: When the patient comes back for post-surgery physical therapy, a hospital employee at the registration desk can remind them that they still owe $150 for anesthesia and ask if they’d like to take care of that now. In my experience, patients usually hand over their credit card and settle their bill on the spot when asked at the time of care about a balance due.
System-Agnostic Billing Across Hospital Platforms
Change Healthcare has a long history of providing full-service, outsourced anesthesia-billing services to hospital and health-system clients. Unlike most other billing vendors, we’ve developed what we call a system-agnostic approach. That means we’ll provide billing services on our proprietary system or on the hospital’s existing billing platform, regardless of type, to generate accurate anesthesia-billing results.
In practical terms, we’ll function as part of your billing team and use the same system your coders and billing staff rely on to generate anesthesia charges that can be included in a single patient bill.
System-agnostic billing also allows us to provide clients with custom anesthesia reporting that wouldn’t otherwise be available with an outsourced billing solution. This helps clients gain far greater visibility and insight into anesthesia-billing charges. And by incorporating our anesthesia coding and billing capabilities into your existing billing system, you’ll be spreading the platform’s fixed costs across a greater number of departments.
The bottom line? It’s not a heavy lift for us to virtually embed our trained anesthesia coders and billing professionals into your system. Our specialists will review your existing platform and provide, at no obligation, a return-on-investment analysis that can help you determine whether outsourcing anesthesia billing to capture claims on a single hospital bill makes sense for you.
We expect the answer will be yes. Not only will you enjoy greater system efficiencies, but you’ll be in a position to produce a single bill that truly reflects the entire episode of care.
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Health Technology, Digital Healthcare
Article | August 16, 2023
With consumers’ share of healthcare costs expanding, we need to do a better job making charges more transparent and more predictable
My husband recently stubbed his toe. Badly. Badly enough that I encouraged him to go see a doctor. He was reluctant. While I suspected he’d rather just garner sympathy by complaining to me while limping around the house (just kidding, honey), his stated reason was all too familiar: “I have no idea what we’ll have to pay. They’ll want to do anX-ray,it might need surgery, and I have no idea what it’ll cost.” All true. We have good health insurance; but like most Americans, when we go to the doctor or have a procedure, what we will actuallyhave topay out of pocket remains a mystery.This is something that we can and should change.
As consumers we are shouldering more and more of the cost of healthcare. And the biggest increases are for those of us with employer-sponsored plans. According to an analysis of federal data by the Commonwealth Fund,deductibles in employer plans more than doubled between 2008 and 2017, from $869 to $1,808. Especially troubling, an accompanyingCommonwealth Fund survey revealed that only 62% of adults were very or somewhat confident in their ability to afford healthcare.
This increasing burden is also evident when you look at the crushing levels of medical debt in the United States. According to a new studyby JAMA, medical debt is now the largest contributor to personal debt. And the data for this study was collectedbeforethe COVID-19 pandemic.
Some of this debt is driven by unpredictability—if the heart procedure you needed costs several thousand dollars more out of pocketthan you thought it would, you may not be prepared, emotionally or financially, to pay it. This is a bad outcome, obviously. The risk of nonpayment rises for the provider; and a recuperating patient is burdened with the stress of a large,unexpected bill.
More skin in the game
Soas consumers are paying more out of pocket, some may become reluctant to seek care (like my husband) or seek more information about what they willhaveto pay for the care they receive. Consumers are also armed with incredible levels of price transparency with other products—everything from hotel rooms to clothing to household items. With so much skin in the game, and the internet providing so much information, consumers’ expectations are changing when it comes to healthcare.
State and federal regulators are also beginning to take action, a trend that will likely accelerate. Most hospitals are now required to publicly disclose the prices they charge. This does not, however, solve the issue for consumers. While it provides a measure of visibility into pricing for insurance companies, Medicare, and Medicaid, it doesn’t show what share the patient will ultimately pay.
Making the complicated simple
The complexity of pricing in healthcare is well documented. Niall Brennan, CEO of the Health Care Cost Institute, a nonprofit that analyzes medical costs, suggests that healthcare costs are too high.As a recent Wall Street Journal article reported, a price of a C-section varied from $6,241 to$60,584 at one hospital. This all has to do with the vagaries of the agreements that hospitals sign with multiple insurance companies and government payers. In turn, each insurance company will have its own deductible and out-of-pocket schedules, which providers don’t have access to.
We are seeking to change this at Change Healthcare. We are piloting our Care Cost Estimator with a few innovative providers. With the Care Cost Estimator, weleverage our unique dataset, and the largest eligibility network in the industry, to make the unpredictable, predictable.Because we’ve managed 15 billion healthcare transactions—and our network covers 1 million physicians, 6,000 hospitals, and 2,400 payers—we have an unmatched ability to analyze what real-world patients are paying for practically any procedure, performed at almost any hospital or clinic.
With a cloud-based transaction engine, providers will now be able to tell their patients how much they will have to pay out of pocket for a given procedure.And this analysis takes place in real time.
Removing unpredictability in pricing
This gives providers the opportunity to offer added value for their patients, taking some unpredictability out of whatis often a stressful transaction. In addition, it accelerates patient payment cycles which, as the patient’s share of the cost burden increases, is becoming more and more important. We’re not talking $50 co-pays anymore; it’s thousands of dollars per transaction. If necessary, providers can also help the patient plan for the expense, offering financing options, thus reducing unpaid bills. For the patient, it allows more informed decision-making and peace of mind.
Testing the beta version of our Care Cost Estimator with our partners will allow us to receive real-world feedback and collaborate with customers on how to continuously improve the product as we scale it. We expect the ROI for providers, in addition to the payment-cycle improvements, will include greater patient satisfaction and loyalty. For the patient, it provides information necessary to help make proper decisions and plan emotionally and financially; in other words, giving the consumer the same information for vital healthcare transactions that’s available to them for practically any other purchase.
This kind of win-win solution is at the core of Change Healthcare’s mission to improve the healthcare experience for everyone—including my husband and his broken toe!
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Digital Healthcare
Article | November 29, 2023
The fall is a time of renewals and choices. It is also a time of so called “open enrolment” for health plans. It is the one time of year we can study and learn about the options offered through employers or government sponsored plans. Individuals and small business owners alike are also are faced with a myriad of choices with confusing and often contradictory language promising lower premiums with higher out of pocket costs for covered services subject to deductibles. What does it even mean anymore when your monthly premiums exceed your pay check and you still have to pay for your colonoscopy or your insulin? Where is it all going?
Let’s imagine you twist your ankle playing basketball. You might go to an urgent care, receive an X-ray, probably be examined by a non-physician, and then referred to your primary care, who can’t see you for a few weeks but eventually sends you to an orthopaedic who takes another X-ray and treats your injury. Weeks have passed, multiple visits, time out of work, and co-pays, not to mention the out-of-pocket fees associated with imaging and perhaps a $100 ace bandage. What stops you from going straight to the ankle specialist in the first place? First, we have become conditioned to follow the directions dictated by the insurance companies, even when restrictions are not in place, patients have been convinced that stepping out of line will make all insurance promises null and void resulting in catastrophic bills and financial ruin. Second, the doctors and their office staffs have been conditioned to deny entry to any patient who does not have the proper referral, authorization, or identification. There are dire consequences for both if the insurance rules are not followed and fear keeps both sides aligned.
The past two decades have seen an explosion of healthcare costs. Health insurance has become the single biggest line item second only to payroll for most businesses. It is no coincidence that as the government increased its role as payor with state subsidies, the prices have gone up. Much like college tuitions, when loans are easy to obtain and guaranteed by federal support, there is little to deter those in charge from increasing the price. After all, everyone is doing it, it must be OK, and even if students end up in debt, it will be repaid because they have received the value of a great education. Right? But unlike higher education, healthcare is a necessity. We cannot avoid it, and there needs to be a reliable mechanism in place to guarantee access.
Ironically, as charges and prices have continued to escalate, payments to doctors have diminished. Why medicine is the only service industry where there is no transparency is truly astounding, especially since the there has been no increase in so called “reimbursements” for decades. As physicians, we have been complicit, being fully aware of the discrepancies between what is charged and what a patient’s insurance will pay. Even as patients began to have higher deductibles, and therefore higher out of pocket expenses, we continued to follow the rules, asking insurance permission to collect payment from the patient. It is not surprising that bad debt accounts for over 50% of most account receivables and why over 70% of doctors are now employed by hospital networks or private equity, who not only go after patients, but benefit from the repricing that occurs when insurers pay a negotiated amount as opposed to the charge. In other words, we pay more not just for less, but for nothing.
But what if we twisted our ankle and went directly to that specialist and paid out of pocket a transparent price? What would it take for that to happen? Not much, the cost of care is predictable, and because payments have always been decreasing, most physicians have learned to be economical. Plus, out of pocket costs are capped by federal law, so no patient is really responsible for catastrophic bills. Charges inflate to cover overhead, but if payments were guaranteed and immediate, then the cost of doing business goes down. Add technologies like telemedicine to a practice and you have increased patient access to a doctor without adding more personnel. Direct pay doctors are emerging all over the country and have consistently offered better access and more affordable care. The bar is also being set by independent surgery centers and imaging centers who offer better outcomes at lower costs. Perhaps motivated by prohibitive pricing, better options have emerged that have moved patients away from expensive operating rooms to safe, office-based procedures. Even cutting-edge cancer therapies can be delivered at home, preserving more of the healthcare dollar for medical care rather than the complex system built to manage it.
Competition and choice inevitably drive prices, but in a monolithic system the price is not negotiated, but instead it is set by only a few, in this case the big insurers. Small businesses cannot compete when bigger companies come to town. Eventually, the local hardware store gives way to a national brand, and the consumer is left with fewer choices and eventually higher prices. Amazon disrupted this equation by creating a marketplace for individual buyers and sellers. The convenience of finding a trusted brand, no longer available locally, is irresistible and the reason why we became loyal consumers. Healthcare is no different. Trust exists implicitly between a physician and patient, because it is an authentic, empathetic, and logical relationship. Trust does not exist between a patient and their insurer, on the contrary it is an unsympathetic business relationship without transparency or consistency. Few doubt the insurance company’s top priority is the premium, not the patient. Creating a direct relationship between the doctor and patient is a common-sense approach that serves both stakeholders well, and requires merely a fair and affordable price. But do doctors have the capability or the will to do it and if so, can the rest of the system follow?
Never in the history of modern medicine have physicians been more dissatisfied. US healthcare used to lead the world in innovation and outcomes, now we struggle to break the top thirty. We may have the most brilliant doctors and scientists with access to the best resources, but the need to maximize profits while catering to special interests, be they commercial or political, has led us to favour certain therapies over others despite marginal proven benefits. Doctors have little autonomy and less authority; prescribed treatments are routinely denied by insurance companies without a second thought or appropriate peer review. In fact, insurers even renamed us “providers”, a term used to by Nazis when referring to Jewish doctors to devalue them professionally. Over 56% of physicians are burned out, nearly all report moral injury and as hospitals have systematically replaced doctors with non-physicians with limited training, we have watched the standard of care deteriorate. It is no wonder we have witnessed the single biggest loss in life expectancy since WWII. The prognosis is grim, but there are solutions.
We need to reinvent healthcare by removing the middleman. We don’t have to set the price, but we can make it transparent so patients can decide for themselves if it is worth the inconvenience, the delay, and the co-pay to use insurance or just pay directly. Health savings accounts are tax deferred and can cover an out-of-pocket maximum in just a couple of years. Paying for care means there are no surprise bills or out of network costs, because there are essentially no networks and therefore no need to follow restrictions. You’d be hard pressed to find a doctor or hospital unwilling to accept an immediate cash payment, especially when it costs nothing more than the service provided. There are no billing cycles, or claims to prepare, no up coding, or authorizations. Doctors free to care for patients, patients treated individually and not subject to protocols designed to maximize charges. There are literally thousands of direct pay primary care and specialists now available all over the country and they are building alliances with likeminded people providing imaging, ancillary services, surgery centers, and prescriptions all at fair market prices. More and more employers are moving toward medical cost sharing plans that not only lower the cost of care but the cost of administration. Even the biggest payor, namely the government, sees the benefit of price transparency and is piloting models of direct contracting.
We will always need coverage for those unexpected events, emergencies, or hospital-based services, but all the rest - doctor visits, screening tests, and outpatient procedures - are easily affordable. After all, do we use our car insurance to pay for an oil change? If we did, the cost would be prohibitive and few of us would drive. But health insurers have lost our trust, they no longer cover necessary services and no longer honour contracts with physicians or patients. It is time to offer another option and let the patients and doctors get back to the real business of medicine.
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Health Technology, Medical Devices
Article | April 17, 2023
Contents
1. Getting Started with LIMS Software
2. Benefits of Incorporating LIMS Software into Lab Management
3. LIMS Software Classification
4. Selecting the Right LIMS Software: A Comparison of Variants
5. How LIMS Software Revolutionized Laboratory Management
6. Future Scope
1. Getting Started with LIMS Software
Laboratory Information Management System (LIMS) software automates laboratory operations, improves productivity, and ensures the accuracy as well as reliability of laboratory data. It can be implemented in clinical laboratories, research & development labs, and environmental testing labs and tailored to meet specific needs. LIMS software seamlessly integrates with other laboratory systems, such as electronic lab notebooks and scientific data management systems.
LIMS class software enables storing and managing all information in one place, improving day-to-day work. Yet, research reveals that still 40% of industry leaders 'had not embarked on applying digital to research and development or quality control labs'.
(Source: Accenture)
2. Benefits of Incorporating LIMS Software into Lab Management
By implementing LIMS software, laboratories can significantly reduce time spent locating samples and records, entering data, and generating reports.
LIMS software also offers additional advantages when integrated into laboratory management, such as
1. Optimizing: LIMS automates laboratory processes, allowing for a paperless environment and increased productivity. It also ensures accurate test results by preventing the use of outdated instruments.
2. Automating: LIMS facilitates the input of essential sample information, including its source, date, time, and location of the collection as well as processing data.
3. Compliant: LIMS helps labs follow FDA regulations by creating an audit trail that tracks all activities, including record creation, modification, and deletion. It also enables electronic signatures to authenticate key activities and keep data secure and traceable.
4. Collaborative: LIMS streamlines inter-laboratory collaboration through the option to share data access. This allows lab technicians from disparate laboratories to be seamlessly assigned to different projects and obtain the required information without disruption.
5. Security: LIMS systems offer various mechanisms for managing user access, such as an in-built user management system with a unique username and password, integration with LDAP or Active Directory for user authentication, and access through an Identity Server.
3. LIMS Software Classification
Laboratory Information Management System software can be classified based on several criteria, including functionality, deployment model, industry focus, and the laboratory's needs.
Here is a list of critical features that can be considered while classifying LIMS software:
1. Functionality: Different LIMS software may have varying functionality, including sample tracking, data management, instrument integration, quality control, workflow management, and reporting.
2. Deployment Model: LIMS software can be deployed on-premises or in the cloud. On-premises deployment means that the software is installed and run on the laboratory's own servers, while cloud-based deployment means that the software is hosted and maintained by a third-party provider.
3. Industry Focus: LIMS software can be designed for specific industries or applications, such as pharmaceutical research, clinical laboratories, food and beverage testing, environmental testing, and more.
4. Open-Source vs. Proprietary: LIMS software can also be classified as either open-source or proprietary. Open-source software is freely available and can be modified by users, while a company owns proprietary software and requires a license to use it.
5. Scalability: The size of the laboratory and the number of users accessing the LIMS software can also be a factor in classification. Some LIMS software may be more scalable, allowing for easy expansion as the laboratory grows.
6. Integration Capabilities: LIMS software can also be classified based on its ability to integrate with other software or instruments. Some LIMS software may be more flexible and have better integration capabilities than others, allowing for seamless data exchange between different systems.
4. Selecting the Right LIMS Software: A Comparison of Variants
While selecting the most appropriate LIMS variant, the wide range of available options can pose a challenge for laboratory decision-makers. To aid in this selection process, a comprehensive comparative analysis of LIMS variants is presented below:
1. Lab managers can adopt an objective approach for evaluating and comparing different LIMS solutions by creating a grading rubric. This involves designing a table with separate columns for each LIMS vendor and rows listing the desired features as well as functionalities. To provide a more comprehensive evaluation, advanced rubrics may include rating each functionality on a particular LIMS using a scale of 1 to 5.
2. Next, it is crucial to review how LIMS solutions are structured and stored. This includes determining whether the solution is on-premise or cloud-based, either as a platform-as-a-service (PaaS) or software-as-a-service (SaaS). For optimal flexibility in the laboratory's computing structure, choosing a vendor that offers LIMS as a comprehensive solution is advantageous.
3. Data access must be controlled by using unique user IDs and passwords. Furthermore, data security standards such as HIPAA compliance and SSL encryption will likely be mandatory across many laboratory industries. It is thus imperative to carefully consider and ensure the security features of any potential LIMS solution.
4. To assess the level of support that can be expected with a particular LIMS, one effective method is to directly inquire with the software vendor about outages, response time, and plans of action to address any glitches preemptively. Managing expectations around the LIMS requires asking about the frequency of LIMS updates, including how often the platform is updated, how updates are announced and deployed, and the expected duration of any update-related outages.
5. While selecting a LIMS solution, laboratories must establish a target go-live date, especially when implementing the system in response to, or preparation for, an audit. Software vendors should provide a deployment and implementation timeline, which can be used to compare with the laboratory's objectives and goals. This helps to ensure that the LIMS solution is implemented in a timely and efficient manner.
5. How LIMS Software Revolutionized Laboratory Management
LIMS software has fundamentally revolutionized the laboratory management system in several ways. Before the advent of LIMS, laboratory operations were often paper-based and highly manual, leading to inefficiencies, errors, and inconsistencies. However, with the implementation of LIMS, laboratories have become more efficient, accurate, and compliant.
LIMS has also improved laboratory productivity, allowing scientists to focus on higher-value tasks like data analysis and interpretation. It has enabled collaboration between different laboratories, facilitating communication and knowledge sharing between scientists, researchers, and analysts, and is also leading to more significant innovation and progress in the field of science and research.
6. Future Scope
The future scope of Laboratory Information Management System software is promising as it continues to evolve and adapt to the changing needs of laboratory management. Potential developments include integrating emerging technologies such as artificial intelligence, machine learning, and robotics, cloud-based solutions for scalability and accessibility, IoT integration for automation and safety, enhanced data analytics for improved decision-making, and mobile applications for on-the-go access. Moreover, with SaaS LIMS, there are no license costs, minimal installation fees, and no need for in-house servers or databanks, resulting in reduced IT maintenance costs for hardware and software.
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