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A glimpse into the past as we celebrate 100 years of Medical Economics

Medical Economics 100th anniversary: The first editor’s column from the 1923 debut issue of Medical Economics

What is the current situation with the COVID vaccine, and what are come common objections?

Is pandemic-era misinformation still a problem - and how can objections be overcome?

How has COVID vaccine hesitancy affected other vaccines?

 have been proven to be safe and effective, but many patients still harbor concerns. These concerns can affect whether they give the vaccine to their children, or even their opinions on childhood vaccines. 

Steven. P. Furr, M.D., president of the AAFP, discusses the current status of the COVID-19 vaccine uptake, reasons behind hesitancy, and what physicians can do to 

Physicians need to understand the reasons behind COVID-19 vaccine hesitancy so they can better address it.

Topics

How to overcome COVID-19 vaccine hesitancy

Identifying revenue leakage in your medical practice, including coding and other reimbursement reasons

Identifying revenue leakage in your organization

Medical practices across the country often struggle with significant revenue leakage. In this session, we'll delve into the critical aspects of identifying revenue leakage for practices — those often unseen or overlooked areas where potential earnings slip through the cracks. 

This interactive webinar will equip physicians and their administrative teams with the knowledge and tools necessary to identify, analyze, and address revenue leakage effectively. Through real-world examples, best practice tips, and practical strategies, attendees will learn how to conduct thorough audits of their practice's revenue cycle processes, pinpoint areas of potential revenue leakage, and implement proactive measures to prevent unnecessary financial losses.

Review the most common examples of revenue leakage.

Explore examples of coding errors that lead to revenue leakage.

Identify examples of billing errors that lead to revenue leakage.

Discuss examples of practice management errors that lead to revenue leakage.

Describe effective strategies for identifying revenue leakage in your practice.

Toni Elhoms
CEO, Alpha Coding Experts, LLC

Toni is an internationally known speaker and recognized subject matter expert on medical coding, reimbursement, compliance, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC (ACE). She holds multiple credentials with the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Toni’s expertise extends to both inpatient and outpatient coding, compliance, billing, and reimbursement. She has extensive experience in working across various specialties, from surgical specialties to primary care. Ms. Elhoms serves as ACE’s Senior Consultant and conducts training and educational seminars across the country on a variety of topics including, but not limited to, Medical Coding, Medical Billing, Practice Management, Managed Care, Revenue Cycle Management, Revenue Maximization, Regulatory Compliance, The Social Determinants of Health (SDoH), ICD-10-CM and more. With 15 years of industry experience, Toni has led and supported hospital systems, universities, physician practices, payers, law firms, government agencies, and other entities on coding, billing, and compliance initiatives. Ms. Elhoms is a frequent contributor to various media outlets, highly sought-after conference speaker, and regular guest on industry podcasts.

In this session, we'll delve into the critical aspects of identifying revenue leakage for medical practices, those overlooked areas where potential earnings slip through the cracks. 

Identifying Revenue Leakage in Your Organization

For many private practices, selling to a large corporation or hospital may seem like the only answer to address the challenges of today’s health care market. According to the 

AMA 2022 Physician Practice Benchmark Survey

, many private practices turn to corporate medicine for help negotiating higher payment rates and managing regulatory and administrative requirements. But there is another way forward.

Innovative AI-powered technology is one factor disrupting the corporate takeover trend, making the private practice business model more feasible by enabling transparent costs, increasing instances of payment at the time of treatment, resolving accounts receivable, simplifying patient education and enhancing clinical documentation.

Financial challenges and regulations stifle private practices

Private practices increasingly find themselves squeezed between higher administrative costs and increases in unpaid medical bills. At the same time, they must comply with new laws and compliance regulations that make it harder than ever to collect balances due from patients.

Managing a practice encompasses many costs including 

, clinical integrations, patient engagement, payment processing and billing services. Each vendor carries set fees plus additional fees for normal use volumes, driving massive expenses – even for those marketed as "low cost." These expenses are compounded by rising costs for rent, insurance and medical equipment – making profitability evasive for private practices.

At the same time, there is an increasing threat of never receiving outstanding balances due to the 

 debt less than $500 from patients’ credit reports. States like 

 extended this, prohibiting inclusion of any medical debt information on credit reports. When patients are unwilling to pay what they owe, it strains the private practice’s budget – impacting cash flow and making it difficult to cover operational costs and payroll. On top of that, confusion and frustration regarding unpaid balances is a top source of negative reviews, which also causes lost patients.

Adding to these challenges is new legislation, such as the 

 to ensure transparency in health care costs prior to treatment. The 

 include providing Advanced Explanation of Benefits (AEOB) for in-network visits and Good Faith Estimates (GFE) for self-pay patients. Many practices have not yet fully addressed the impact of these changes on their business.

AI-enabled technology boosts private practice profitability

Technology powered by the latest in AI and automation is key to enabling private practice owners to address these challenges. Infusing AI throughout each function optimizes the practice management system to help physicians save time, reduce costs and enhance profitability. Here are a few examples of the benefits of AI-enabled technology:

Eliminate the manual steps needed to gather data and the subsequent guesswork required provide cost transparency and accurate estimates before treatment as required by the No Surprises Act.

Increase frequency of complete payments by estimating patient liability before treatment, offering payment options, and making payment arrangements at time of treatment.

Resolve accounts receivable with analysis of outstanding patient balances and automated tasks to reduce accounts receivable.

Simplify patient education and improve the patient experience with easy-to-understand, personalized information explaining eligibility, fees and balances.

Enhance clinical documentation with advancements in charting to save physicians time and effort while maintaining compliance and data security.

Being a health care provider carries a heavy weight of responsibility for patient safety and security that also applies to the private practice’s technology selections. When considering non-EHR AI plug-ins, ensure they do not share information with centralized databases, which can impact HIPAA compliance. Instead, look for a secure, 

 system that does not rely on outside data sources or pass data to third parties.

At the same time, be wary of systems that use outside knowledge to write narratives, code procedures or diagnoses, or make patient plans. AI can be used to augment practice efficiency but should not completely replace information that the physician – the clinical expert – originates.

Consolidating vendors and streamlining systems is one way to simplify workflows and controls costs, but it is also important to consider the latest technological advances. Several technology innovators have applied AI to various practice workflows, offering new ways to save time and effort.

The ideal solution is an all-in-one practice management system that offers benefits across the entire patient interaction – from marketing to scheduling to onboarding to office visits to clinical documentation to billing and payment. The value of the system is further maximized when data is shared in an integrated loop across functions to increase efficiency, optimize revenue cycle management and improve work-life balance. The savings flow through to the bottom line and keep the private practice profitable.

Technology for patient care and office use is essential in today's medical practice. AI is a catalyst for changing the status quo with new advancements that help private practices thrive in today’s health care landscape. Without significant technological improvements, rising overhead costs and documentation pressures will continue driving many physicians to sell their private practices to corporations, or worse, leave the profession.

Jeremy Shiner is the founder and president of 

, a provider of comprehensive practice management software and services designed exclusively for private practices.

Innovative AI-powered technology is one factor disrupting the corporate takeover trend

The role of AI in revitalizing private practice

Amid rapid health care industry consolidation, a challenging cost environment, and increasing patient needs and expectations, only truly nimble health care organizations will survive and thrive.

Medical groups focused on prepaid, value-based care are better positioned to innovate, develop, and invest in technologies to respond to patient needs and market dynamics. For example, value-based organizations that bet big on 

 and remote patient monitoring technologies prior to 2019 were able to continue seeing patients remotely during the COVID-19 pandemic. In contrast, fee-for-service health care systems — which are paid per office visit, treatment, and test — struggled. As a result, a movement is now underway in health care, from volume of care to value of care.

Value-based care organizations prioritize prevention through early detection and proactive treatment of health issues. Physicians and care teams work together to manage the overall health of individuals and populations. Financial incentives are tied to keeping the patients and communities they serve healthy. Every interaction, from telehealth, 

, to in-person visits, is an opportunity to address patient needs, including access to healthy foods and community-based resources. The guiding principle is evidence-based, quality care that is cost-efficient while 

U.S. Centers for Medicare & Medicaid Innovation

 issued an ambitious goal to shift 100% of Medicare beneficiaries into an accountable care insurance plan by 2030. Given that the number of Americans 65 years and older is projected to increase more than 40% to 82 million by 2050, that announcement signals a massive shift in strategy where a huge swath of Americans will receive some form of health care services tied to value arrangements.

the future of medicine, and everyone is trying to get it right. Based on our nearly 80 years of experience, here are four innovative strategies physician leaders can adopt to advance value-based care.

Embrace artificial intelligence (AI) to help physicians with administrative tasks and improve quality care. 

With AI, physicians can get comprehensive insights into patient health, experience, and health care utilization at the individual and population levels. For example, at Kaiser Permanente Northern California, computer vision algorithms were used to identify patients at risk for breast cancer quicker and more efficiently. Also, we are using new ambient AI scribe technology to help physicians write clinical visit notes, enabling more face time with patients and reducing physician time spent after-hours on administrative tasks.

Focus on optimal wellness by delivering the right care in the right venue, including care-at-home for an aging population. 

Value-based care models allow organizations to invest in people, technology, and services that support team-based care. We currently provide at-home services in six regions across the country, doubling our commitment to this care model from 2022. Patients have told us they love recovering at home. As of April 2024, more than 320 hospitals across 133 health systems in 37 states are authorized by the Centers for Medicare & Medicaid Services to offer acute hospital at home under a 

 expiring at the end of this year. To make these programs scalable, we support a five-year waiver extension. We also want these services to be included in traditional Medicare coverage so health systems can sustainably care for the increased number of older adults.

Solve the shortage of primary care physicians. 

Primary care physicians are the first line of defense against illness or injury. However, 30% of Americans currently do not have a primary care physician due to a shortage. Policymakers should consider measures that bring a new generation of talented and diverse physicians into medicine. Increasing the number of graduate medical education slots — proposed by the Resident Physician Shortage Reduction Act — would be a good start. Additional solutions include immigration policy reforms that remove obstacles for foreign-born physicians and significant investment in medical education and training. Permanente medical groups participate in community-based programs that spark interest in medicine among diverse students at a young age. They include Kaiser Permanente Southern California’s Hippocrates Circle Program and Kaiser Permanente Northern California’s Prep Medico and Medical Scholar’s Pathway.

Identify and address health disparities and emphasize prevention.

 Value-based care focuses on quality outcomes. This encourages physicians to provide equitable care by addressing the root causes of health inequities. This is preventive medicine at its best. Through an effort led by our National Equity, Inclusion, and Diversity and Quality departments, our outcomes reporting has brought greater visibility to health disparities and their impact on patients. We use insights from this reporting to create comprehensive plans to address disparities. For example, research published in 

 showed that a decade of enhanced screening for colorectal cancer with fecal immunochemical tests (FIT) essentially eliminated disparities between Black and White Kaiser Permanente members in Northern California and that organized screening improves colorectal cancer outcomes for all our members.

Innovation thrives in prepaid, value-based care systems, which have successfully demonstrated their ability to adapt to major market disruptions. During this time of rapid change and increasing uncertainty, health care organizations will need to shift to value-based care to better serve patients and remain competitive.

Maria Ansari, MD, FACC, is CEO and executive director, The Permanente Medical Group; president and CEO, Mid-Atlantic Permanente Medical Group; and co-CEO, The Permanente Federation.

Ramin Davidoff, MD, is executive medical director and chair of the board, Southern California Permanente Medical Group; chair of the board and chief executive officer, The Southeast Permanente Medical Group; chair of the board and chief executive officer, Hawaii Permanente Medical Group; and co-CEO, The Permanente Federation.

Value-based care is the future of medicine. Health care organizations must adapt technology, venues, primary care and prevention to survive and thrive.

Four strategies to advance value-based care

There is no doubt that American health care is in crisis. Tens of millions of Americans are in medical debt. Hundreds of thousands are injured or die each year from avoidable health care errors and hospital-acquired conditions. Insurers categorically deny patients the appropriate treatment and medications in a misguided approach called “prior authorizations.” Employers have been asleep at the wheel for decades, allowing the system to unnecessarily jack up the costs of health care.

The U.S. is the only developed nation in which life span is decreasing, and we have, by far, the worst disparities in health care and health outcomes. Burnout and demoralization amongst clinicians and staff now adversely impact nearly half of the American health care workforce.

If we are to solve the dire dilemma in American health care, it is clear that the approach will have to be radically different from those we’ve taken to date. Over the past decade I’ve been studying visionary leaders who are thinking and acting differently. There are replicable lessons we can learn from these divergent leaders – approaches that we can adapt and scale. Below are three foundational principles and three examples we can learn from to humanize healthcare.

If you’re not actively and intentionally 

, then you're fostering distrust. When people talk about trust, I ask (1) How are you defining it? (2) How are you measuring it? (3) How are you operationalizing it?

Address health inequities and disparities. 

The immediate goal is to eliminate inequities in health care and disparities in health outcomes. What we must do is replace all of the systemic ‘ism’s: racism, sexism, ageism, ableism, classicism – with humanism - and again, operationalize and systematize it.

The evidence is overwhelmingly clear. More preventive primary care in a community leads to greater health and lower costs. 

 is fundamental to achieving any effective and sustainable health care system. This also includes attending to the emotional, relational, and psychosocial aspects of an individual’s life.

There are several examples of these principles in action. Unbeknownst to most, the Veterans Administration (VA) has become one of the most innovative and transformative epicenters leading the way in humanizing health care delivery. It’s also the largest health care system in the US – with approximately 150 hospital centers, 1,400 ambulatory care centers, and over 400,000 employees providing care to over nine million veterans annually.

If we are to solve the dire dilemma in American health care, our approach will have to be radically different from those we’ve taken to date.

H. Sheridan Baketel, M.D.

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