Transforming Physician Practices Through Network-Based Services
Can a billing and practice management system dramatically transform the way you do business in your practice?
It’s all about the network
Network-based solutions, like athenahealth’s, are accessed through the Internet. These solutions offer remarkable benefits over traditional billing and workflow software – including consistently superior business results – and could be a major factor in improving patient care and the health care industry.
The end of software?
Chances are, your practice has used (or still is using) a back-office technology “solution” – usually a combination of practice management (PM), electronic medical record (EMR), and billing and workflow software.
Unfortunately for physician practices, this kind of software solution ultimately fails them in one way or another. Why? High fixed prices, hardware that gets obsolete quickly, poor training, and clunky upgrade processes... not to mention the increasingly complex environment and unique industry dynamics that surround a typical medical practice’s supply chain – payers, laboratories, pharmacies, patients and more.
This will sound familiar...
As providers are well aware, today’s practices have to deal with complex reimbursement rules from thousands of payers and employer group benefit packages. It is not surprising that today’s practices work harder to get paid but actually earn less. On top of that, Medicare reimbursements continue to decline and large commercial insurers use their leverage to negotiate lower rates.
Pay for Performance (P4P) initiatives add another variable to the mix. Each P4P program asks practices to track a different set of quality indicators in order to receive maximum reimbursement.
In addition, the Physician Quality Improvement Initiative (PQRI), created by the Centers for Medicare & Medicaid Services (CMS), adds more performance measurements that physicians must track to earn full reimbursement.
Physicians do not practice in isolation. Providers and staff are in frequent contact with labs, pharmacies, and other physicians. Given time constraints throughout the day, and the chaotic methods each practice uses to maintain these contacts – written messages, sticky notes and piles of faxes – it is increasingly difficult for practices to maintain proactive, efficient communication with colleagues and suppliers. Providers also typically lack access to financial and clinical performance data for theirs and other similar practices – information that is vital for staying competitive and improving care.
Software is not the answer
Software alone is no longer a reasonable solution for physicians. It adds unwanted layers of cost and complexity.
Software is expensive to purchase, implement and maintain. It is difficult for practices that have implemented software-based EMRs, to achieve a solid return on investment (ROI).
Software can delay billing. Software can’t track the constantly changing reimbursement rules in real time, so practices must deal with denials, time consuming follow-up with payers, and patient collections.
Software leaves practices out of the loop. Software alone can’t help the practice keep pace with emerging trends such as P4P and CDHC – physician practices are left to their own devices when it comes to incorporating and managing these initiatives.
Why athenahealth clients are ahead of their peers
Web-based, centrally-hosted networks like athenahealth’s produce consistently superior business results unlike traditional software.
How?
By centralizing work into a massive, high-performance back office for our clients. With centralization, clients tap into a “comparative advantage” that is impossible to achieve on their own.
Because of their scale, highly evolved workflow and expert systems, network-based service providers simply get the complex tasks done faster, more efficiently and with higher quality outcomes than software alone could ever do. Furthermore, as membership grows, the network gets “smarter and smarter” - increasing the comparative advantage delivered to the member over time.
Benefits of a network-based system also include:
Information sharing that boosts practice performance. With many practices participating in a network, it’s easy to view aggregate performance data and compare financial, operational and other practice-based measures to other practices in a specific specialty, region or across the country.
Real-time connectivity for improved operations. With a direct, real-time connection to payers, labs, patients, pharmacies, and referral networks (accessible anywhere an Internet connection is available), physician practices eliminate the inefficiencies of written requests, unreturned phone calls and wasted staff time.
Constantly updated, collective intelligence for better profitability. The collective knowledge amassed in a network’s health insurance rules database gives practices instant access to the latest payer rules. This reduces claims denials and rejections by applying intelligence to review claims and catch potential errors before submission. When errors occur, providers have the opportunity to correct the claim, retest it, and submit it to payers with minimal delay.
Regular upgrades without service interruption. Unlike software-based systems, updates are performed automatically in the background with network-based solutions for no additional fee. In addition, because the system is updated continuously from a central location, providers can react quickly to market changes. For example, all 119 PQRI measures can be loaded into the system and deployed to all users immediately, without each user undergoing software upgrades.
Transparency for better business decisions. Practices can track and access information on any claim, from its starting point to its payment date. They can create simple, point-and-click financial and clinical performance reports. There is instant access to data – from staff productivity to payer revenue – for every business decision practices need to make.
Time and place convenience. One of the best-loved (and least expected) benefits of having a practice on a network service is that doctors and practice administrators are not wedded to the office to get their work done. Because the service is provided over a secure Internet connection, doctors and staff can log in anywhere (in the US) and anytime – after dinner, while traveling, or in front of the TV – to manage their electronic charts, check lab results, tie up billing for the day, or look at practice performance.
Easy implementation and reduced costs. Most practices already have all that is necessary for getting started with network-based services: PCs, browser, and high-speed Internet. There’s no hardware to buy, no licensing fees, no need for a server, and a central company takes care of hosting and management.
The network is the future
The health care industry will transition to a network model as other industries have successfully done. And new ways to manage patient care and the business of care delivery will emerge.
Disease management efforts, for example, will benefit from the wealth of information collected from all network participants. Increased connectivity also has the potential to elevate patient communications as patients begin to play a larger role in care management.
We know that providing quality care is an important mission in every practice. But medical groups need solutions that allow them to improve care while also enhancing profitability. A network-based solution provide a model that practices can afford and can deliver the financial and operational results needed to position physician offices to remain competitive in the changing market place.
For a full report on the advantages of network systems – and why your practice should consider one now – click here.