Amazon Announces Plans to Buy OneMedical

Amazon has announced plans to buy OneMedical for $3B. OneMedical is a brick and mortar plus digital healthcare marketplace that operates in several major U.S. markets. The acquisition is Amazon’s latest move in the healthcare sector, and analysts say it could be a sign of bigger things to come. This is not Amazon’s first foray into the healthcare market, but after the Haven experiment closed down, the company has kept a relatively low profile while it tests new business models. In June, Amazon was among several investors that participated in a $35 million funding round for Zscaler, an Austin-based cybersecurity firm that offers an edge security service for cloud networks and internet-facing applications and services. A few months earlier in March, news broke that Amazon had hired former pharmaceutical executive Bernard Jegou as its new vice president of e-commerce strategy and new business development. 

 

And in a very public failure back in 2017, Amazon partnered with Berkshire Hathaway and JPMorgan Chase to form an independent healthcare company called Haven, which it quietly scuttled mid-pandemic, February, 2021. Read on to learn more about how this acquisition could indicate continued interest from Amazon in the healthcare space — or if it is just another pivot from one of its many subsidiaries.

 

 

What is OneMedical?

OneMedical is a primary care practice and digital healthcare marketplace that uses technology to reduce healthcare costs and increase convenience for patients. The company has built a network of more than 500,000 doctors and has partnered with health insurance providers across the country to serve more than 3 million members. OneMedical offers a range of services, including access to an online portal for patients and a concierge service for their members. OneMedical’s network of doctors comes from a variety of specialties, including general practice, pediatrics, OB/GYN, and family medicine. OneMedical also offers telemedicine services, including video visits with doctor consultations and prescription refills.

 

 

Why might Amazon be buying OneMedical?

While Amazon has not released any details about why it is acquiring OneMedical, analysts say this acquisition may be a sign that the company has larger ambitions in the healthcare sector. Amazon has a track record of acquiring companies in sectors where it sees potential for disruption and then gradually building out its business there. This could be a way for Amazon to expand its e-commerce business into health insurance. It could also be a sign that Amazon wants to become a one-stop shop for healthcare services. Amazon has been experimenting with new business models in the healthcare space for several years now. The partnership with Berkshire Hathaway and JPMorgan Chase formed an independent health company called Haven began with promise, but was quietly closed a few short years later. And in June, news broke that Amazon had participated in a $35 million funding round for Zscaler, an Austin-based cybersecurity firm whose edge security service could help internet-facing applications and services like those that run on Amazon’s AWS platform.

 

 

Possible reasons for the acquisition

Analysts say there are a few reasons why Amazon might be interested in acquiring OneMedical. Amazon may be looking to expand its reach into healthcare marketplaces beyond its partnership with Berkshire Hathaway and JPMorgan Chase to form an independent health company called Haven. Acquiring OneMedical could give Amazon a foothold in the digital healthcare space, which has been growing rapidly. Amazon could also be interested in OneMedical’s digital platform for its members. Having an online presence and digital tools for patients and doctors could let Amazon expand into other healthcare sectors, including pharmacy. And Amazon might be interested in the data that OneMedical has on its members, which could be useful for the company’s future endeavors in the healthcare space.

 

 

Amazon has bigger plans in healthcare

Analysts say the acquisition of OneMedical could signal Amazon’s intent to become a major player in the healthcare space. It is unclear exactly what the company’s strategy will be, but it is likely that Amazon will focus on improving the customer experience across the healthcare sector. Amazon is no stranger to industries with high-barrier-to-entry business models. The company has made inroads in industries such as grocery and e-commerce, as well as more traditional businesses such as manufacturing and cloud computing. Amazon has long been a disruptive force in the retail sector. The company has reshaped consumer expectations of online shopping and shifted the entire retail landscape in its wake. The company’s foray into digital and bricks-and-mortar retail has been a boon for customers, and it has also provided a boost for shareholders: Amazon’s stock is up almost 102% over the past year.

Value-Based Care and Risk Adjustment

Experts say that Amazon’s involvement may help OneMedical’s risk management as the adoption of more value-based care programmes continues. Most of One Medical’s business has traditionally been generated from charging commercially insured patients per-visit fees, but since the acquisition of Iora last year, Medicare patients are now served, and revenue is captured as a result of savings through risk contracts. According to their website, OneMedical serves scores of Medicare Advantage plans, though patient numbers were not readily available. Scaling value-based care is challenging for providers without extensive data experience. Those in primary care, retail health, and telehealth should be concerned, experts say.

 

 

The big question: Is this a pivot or a sign of future intent?

Analysts say Amazon’s acquisition of OneMedical may be a sign that the company is pivoting from its health technology investments, like Zscaler, and looking to establish a more direct presence in the healthcare sector. But it is  also possible that Amazon has more ambitious plans in the healthcare space that the acquisition of OneMedical is only the first step in. Whatever Amazon’s end goal is in the healthcare sector, it seems likely that the company will take a slow and methodical approach to growing its business. After all, Amazon has plenty of experience building new businesses from the ground up, and it has a track record of entering new sectors and disrupting existing players with a more customer-friendly approach.

DoctusTech Helps Clinicians Learn HCC Coding

DoctusTech Helps Clinicians Learn HCC Coding

DoctusTech helps clinicians learn HCC coding through clinical vignettes in an app that is fun and engaging. Diagnosing with the appropriate HCC code is a critical skill for modern clinicians who care for patients in a value-based care arrangement. You cannot treat what you do not accurately diagnose, and you cannot afford to treat what you do not appropriately code. Without the correct diagnoses and accurate documentation and coding, caring for patients with complex disease will be unsuccessful, leading to increased avoidable hospitalizations and increased cost to the organization. 

 

And without a tool to get clinicians quickly up to speed on diagnosing for risk at the point of care, coding accurately and documenting correctly, you will be stuck. Stuck in boring seminars that rarely affect lasting behavior change; stuck with missed diagnoses and missed revenue targets; stuck with patients missing out on essential care; stuck with overworked clinicians; stuck. 

 

How do clinicians learn HCC coding?

This is where DoctusTech Helps. We provide a modern learning tool for the modern clinician, using gamification, competition, real prizes and administrative oversight to see who is engaging and who needs a little extra help. Also, our app deploys all the subtle nudges and complete with the most advanced HCC code search tool on earth.

 

And clinicians earn 25 hours of CME per year, while they learn HCC coding in a non-boring app!

 

In SCUBA diving, the diver must add just the right amount of weight to maintain perfect positive buoyancy; too much and you will sink, too little and you will bob on the surface like a cork. Risk adjustment in value-based care has some similarities: a successful VBC program will diagnose and treat just the right conditions. Not over-coding, and not under-diagnosing. 

 

Clinicians learn HCC coding better in clinical vignettes

And doctors coming out of medical school and even residency programs know little to nothing about HCC coding and diagnosing for Risk Adjustment and Value-Based Care. Traditionally, these clinicians sit in seminars getting force-fed codes in an effort to teach them how to accurately diagnose and document with the appropriate HCC codes. Unfortunately, this is not how every other vital piece of medical information was learned, so clinicians struggle to retain the information and utilize it in daily practice. 

 

Medical education is all about the Socratic method, question and answer, clinical vignettes. Doctors learned to learn this way, and they prefer it. Which is why DoctusTech helps doctors learn HCC coding the way they like to learn – from other doctors, in clinical vignettes, on their own time, and in an average of 5 minutes per week.

 

Truly, DoctusTech helps clinicians learn HCC coding. And when clinicians master diagnosing for risk with HCC codes, your whole VBC program improves. 

 

See more ways that DoctusTech Helps:

  • DoctusTech Helps: Increase RAF Accuracy
  • DoctusTech Helps: Decrease clinician workload
  • DoctusTech Helps: Deploy HCC coding education across your org 
  • DoctusTech Helps: Change Clinician Behavior
  • DoctusTech Helps: Value-Based Care

Everything You Need To Know About HCC Coding Training

Everything You Need To Know About HCC Coding Training

Why is HCC coding training important? Without proper coding, it is impossible to diagnose accurately, treat effectively, document those diagnoses, or achieve revenue goals. Coding training will help you master the skills you need to properly code patient records, so investing in HCC coding training might be the right move for you! Read on to learn more about HCC coding training!

 

What is HCC coding?

Hierarchical condition category (HCC) coding was created to estimate future health care costs for patients. The Centers for Medicare & Medicaid Services (CMS) HCC model was established in 2004 and is increasingly being used as value-based care gains traction. The HCC model relies on ICD-10-CM coding to assign patients risk scores based on their medical condition. Each condition is associated with an ICD-10-CM code. For example, a patient with few serious health problems is likely to have average health care costs for a specific period of time. Patients with many chronic conditions, however, are more likely to have higher health care utilization and costs.

 

Why is HCC coding training so important?

As we mentioned above, proper healthcare coding is important for a number of reasons. However, even the best healthcare providers cannot properly code without the right training. If you are new to the healthcare industry, you will need training to learn the coding system and understand the complexities of accurate diagnosis and documentation. If you have been in the industry for a few years but have not kept up with the latest coding trends, you may also need training to refresh your skills. Whatever your situation, it is important to take the time to invest in HCC coding training. This training will help you master the terminology and coding systems that are used in the healthcare industry. It will also help you learn how to properly diagnose and document for better patient care.

 

Which platforms and tools are effective?

HCC coding training can be delivered in a variety of ways. Depending on which courses you decide to take, you may be able to access them online or on your mobile device. Most HCC coding training courses will include videos, interactive activities, and practice tests. These tools can make learning easier and more effective. They can also help you retain the information you learn effectively. If you are looking for HCC coding training, it is important to find a platform or a course that fits your learning style and skill level. If you are new to the industry, you may want to take a beginner’s course. If you have been in the industry for a few years and just want to refresh your skills, you might want to take an intermediate or advanced course.

 

3 Things to include in your training plan

When you are ready to start your HCC coding training, it is important to make sure you have a plan in place. This will help you stay motivated and on track and make sure you finish before the course’s deadline. There are a few things you should definitely include in your plan.

 

Set specific goals

Before you begin coding training, you should sit down and set some specific goals for your course. What do you hope to achieve by the end of your training? By setting specific goals, you will know what you are working towards and have something to motivate you. 

Set a schedule

It is important to set a schedule and stick to it. This will help you stay motivated and make sure you do not get overwhelmed by the coursework. Make sure you allot enough time for studying each week and do not try to cram. A healthy pace is achievable at 5 minutes per week, if you have the right tools. 

Stay focused

Finally, during your coding training, it is important to keep your eye on the prize. While coding is interesting and can be complex, you do not want to get so involved that you lose sight of your goal. Stick to your schedule, do not try to push yourself too hard and you will be on track to finish in time.

 

Get Started Today

Doctus Tech is the best way for clinicians like yourself to start learning to diagnose with HCC codes. Benchmark yourself with other clinicians, identify your team’s knowledge gaps and benefit from a 30% increase in RAF accuracy. Sign up for a 14-day trial now!

Risk Adjustment Coding – Challenges And How To Get It Right

Risk Adjustment Coding

Risk adjustment coding is a vital part of any managed care organization. It helps to ensure that patients are appropriately diagnosed and documented accurately according to risk level, which in turn allows the organization to receive appropriate capitated payments to provide all the care needed to reduce avoidable hospitalizations and achieve maximum health. And regardless of how  challenging and time-consuming it can be to implement, getting it right is vital on many levels. Diagnosing and coding for risk can be tricky. 

 

It is not always obvious how complex and risky a condition is, especially because some patients are at higher risk than others for diseases like depression or schizophrenia, but many conditions can be difficult to diagnose. Those who appear low-risk might actually be high-risk, once you dig deeper into the specific diagnosis details. There are thousands of potential codes and conditions to diagnose that can be used to determine risks. There is no perfect formula for every managed care organization; you have to find protocols for training and improvement that work best for your clinicians and operators. Let’s take a look at some of the challenges involved in risk adjustment coding and how to get it right.

 

Determining risk is difficult

When implementing a risk adjustment program, make sure you have a team on hand with strong coding and data management skills. These team members should be able to look at each patient record and determine both the conditions that have been diagnosed as well as the documentation criteria to be  applied to that patient in the chart. This team will be responsible for determining and documenting  diagnoses that correlate to the risk level of each patient. This task can be difficult since mastering HCC coding for risk adjustment requires a lot of learning and is often different than standard ICD-10 coding. But there are modern tools for mastering this, so do not lose hope.

 

Risk adjustment requires a lot of data

Risk adjustment also requires a lot of data. The more information you have about each patient, the better you are able to diagnose based on their true conditions and related risk. If you do not  have enough data about a patient, or lack consistent data throughout the lifetime of a patient relationship, you will have a hard time determining their true risk level. 

 

For example: Patient A has been a patient for 10 years, and Patient B has been a patient for 2 years. If you’re trying to diagnose the patients, you’ll have to take into account their lifelong risk factors and current health status. This includes things like socioeconomic status, age, family history of certain diseases, how much they smoke, and more. If you have a few years of data points on Patient A, and only a few months of data points on Patient B, you’ll be able to diagnose Patient A more accurately.

 

Coding errors are common

Coding errors are common in risk adjustment, but they can be avoided with consistent training, accountability, strict internal audit procedures, and improved clinician buy-in. Coding errors can lead to overcharging or undercharging the CMS, resulting in either missed earnings or painful charge-backs. Coding errors can be caused by a number of different factors. For example, mistakes could be made when determining which diagnoses apply to patients, which codes to use for the diagnoses, or what to document to justify the diagnosis in the chart. Diagnoses require clear communication as well as consistent documentation on all patient records.

 

It is only going to get harder.

The bad news is that risk adjustment is only going to get harder. New technologies like AI, voice recognition, and machine learning are changing the way health care providers analyze and manage data. While these technologies will make many aspects of coding and managing data easier, they will also make it more complex by introducing even more variables and data points to consider. So while risk adjustment could be more challenging, there are tools available that simplify the process both in training and inside the EMR.

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Conclusion

Risk adjustment is vital, because it ultimately determines what type of care an individual patient needs and how much risk the organization is taking on, managing that care. It is important to ensure that your organization is accurately diagnosing and documenting so that patients stay healthy and your organization has the needed revenue to manage their care.

The Intricacies of Value-Based Care: A Step by Step Guide

Value-Based Care is a game-changing advancements for patients and the providers who care for them. Value-based care is revolutionizing  the healthcare industry and aligning incentives more and more each year. The concept of pay-for-performance, patient-centered care, and outcome measures have all been developed with the intention of providing more value to patients and healthcare providers alike. These new standards are also a response to the Affordable Care Act’s emphasis on cost containment and value in healthcare services. Therefore, it is no wonder that many hospitals and medical practices have adopted a value-based approach when considering how best to meet the needs of patients and the business needs that make care happen. However, navigating this new territory can be challenging without proper guidelines.

 

What is Value-Based Care?

Value-based care (VBC) is a system of payment designed to change the incentives for healthcare providers, so that they are rewarded for providing high-quality, cost-effective care. In VBC, providers are reimbursed based on the relative value of their services. The amount a provider is paid is based on the quality and outcomes of the services provided as well as their costs. Similar to the H and R Block tax model, providers are rewarded for going above and beyond what is expected of them. VBC providers are rewarded for providing high-quality and cost-effective care, whereas higher cost or decreased patient outcomes  can result in  financial penalties. 

 

This is a significant change from the fee-for-service model that has long been the primary financial model for  healthcare. In the fee-for-service model, healthcare providers are reimbursed based on the number, kind and cost of procedures and services provided to patients. More expensive procedures make providers more money, even when not medically necessary. And care that is shown to benefit the health of the patient but does not directly result in revenue for the practice is not financially viable and often gets overlooked (e.g. care-coordination, regular nurse follow-ups, ancillary services, nutrition, transportation, counseling, remote patient monitoring, and so many more).

 

The Basics of Value-Based Care

Value-based care is centered around the idea that quality and cost should be the focus in providing healthcare services. As such, it is the responsibility of healthcare providers to optimize the care they provide in terms of both quality and cost. This can be achieved by looking at the overall cost of care, rather than just the cost of the single procedure. The shift from volume to value in healthcare has been occurring over the past two decades. There have been many policy changes and legislative initiatives aimed at reducing healthcare costs by focusing on quality. Key indicators of the shift from volume to value include: The Balanced Budget Act of 1997; The formation of the Medicare Payment Advisory Commission (MedPAC); The creation of accountable care organizations (ACOs);  The Affordable Care Act (ACA).

 

Key Strategies for Transforming to a Value-Based Care Environment

While the overarching goal of value-based care is to reduce healthcare costs while maintaining or improving quality, there are several strategies that providers can employ to make this transition. 

 

  • Look at the big picture: Value-based care requires providers to look at the big picture of healthcare costs, which includes both the costs of the care being provided as well as the costs of delivering the care itself. 
  • Focus on the patient: Value-based care should focus on patients and how they can expect to be treated. The focus should be on patient satisfaction scores and more personalized care. 
  • Improve the care delivery process: By improving the care delivery process, providers can reduce errors and make it easier for patients to receive the care they need.

 

Who Is Responsible for Value-Based Care?

A number of different stakeholders are responsible for enacting value-based care at each step along the continuum of care. At the patient level, patients themselves play a critical role in the success of VBC. Patients should be providing honest feedback on the quality of care they receive and the outcomes they experience. Healthcare providers are responsible for coordinating the collection of data, assessing the value of the care they provide, and reporting on the outcomes of their services. Finally, payors are charged with using the information from providers to make risk-adjusted payments.

 

Identifying the Right Measures and Outcomes

As previously discussed, VBC providers are reimbursed based on the relative value of their services. The amount a provider is paid is based on the quality and outcomes of the services provided as well as their costs. In order to determine the relative value of a particular service, providers must first select the appropriate outcome measures. 

 

In selecting outcome measures, providers should consider the following: 

  • Is this outcome measure important to patients? 
  • Is this outcome measure accurate? 
  • Is this outcome measure feasible to collect?

 

Other Strategies to Consider: Staffing, Infrastructure and Technology

Beyond the strategy of selecting the right outcomes and measures for VBC, providers should also consider the following strategies when endeavoring to improve the delivery of quality and cost-effective care. 

 

  • Staffing: There are a number of strategies that providers can employ to improve staffing outcomes, such as considering the optimal staffing mix, providing on-the-job training, and leveraging digital technologies to improve efficiency. 
  • Infrastructure: In addition to factors such as the condition of the building, providers should also consider the functionality of their facilities, such as the accessibility of their services or the location of their facilities. 
  • Technology: Providers should also consider the technologies they have in place, such as EHR systems, scheduling software, HCC coding education apps, and diagnostic equipment.

 

Conclusion

There are many benefits to adopting a value-based care approach. VBC providers are beginning to see improvement in outcomes, such as fewer avoidable hospitalizations, reduced readmission rates, increased patient satisfaction scores, improved quality scores, and lower mortality rates. Furthermore, providers who embrace VBC are actually seeing  bottom-line financial benefits, as they are rewarded for providing high-quality, cost-effective care. However, adopting a value-based care approach is not without its challenges. In particular, providers must be willing to take a critical look at their current practices and begin to change where necessary. Along the way, providers should be transparent with their patients about the changes they are making, the things that are being actively improved, and the over-arching WHY behind their shift to Value-Based Care. 

 

Value-Based Care is a natural movement toward the benefit of the patient. And as providers make the shift, patients will be encouraged both by the motive behind the transition as well as the improvement in their overall health and the reduction in the costs of their care. Truly, Value-Based Care has the potential to be a significant win-win for patients and providers. And in the end, isn’t that why you spent all those years pursuing your medical training?  Value-Based Care is for patients, and for the providers who care for them.

4 HCC Coding Education Strategies for Physicians

HCC coding education is a fast growing need for physicians. To meet the demands of today’s fast-paced and dynamic healthcare environment, many are now accelerating their transformation from a hospital-centered fee-for-service model to a more patient-centered model, and Value-Based Care is at the forefront of this change. The increased HCC coding knowledge requires clinicians to become more efficient with their time and resources as they are forced to master HCC coding in the gaps between patient care. 

 

The focus  on implementing coding education programs for clinicians is a hot topic. Unfortunately, many of the strategies being deployed actually add to the  challenges clinicians face in the day-to-day. They do this by attempting to educate with outdated methods, forgetting some of the tried-and-true teaching techniques that worked so well in med school. Namely, clinical vignettes deployed using the Socratic method.   In order to achieve the proficiency they need to code efficiently in real time, today’s clinicians need a solution that works well, without adding to their already stretched workload. 

 

Whether you are just getting started with your organization’s coding education strategy or you want to take it to the next level, this blog post compares the four key HCC coding education strategies, highlighting their strengths and weaknesses.

 

1. Lecture by Zoom / Classroom

The classic classroom setting, training through seminars deployed in person or over Zoom. This method does allow you to reach a massive audience and deliver identical content to them. 

 

If only doctors learned this way, it just might work! Unfortunately, most doctors come out of med school hard-wired to learn through clinical vignettes and the question and answer techniques, AKA the Socratic method.    Why? Because while some people do not learn well in a lecture setting, med school teaches doctors how to retain massive amounts of information using this proven teaching strategy. 

 

2. One-to-One Coaching

One-to-one coaching is the gold standard of HCC coding education. If there was one coach for every 5 clinicians, and if every clinician had time to be coached, this could work. And if every clinician learned the same way, it would work. But that is not the case! This strategy has its advantages. The sessions are intense and generally effective, as it results in an immediate correction to a clinician’s thought process. But this strategy will only work if clinicians have unlimited time and nearly unlimited coaches, which they do not. This method is super time-consuming, and do not forget, to organize this, you would need a massive staff to run the entire thing. Also, unlike Zoom classrooms, your reach is limited by  geography.

 

3. Email Blast

 Other than the fact that it does not work, it is great! Email is fast and easy, but also super easy to ignore. Whether you opt to  share all the codes in a single email, or drip out Code of the Month in a series of emails, it still falls flat. Easiest to deploy,  easiest to ignore, and hardest to retain. 

 

4. DoctusTech App

We admit to a certain bias, but hear us out. Learning can be done on  the doctor’s timeline,  and there is no scheduling required. Track the progress and performance, and help them to learn more and focus on areas needing attention. The DoctusTech app is ideal for larger groups, helping clinicians  learn without negatively impacting workload or patient care. JIT Learning enables clinicians to learn what they need when they need it. And without the limits of geography, the same HCC coding education can be deployed to all clinicians at once. No coaching staff to hire, train, deploy and manage. Accountability across the organization. Ease of use for clinicians with only a five minute lift per week. 

 

To make learning interesting, the app uses gamification to keep things competitive and fun. Clinicians can see how their peers are doing, and that competitive drive kicks in, pushing learners to engage even more. And when new information, rules, and codes come out, the app serves content to rapidly update the whole org. This app is cost-effective, saves time, and provides real-time behavior change.

 

HCC Coding Education Matters

No matter where you are in your value based care journey, HCC coding education is a vital tool that your clinicians need right now.

 

The best way to learn HCC coding is in the DoctusTech app. The second best way is deploying an army of coaches. And if you are still using email or seminars to onboard new clinicians and teach HCC coding to your doctors, please schedule some time with our team. The DoctusTech app is less expensive, more effective and far simpler to deploy, use, manage and maintain than any of the other HCC coding education strategies. 

 

Learn More about HCC Coding Education

Book a demo to see the best HCC coding education strategy in action.

5 Ways to Improve Your Revenue Cycle Management Strategy

Revenue Cycle Management

Revenue cycle management (RCM) is a hot topic this year. Monitoring, analyzing and improving the efficiency of your organization’s revenue processes is top of mind for leaders across many healthcare organizations. And you’ are probably still reading because you know that improving your organization’s revenue processes is essential to its success. But are you doing everything you can to implement a robust RCM strategy? Your competitors will not sit back and watch you take the lead. If you do not take action now, your competitors will leapfrog you with efficiency and better margins. . Read on for five ways that a strong RCM strategy will help improve your organization and drive financial success.

 

Build Strong Relationships with Partners

Revenue cycle management starts with strong relationships with your partners. This is especially true for organizations that rely on managed services or outsourcing partners to complete some or all of their revenue cycle activities. A strong partnership with your managed services providers will increase the likelihood that they will help you achieve your revenue goals. 

 

Partners are crucial to your success, so you must work to build strong partnerships with them. How can you do that? First, decide how your organization will work with partners. Then, clearly communicate that decision to all partners with which your organization does business. Strong relationships with partners will help drive success in all other areas of revenue cycle management.

 

Improve Customer Experience

One of the best ways to improve your customer experience is through managed services. Providers of managed services can handle many customer-facing activities, such as claims processing, that your organization might struggle to handle on its own. Doing so will free up your staff to spend more time on strategic revenue-generating activities. Strong relationships with managed services providers are also essential for ensuring that clients receive a quality experience. If managed services providers are not communicating with your clients in a helpful, empathetic way, your organization’s reputation will suffer. You can avoid these problems by clearly communicating with managed services providers regarding your company’s communication strategies and expectations.

 

Improve Diagnostic Accuracy and Specificity

One of the fastest pathways to improving revenue is to repair broken methods of diagnosing chronic conditions in risk contracts. Diagnosing very specifically, HCC coding correctly and documenting very accurately can provide not only a direct boost to revenue, but improves outcomes in patient care. HCC coding is vital to successful risk contracts, so RCM requires your organization to improve the actual fund of knowledge within your individual team members. If your organization is educating clinicians in seminars or zoom calls, emails and PDFs, you are missing out on the opportunity to improve diagnostic specificity and accuracy. And while accurately diagnosing can improve patient care revenue, inaccurate HCC coding can have dire consequences on your org’s bottom line. 

 

You might be hesitant to overhaul your HCC coding education, because it feels like a lot of work. However, it is far less of an organizational lift to improve training than it is to audit and fix errors along the way. And while some may claim that the new app-based HCC coding education is far less expensive than traditional training strategies, the real impact to revenue is cash flow positive. And that cost must be benchmarked against the inevitability of audits and repayments. Choose a partner you can trust to improve your team’s HCC coding, and see a direct impact to revenue, and simplification of the entire RCM process.

 

Monitor and Measure Key Performance Indicators

Management guru Peter Drucker once said, “Only what gets measured gets managed.“ No matter which areas of your revenue cycle you decide to focus on, you must monitor and measure your progress. This is critical for assessing the impact of your efforts and identifying areas where you might need to make changes. You can use metrics to measure customer experience, revenue cycle time, productivity, expenses and more. Choose the metrics that will help guide your RCM strategy the most. For example, customer retention and customer satisfaction metrics will be helpful for an organization that offers customer-facing products or services. RCM metrics that track the efficiency of your revenue cycle are also helpful for organizations that sell products and services. For example, tracking net revenue per customer and average revenue per customer over time can help you determine how well your revenue cycle is performing.

 

Automate Proven Processes

One of the easiest ways to improve your revenue cycle management strategy is to automate proven processes. If your organization is managing customer information, claims, billing or some other process manually, you are missing out on the opportunity to improve the process and save time and money. You might be hesitant to automate certain processes because you aren’t sure how they will work or if they will produce accurate results. If so, start small. Choose one process that you are confident will work as intended. Then, put the process into action. If it works as expected, implement it in other areas of your organization. If it does not work as planned, do not be afraid to scrap it and try something else.

 

Conclusion

Revenue cycle management is an essential strategy for all organizations. You cannot sit back and hope your revenue processes will improve on its own. It is the nature of RCM to get worse the moment you look away. You must take action to ensure that your organization is managing its revenue cycle as efficiently as possible. To succeed, you must work to build strong relationships with partners, improve your customer experience, improve diagnostic specificity and accuracy, monitor and measure key performance indicators, and automate proven processes. If you do, your revenue cycle management strategy will be strong and successful.

Check out our website https://www.doctustech.com/

4 HCC Coding Challenges All Clinicians Face

4 KEY HCC Coding Challenges Clinicians Face

As the U.S healthcare system transitions towards value-based payment models, independent clinicians and physician groups continue to face HCC coding challenges that not only impact their bottom-line, but patient care as well. On top of all this, the pandemic has added a significant burden to the already stretched clinician workload.

 

Here are 4 key HCC coding challenges clinicians are facing now, and how they can overcome them.

 

  1. Physician training for HCC coding – Physicians are already working tirelessly to provide excellent care to their patients. Asking them to learn HCC coding through brute-force via zoom calls, classroom seminars and email blasts is a bridge too far. On the other hand, the focus on value-based care has made it imperative for physicians to know and understand HCC coding so that they can accurately document patient records. So clinicians know they need to know, they just don’t have an effective and engaging mechanism for efficient and effective learning.

 

  1. Revenue impact due to incorrect coding – Accurate HCC coding is necessary for accurate reimbursements and patient care, and inaccurate coding can directly impact the bottom line. That is why it is imperative that clinicians and staff be well trained in HCC coding. And the complexities don’t stop there. HCC codes not only impact RAF scores, they also interact directly with patient care, and a fair level of decision support is required , as HCC codes are not intuitive.

 

  1. Poor HCC integration with EMR systems – When HCC coding does not integrate with the EMR, it creates a complex struggle for clinicians and physician groups. This not only leads to unintentional errors, but makes workflows more difficult and adds to the burden of an already heavy workload. It is critical to put a system in place that teaches clinicians to accurately document HCC codes on every patient, and integrates within the EMR.

 

  1. Lack of trained HCC coding professionals – Staffing shortfalls not only plague small practices, but larger physician groups are short-staffed as well. A lack of well-trained staff may be related to revenue or rising salaries, which sometimes small practices are unable to sustain. And when larger hospitals acquire smaller practices, a shortage of trained staff is often just one side-effect. Training clinicians and non-clinical staff on HCC coding is vital.

 

Transitioning to a value-based care model will never be seamless until these challenges are solved. How? With our unique suite of HCC education and EMR integration tools, enabling physicians to learn HCC coding and integrate an AI-powered HCC coding system into their existing EMR platforms to drive efficiency and accuracy.

 

To learn how our HCC coding app lets physicians train for HCC coding click here.

 

To understand how our EMR integrated platform works, click here.

HCC Coding and Physician Burnout

HCC Coding and Physician Burnout

RaDonda Vaught was just sentenced to three years of supervised probation. The former Vanderbilt University Medical Center nurse was found guilty of negligent homicide and gross neglect of an impaired adult in the death of a patient, because she administered vecuronium rather than Versed.

 

A tired, overworked nurse could not find the prescribed medication in an automatic drug dispensing cabinet, so she used an override and grabbed the wrong drug. Her patient died, and she was convicted of two felonies.

 

Burnout is a pervasive evil in any industry. But in healthcare, the stakes are measured in lives, and a career-ending error could also land a well-meaning provider in court, battling more than a malpractice suit. 

 

The Rise and Fall and Rise of Physician Burnout

A study from 2019 demonstrated a decline in physician burnout [Source]. Good timing, as the burnout decline preceded an overall healthcare worker burnout event rivaling the black plague at a drag strip. Just one year after publication, COVID-19 ushered in the worst, longest, darkest season of overwork, stress and burnout the healthcare industry has seen in a century. 

 

And with the industry marching predictably toward Value-Based Care, onboarding a new clinician comes with a massive learning curve. Requiring providers to add HCC coding to their already complex workflow is not only vital to improve the industry, it is increasingly mandated by CMS.

 

Add to it that none of this HCC coding was taught in medical school, and you have a perfect storm that even Clooney & Wahlberg would struggle to make sexy. 

 

Why do they make it so hard?

The rising tide of burnout and the steady growth of VBC and HCC coding knowledge form enough of a riptide of impossibility for today’s practitioners. But the teaching methods being used to bludgeon new codes into the weary minds—and workflows—of new residents and established docs alike are downright cruel. Consider that HCC coding education is  being deployed using some of the most arcane and ineffective teaching tools available today. 

 

1 hour seminars are the lingua franca across nearly every provider group in a risk payment model. And if sitting in a classroom being talked at while pretending not to stare blankly at your phone was not bad enough, the two worst years in most providers’ careers were met by shifting those interminable seminars to a Zoom call, probably on your phone.

 

Consider the vital role that HCC coding plays in capturing critical diagnoses to be treated, documenting those diagnoses to keep them treated, and billing against Risk Adjustment scores to reimburse for essential healthcare services that keep patients out of the hospital. 

 

And we are teaching these skills over a Zoom call? With providers more burnt-out than ever, and Zoom fatigue at a universal high – we are lecturing doctors on HCC coding over their phones? Is it a surprise that engagement is low? Is it a surprise that errors are high? Or that adoption of full risk models is sluggish at best? 

 

And yes, one-to-one coaching is the gold standard, and those who provide this mission-critical service should be heralded in the streets and welcomed with ticker-tape parades. This is heroic work. But with global workforce shortages, there are definitely not enough coaches to tackle the task at hand. Not for all the clinicians in desperate need of a rapid increase in their fund of knowledge on VBC and HCC coding. 

 

Is there really no other way? 

 

Full disclosure: this is a blog post by a brand that has pioneered another way to teaching HCC coding to doctors. And it really works. But we are not here to sell you our solution. At the moment, we are only here to say as loudly and as clearly as we can that Ye Olde Ways™ are not working. And if there is a better way—which there is—we need to be running toward it like actual lives depended on it. And not just patient lives – doctor lives, nurse lives, NPs and PAs and coders and operators and the IT team, too. There is a lot at stake, and it’s time to search for answers. 

 

Our Offer

If HCC Coding and Physician Burnout are at all on your radar, we’d love to share a solution to both. Better solutions are out there – and they outperform seminars and code-of-the-month email blasts for engagement and results. And they free up your coaches to focus on the 20% that need it the most. 

To learn more, book a conversation with our team!

 

Implementing Value-Based Care – A How To For Physicians

Value-Based Care

Implementing Value-Based Care is essential for today’s physician. Value-based care is a system of payment and reimbursement that rewards healthcare providers for delivering high-quality, cost-effective care to patients. There are two ways to improve the value of care: improving the quality of care (fewer complications, less re-hospitalization, shorter length of stay, better patient experience); and reducing the cost of care (more efficient services, fewer administrative costs, reduction in waste and overuse of services). 

 

What is value-based care?

Value-based reimbursement is a system that aims to reward healthcare providers for providing high-quality care at an affordable price. It is important to understand that value-based reimbursement is not the same as cost reduction. It is not about minimizing costs, but rather, it is about maximizing quality while keeping costs low.

 

Benefits of value-based care

Better patient outcomes and experience – Through improved value-based care, you will likely be able to reduce the number of complications, readmissions, and other negative outcomes that patients experience. 

 

Reduced costs – An effective value-based care program will not only result in higher quality, but will also likely reduce your costs. You will be reimbursed for all of the services you provide, but only for the ones that meet your quality standards.

 

Increased revenue – Providing high-quality care can lead to greater patient satisfaction, word of mouth referrals from happy patients, and thus, more revenue.

 

Better reimbursement – A value-based care program will be focused on providing high-quality care, so your reimbursement should be higher as a result.

 

A sustainable business model – If you want to keep your business open and sustainable into the future, you must be able to adapt to the changing needs of your patients, payers, and providers. In order to do this, you must be open to new ideas and be willing to try new strategies. The best place to start is with value-based care.

 

How to implement value-based care effectively

Start with the end in mind – Before you can implement value-based care, you need to have a clear plan and vision for what your new value-based care program will look like.

 

Educate your staff – One of the most effective ways to implement value-based care is to educate your staff. HCC coding is not taught in medical school, so clinicians will need a fast and effective means of getting up to speed. Accurate and specific diagnosis coding for risk management will ensure better patient care and improved revenue. And when clinicians understand HCC coding,  the process, the metrics, and how their work impacts these metrics, all of VBC just works better

 

Educate your patients – Another important aspect of implementing value-based care is to educate your patients about what it means and why it is important.

 

Measure the right things – The first step in implementing value-based care is to make sure that the metrics you are measuring are actually contributing to value.

 

Find ways to reduce costs – Although you want to increase revenue and improve reimbursement, you also want to minimize costs.

 

Find the right partners – Last but not least, you need to find the right partners to work with to implement your value-based care program. (We would love the opportunity to earn your partnership on educating clinicians on HCC coding, as well as integrating documentation accuracy and value-based diagnosis resources into your EMR. Get in touch to learn more.)

Measure outcomes and quality

Clinical outcomes – In order to determine if a patient is receiving high-quality care, you must be able to measure their clinical outcomes (metrics such as blood pressure, heart rate, blood sugar, or other lab values or diagnostic findings, e.g. pathology reports).

 

Patient experience – While clinical outcomes are important, they do not tell the whole story. Patients may be receiving high-quality care that is resulting in good outcomes, but they may also be receiving poor quality care that is resulting in bad outcomes.

 

Provider experience – In order to provide high-quality care, providers must receive high-quality training. In addition, they must have access to the right tools. If they do not, they will not be able to provide high-quality care.

 

Define your value-based care services

Identify your core services – Before you can define the value-based care services you will offer, you must first determine your core services.

 

Identify your add-on services – Once you have your core list of services, you can then identify add-on services that you offer patients but that are not absolutely required for them to receive care from you.

 

Assign value-based care units (VBUC) – Next, you must assign a value-based care unit cost (VBUC) to each service.

 

Create a menu of value-based care services – Once you have identified your core services and have assigned VBUCs to each one, you can then create a menu of value-based care services.

 

Summing up

Value-based care has the potential to transform healthcare in the United States. It is important to note, however, that value-based care is not a fad or trend that will quickly come and go. It is a system that has been around for decades and is continuously evolving as more is learned about what it takes to provide high-quality, cost-effective care to patients. If you want to survive and thrive in today’s healthcare environment, you must be willing and able to adapt to the changing needs of your patients, payers, and providers. The best place to start is with value-based care.