Likewise many of Healthcare Practices and hospitals which are still adopting the trend of Paper works, Healthcare Insurance Carriers are also still not updated with the Electronic Records.
Many of the Insurance Carriers claims that they’ve implemented all the processes electronically which in real words, I must say that they have been failed to do so.
In Insurance Carriers like Blue Cross Blue Shield and some others has most updated systems but still many of Insurance even having all electronic facilities are unable to be electronically updated. This is all because whether the staff within their organizations are still not ready to adopt the electronic trend or still they don’t want to leave the same old trend of processing information.
It has been identified that if there comes any errors/denials, some of Insurances re-process these claims in a most efficient manner without any hindrance electronically, but some of the insurances are still like they are working with the trade carts. While submitting these corrected claims is still a hectic for the providers and that leads to the loss of money for them.
When these providers are getting such responses that they are losing money, lots of companies comes up with their marketing ideas and they do over charging to the healthcare providers to clean their all such records with payments. In this case Healthcare providers lose money and pay a big money to the market for their recovery.
Here the problem is not of losing money but the problem is to promote Healthcare Providers to provide them with all facilities so they should be able to provide with 100% stress free services to their patients, while he should be confident that the insurance will pay for the benefits they are providing to their patients. Sometimes Insurance demands for such paper works, COB’s and all these things which delays or cancel the payments incurred from Insurance side, make upset to the Healthcare Providers, which sometimes leads to the issue to send long bills to the patients. Once the patients receive such bills they use to shout on Healthcare Providers, that why is it so happening. Result loss of Patients within their practices.
On other hand Provider Enrolment/Credentialing is a basic issue for these providers, which leads a massive loss to these Healthcare Providers. Enrolling themselves with different Insurances and sometimes Insurance rules and regulations get changed and all contracts get revised which results in lots of difficulties while providing Healthcare services to their patients.
I’ve raised here two basic issues for the Healthcare Provider Revenue; one is Electronic Submission/re-submission of bills to Insurance Carriers and another is of Provider Enrolment/Credentialing. For Electronic Records there should be a general body of every Insurance which take steps to make it sure that they are providing 100% Electronic Submission for the bills and for all other records, where for Credentialing there should be a central body like CMS who regulates not only all rules and regulations but also provider all-in-one enrolment to their Healthcare Providers.
Step from CAQH was a good start but still I feel it is not compatible with the problems of Healthcare Providers. Their should be more lenient way so that Healthcare Provider never thinks about these things. He should only be focused on their Patient’s health.
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I think the only reason is the unwillingness of the acceptors. We all want to have modest furnitures, latest mobiles, awesome cars, and the list will keep on increasing...but when it's about our own health, we are reluctant and a bit lazy to adopt the changes or you can say reluctant about adopting the role and importance of EMR in Healthcare.
ReplyDeleteWe think about the outcomes first, and in that outcome, we already predict the problems and errors in the whole process of implementations of EMR's. Basically the need of the time is to change the mentality of ours only. Some of us are providers and some of us are acceptors. so we all need to be united and should promote the urgency of implementing EMR's in Healthcare, otherwise if we have some another disaster like Japan, then we have many thing to loose and nothing to gain.
I think the issues pointed out here are very accurate and unique. Due to the prevalent system, each change in regulation brings about an outbound wave of changes which keep growing outwards. The hardest hit being practices which need to spend to update their systems but remain uncompensated due to the very same insurance payers for whom the change is made.
ReplyDeleteAditya Patkar
(http://www.plus91.in)
Well is it that they are unable to replace paper records, or is it that there is a generation of physicians that are fighting the new technology. I mean as a matter of practicality, it certainly seems far simpler to open a chart and jot down SOAP notes then it does to manipulate data entry on alternate media when your whole professional career has been spent using paper and pen.
ReplyDeleteThere is a newer, younger generation of physicians entering the industry that are embracing electronic medical records. The only remedy here is time. Physicians will eventually adapt. The snowball has started down the mountain and it will only gain momentum. In ten years I suspect the landscape will be entirely different.
I agree with you Chris. But before introducing such complex structures, there should be a remedy to provide them assistance to adopt it. Now ever physician who is unable to use this all, only knows that they need EMR because of incentive and thats it. Where is an advancement of Healthcare Industry? Most of the doctors are adapting it in a similar way that they are paying to their staff and they are still on paper work, rest they are doing all the things. This scenario will be changed in 10 years, but till that 10 years everyone is suffering. Reason to suffer is not to adopt Electronic system but reason is, when one get bothered that one organization is accepting it in their own way and second in their own way. If there is a need of change than that should be on a higher level rather than promoting the product on higher level.
ReplyDeleteAtif,
ReplyDeleteYour points are well made, however you can't stop the ride now. The truth of the matter lies in the government's ultimate goal of getting access to as much PHI as they can. They introduce a hornet's nest of legislation in the ARRA (which outlines MU and provides incentive structure among MANY other things) then they open Pandora's box with HITECH when most practices nationwide were not even compliant with HIPAA. Let the compliance scramble begin!
"Pay no attention to the man behind the curtain!" If I can use a famous line from The Wizard of OZ.... Tucked away neatly behind the curtain is the stipulation that ANY practice that receives incentive monies for meeting MU criteria is ALSO agreeing to provide immediate and cost free access to any and all PHI upon request from the ONC. For those unfamiliar, the ONC is the Office of the National Coordinator for Health Information Technology; Uncle Sam. (Your tax dollars at work.)
So you see, while your point is perfectly correct, it really does not matter that it is unfair. The U.S. government has a vested interest in forcing the health care industry into the digital age. They are requiring that physicians go digital if they want any level of reimbursement from CMS. I think it's the elephant in the room that for some reason nobody sees. They tell you if you want to get paid for seeing medicare/medicaid patients, you HAVE to adopt the EMR/EHR; however we are currently chopping that reimbursement level considerably to make the numbers work for Obomacare. Now I don't care which side of the Obamacare argument you fall on, for it or against it; either way the truth is apparent. Doctors are being arm-barred into this program and most of them don't even understand it.
If they instead would do as you suggest, and educate the industry by stepping them into the digital age, then everyone would see what was going on plain as day. "We have to pass it to find out what's in it." as Pelosi said. Well they are going about this in the same exact way. Force it down your throat. Dangle the carrot of financial reimbursement so nobody understands what's really going on. Docs see the money and they go after it. Before you know it we have HIEs in place and your PHI is whizzing back and forth via HL7 and you have no control over it.
Lest we forget what SHOULD be important; the doctor patient relationship, and ultimately the care of the patient. It is OUR information. And we are losing control of that information without even realizing it. So back on point here, the advancement of the health care industry is NOT the goal. However it will follow and eventually happen. It's just that Uncle Sam has placed the cart somewhat before the horse here in an effort to advance his goal of single payer.
Hi Chris,
ReplyDeleteI believe and accept what you are saying. Hence I am not against the technology. I want that technology should replace the old culture, I only want to add that this technology should work from the roots to replace it.
Being a Healthcare IT Consultant I use to see many Healthcare providers in stress of provider enrollment of different Insurances, making any decisions for their patient notes and all other problems. All my concern is there is a need of Uniformity. Like if there is a need of Credentialing than every Insurance should follow same particular rule so that should come easier for the Healthcare Provider, Like we do with the claims. We submit claims on HCFA or UB-92 or through EDI. Similarly in Credentialing process there should be a uniformity as well. Now, if you move onto the payment cycle, some insurances claims that they accept electronic claims but in some cases like rejections or if they need extra definitions, than they need all notes on paper. That is a hectic. We should become a part to facilitate these providers to adopt this technology, rather than confusing them, that whether to go with paper work or electronic one, either go in this way in electronic or that way. There are so many things. Result confusing for them. There should be a uniformity so that everyone whether that is healthcare provider, insurance carrier, IT vendor or whoever should get familiar with all the things.
This is not yet a perfection Chris.
ReplyDeleteThis is only a step towards a perfection. If we invest money on educating and bringing the uniforminty in all the processes, this will not only help to get into the Technology for those who are unable to get into it but also they'll love to get into it. All Healthcare Industry members should be on a same table and all should try for the process which can bring an ease for the Healthcare Vendors, Providers, Organizations, Administrators and other users.
But that's like getting everyone to use the same OS. The market provides too many products, and none of them talk to one another. I agree with you that it would clearly make it easier, just as the head of the NCO suggests, however in a free market driven by competition, it is nearly impossible to get everyone on the same product so everyone can communicate in the same way.
ReplyDeleteIt's like suggesting we should ALL use an iPhone, so we could all communicate on the same platform. I don't want an iPhone. WebOS is far superior in my opinion. Diversity is what makes this nation great. We'll have to find a better way to synchronize.
No, I don't want to have a same OS. But the purpose should be the same. There are 1000's of Insurance carriers working for re-imbursement, and they all accept HCFA form or UB-92. Still they have their own internal systems. We all are adopting EHR and only look forward which is CCHIT Certified or which can make us eligible for Incentive. Which means that there is a similarity in their programming. A person whether use iPhone or Blackberry, both provide cellular service, only a difference of their services and their applications which makes them different, but all are aware. Likewise there are different vendors for Emails e.g Hotmail, Yahoo, AOL. No matter their pattern is different but they are providing the same service. Means provider knows that by clicking on send button that will be sent on any of the Mailbox other is. But in Healthcare Technology, every Healthcare Organization has their own specific language. Some accept this and some accept that. This is a thing which needs to bring a change by bringing some concentration on Uniformity. Than no matter what the OS is. But everyone will be aware that where to go? This will give Healthcare Provider an easy way to adopt technology that they only has to work with no such fear that in that particular vendor I am enrolled or not, whether to send this report electronically or by paper and so on headaches are there.
ReplyDeleteThe answer already exists. It is now required for Meaningful Use qualification. It's called HL7. However, as you point out, between front end, back end, and myriad supporting software platforms, they simply don't speak the same language.
ReplyDeleteBack to my point about Operating Systems. Sure phones all make calls, and emails all send messages, however I can view flash on my WebOS, but you cannot view flash on the iPhone. My Outlook contacts do not import and auto-sync with Hotmail. Media formats and integration remain an issue. HL7 is the intended solution. Now let's just get everyone to program in HL7! :)
HL7 is only a solution for Electronic Medical Records. But what about the Healthcare Organizations? Healthcare Providers are still confused. As Revenue works like a central nerve for the Healthcare Provider. We should think to facilitate to them on this platform with much and more focus. Like in my article, I need to do a Provider Enrollment, than I need to collect 10's of forms for every Insurance which is different for every Insurance Carrier and for their plans. We cannot bill to any patient until not getting Medicare Enrollment. Medicare claims that they are paying incentive to go electronically, but still they do paperwork,even PECOS needs to submit lots of paperworks. This is only one situation. Now another situation, many Insurances claims that they are providing electronic channel but making that electronic channel too much complicated to understand for the Healthcare Provider. Go onto their sites/go on CAQH, submiting one form online and another by paper. On other hand submiting the claims is really a headache. I suggested to some providers to adopt top rated EMR's, and convinced them this will resolve their issue. Result they shouted that still the issue is same. They are not getting paid fairly. This is not a problem of EMR or Provider do not understand anything. A problem is of Healthcare Organizations due to no any such rules and regulations. They don't even know themselves whether to accept electronic records or to collect paperwork.
ReplyDeleteSituations get worse when all things get mingled that 10 things need paperwork and 12 things need electronic and 8 things needs first electronic and than paperwork. Supporting e-Rx is still confusing for the Healthcare provider whether to connect particular pharmacy or any of the pharmacy. Whether e-Labs will work completely for them, or there will be other issues as well.
Result: Healthcare Providers are much involved in doing IT works and data entry rather than seeing their patients, which is making them to outsource their work like in past times with paperworks. If there is a need of Outsourcing or additional staffing than whats a need to spend $'s on EMR. On other hand that is a good move that they get all $'s back by the government, but what the use of that system which only provides you to go into the race of $'s. Not the patient care. According to my research in Houston territory, 74% patients of those providers using Electronic Records are not happy for their Treatment process, they do complaint that they are limited to check them rather than being busy in their tablets.
This is a difference.
Conclusion: We need a Hybrid Solution, which should have a solution for everything. If we cannot have today but thinking on that broader spectrum can give us a perfect solution, which provides a solution to a complete Healthcare Industry, atleast connect to everyone with each other.
Overall, There is a need of Healthcare Consultants & other Professionals like you to gather on one platform and get the idea to make a smarter move. As this is a right time to make the things in a right direction. Even if it is taking years to complete, no matter but this will work to make comfortable to everyone within Healthcare Industry.
Agree with your thought. I believe the first step should be standardization of paper forms across all TPA and Insurance companies. Take the case of Approval Request form. Although the data elements are more or less same, still there is no uniformity in their design and pattern. The concerned parties can sit together and design a common design for all such forms. It will save a lot in training cost also. Once this is done it will reduce time to fill/process forms. It will be lot easier for s/w developers to incorporate it in application design.
ReplyDeleteThis is exactly what I am saying. There should be a complete Uniformity.
ReplyDeleteLets spread the idea. I Hope very soon we will see lot of healthcare
ReplyDeleteprofessionals and other stake holders supporting it.
Rakesh K Singh
Well thanks for being in this favour. I am already trying that Healthcare Industry should think in the way so that everyone can understand the outcome they are providing to each other. Just lets hope for the best and try for best of the things....
ReplyDeleteHi Atif, I think the only reason is the unwillingness of the acceptors. We all want to have modest furnitures, latest mobiles, awesome cars, and the list will keep on increasing...but when it's about our own health, we are reluctant and a bit lazy to adopt the changes or you can say reluctant about adopting the role and importance of EMR in Healthcare.
ReplyDeleteWe think about the outcomes first, and in that outcome, we already predict the problems and errors in the whole process of implementations of EMR's. Basically the need of the time is to change the mentality of ours only. Some of us are providers and some of us are acceptors. so we all need to be united and should promote the urgency of implementing EMR's in Healthcare, otherwise if we have some another disaster like Japan, then we have many thing to loose and nothing to gain.