10 Things Your Boss Wishes You Knew About Receivables Management

Account Receivables (AR) are amounts yet to be received for goods or services ordered. AR is legally enforceable claims for payments generally in the form of invoices raised by a business for the goods or services rendered to the customer. 

 

In a hospital setting, AR could be in the form of Government Schemes and Insurance Claims owed to the hospital by the administering authority, generally the claims processing department of the Government scheme or the Health insurance company. 

 

Here is where things get a little complex. If you are working in the hospital insurance claims department here are some important things you need to know.

 

  1. Each policy or agency has its cycle of payments against the claim raised. For example Insurance Company A may have a processing cycle of 15 days while Insurance Company B may have a cycle of 45 days 
  2. Accounts Receivables management is critical for a hospital to ensure proper reconciliation. Lack of an AR tracking system could lead to bad debts and bad patient experience. 
  3. Limited mode of payments. If your hospital has a limited mechanism of payment receipts, for example, if the hospital accepts only CASH payments, it somewhere reflects on the profit. The solution is to have multiple payment processing options like Credit/Debit Card, Online direct bank deposits, Digital Payments, among others. This gives more flexibility to patients to pay for services. 
  4. Interdepartmental coordination. How often do we experience that the attending doctor has given a discharge note but the Nursing Station, Pharmacy, Diagnostics, Billing Department and Claims department are running from door to door to get the right discharge summary and supporting documents? The solution is to integrate Medical Records, Pharmacy, and Billing systems that streamline the discharge process. 
  5. Hospital Staff training. Many of the medical staff and nursing staff have limited knowledge of the insurance claims process. Regular internal training could help better communication between departments and better coordination 
  6. Using multiple software systems or paper-based systems could increase the time required to gather all necessary documentation. Having one robust system across the organization could ease-out bottlenecks. 
  7. Requests for more information by the claims department of the agency or the insurance company are very common. This simply means not enough documentation was submitted during the initial claim process to justify the claim. Having a centralized information system could reduce the errors and the claims department could have access to all reports, bills, and treatment data before the claim is submitted therefore reducing the overall AR cycle. 
  8. Patients and Their Attending family members the majority of the time are not aware of the insurance coverage. It would be helpful if one dedicated insurance processing expert reviews the policy at the hospital and educates the coverage and limitations of the policy to help the patient understand the policy better and take better decisions. 
  9. Timely and Accurate information when provided to the insurance claims department reduces the overall lifecycle of the AR in question. 
  10. Develop a Plan, SOP, and KPI for your Hospital Claims department, Define roles and responsibilities. It is essential to have a plan in place. High staff attrition is a problem many hospitals face. The Claims Process plan and Process map will assist in hiring the right resource and providing training. KPI measures the performance of the department. 

 

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Solving Hospital AR problems

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Cyber Security in Hospitals and Healthcare Facilities

“Early last summer, Chinese and Indian armies clashed in a surprise border battle in the remote Galwan Valley…Four months later and more than 1,500 miles away in Mumbai….Hospitals had to switch to emergency generators to keep ventilators running amid a coronavirus outbreak that was among India’s worst…those two events may have been connected — as part of a broad Chinese cyber campaign…”

In the ongoing tensions between India and China, cybersecurity has become a hot button issue. Recent reports suggest evidence of foreign malware targeting critical operations in India. Among other operations, Indian healthcare facilities are being perceived as key objects of cyber attacks. With the recent digitisation of operations, hospitals are particularly vulnerable to these attacks. In this background, this blog explores the sensitive nature of healthcare data, and suggests ways for hospitals to protect against cyber attacks.

PII and PHI

Healthcare data is sensitive as it deals with both Personally Identifiable information, and Protected health information. Personally identifiable information refers to data that could ‘possibly identify a specific person’. Examples include address and credit card details. Protected health information refers to ‘any information in a medical record created in the healthcare process’. This could refer to health information such as blood type and allergies. Arguably, PHI is even more sensitive to handle since it cannot be changed.

Incidents of Data Breach

The extent of damages done to hospitals can be reflected in incidents of data breaches. In July, 2015, UCLA health reported a data breach of the records of 4.5 million patients. Investigation revealed that basic encryption of medical data had not been carried out, which made the data vulnerable. As a consequence, ​​names, dates of birth, Social Security numbers, Medicare and health plan identification numbers as well as some medical information were exposed to hackers.

Measures for Protection

For effectively protecting the healthcare facilities from cyber attacks, we outline the following 1​

measures​ :

● Robust IT platforms: It is important for hospitals to have robust IT platforms with a strong application base. These applications should not constantly break down. If they do, they should be restored quickly.

  • ●  Responsible Planning: Hospital staff should carry out regular planning to review the risks posed to the systems. Anti-malware software needs to be installed and regularly updated. And if possible, data needs to be encrypted.
  • ●  Training and Awareness: Humans can make mistakes, and can err in judgement. For reducing the risks in decision making, regular training and awareness is a useful tool. Learn.MetahOS.com has a course on cybersecurity, which can be useful for hospital staff.In conclusion, increasing digitisation will expose hospitals and healthcare facilities to new risks. Healthcare facilities face extra responsibilities due to the sensitive nature of the information. For securing all grounds, strong technology partners can be critical.

    References:

    https://economictimes.indiatimes.com/news/defence/china-appears-to-warn-india-push-too-hard-and-the-lights-could- go-out/articleshow/81266286.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst

    https://www.latimes.com/business/la-fi-ucla-medical-data-20150717-story.html

    Argaw, S.T., Troncoso-Pastoriza, J.R., Lacey, D. e​ t al.​ Cybersecurity of Hospitals: discussing the challenges and working towards mitigating the risks. ​BMC Med Inform Decis Mak​ 20, 146 (2020). https://doi.org/10.1186/s12911-020-01161-7

Optimising Communication in Healthcare

In today’s world, several individuals are involved in a patient’s care journey. And all of these individuals constantly share information with the patient. Often, these micro-level interactions determine patient satisfaction.

Poor interactions could lead to dissatisfied patients. Pleasant interactions could result in satisfied patients. Consequently, for improving the patient experience, streamlining communications is essential. In this post, we present the advantages and disadvantages of different communication channels.

Type of Communication
Based on the nature of the interaction, communication can be classified as synchronous or asynchronous. Synchronous communication includes two way interactions such as telephony.
Asynchronous communication involves one way interaction such as text messages.

Synchronous Communication
In healthcare, telephones are commonly used for synchronous communication. They involve simultaneous interactions. However, telephonic interactions are known for regular interruptions. Due to these interruptions, individuals with a heavy workload could face problems in recollection. For example, a busy clinician could forget to take notes if he is interrupted often.

Asynchronous Communication
Asynchronous communication does not involve simultaneous exchange of information. This form of communication could involve SMS messages and whatsapp texts. Although asynchronous communication excludes the possibility of interruptions, it is ineffective in getting urgent messages communicated.

Conclusion
Given their advantages and disadvantages, healthcare facilities need to utilize both synchronous and asynchronous forms of communication. The communication channel can be determined depending on the type of message that needs to be communicated. Consequently, metahOS allows for both forms of communication to take place in a seamless and secure way. This helps in increasing patient satisfaction.

References:
Coiera E. Communication systems in healthcare. Clin Biochem Rev. 2006;27(2):89-98.

7 Little Changes That’ll Make a Big Difference With Your Hospital Contact Center

Majority of the patients prefer to connect and talk to a hospital representative over the phone in spite of the advancements and introduction of chatbots and AI engines. In the time of distress, it is natural to have human interaction and reassurance, which dissolves most of the anxiety and ambiguity. 

In most of the modern hospitals there exists a telephone EPABX and intercom framework for structured internal communication. The external communication through inbound telephone calls needs a streamlined workflow, and systematic log mechanism to keep a track on the number of missed calls, type of calls, proper tracking for quality and training among the front office. In many cases these records come in handy incase of medico legal matters.

 

Majority of the small, mid size and large hospitals have an in-house front office team. However, all the hospital administrators or hospital owner-doctors indicate a high amount of attrition in front office staff leading to high costs in training and drop in communication chain against the set internal policy. In many cases, it is being observed that some hospitals and health service providers choose to delegate contact center work process, staffing and training to a third party service provider which has its own set of advantages and disadvantages.

While most of  the hospitals have an in-house front office team, the traditional intercom system is not able to keep pace with the smartphone revolution. Doctors, nurses Hospital staff start communicating using several private chat and messaging systems outside of the legacy EMR or HIS systems, complicating the communication channels, inability to track details of message exchanges for accountability purposes. This may also be against the communication and patient privacy policy regional laws, opening up a new channel for medico-legal lapse. 

 

With this background, it is recommended by a team of policy and hospital administration experts that modern 21st century hospitals should adapt the following :

  1. Transition from paper / emr/ traditional his systems to a contemporary hospital operating system.
  2. Introduce administrative policies preventing hospital staff from exchanging patient related data on private chat / messaging systems.
  3. Adapt a seamless unified digital platform which is a streamlined single window for all internal and external communications.
  4. Track inbound patient communication, missed calls, outbound calls using an advanced contact center system, get more professional. 
  5. To solve the staff attrition problem, choose a system which does not require intense training. Any new staff with basic telephone and computer skills should be able to adapt to the new system. 
  6. Smartphones are a new normal, millenials / gen x / gen y are going to be the major workforce in the coming decades. Instead of forcing them to adapt to a 4 decade old system, the hospitals need to transform their software to work across devices while maintaining the required security. 
  7. The front office and billing department and the clinical services teams should be able to communicate seamlessly to ensure patient experience is enhanced. Modern day hospitals need to look at adapting a patient centric platform which has the ability to provide single window tool to manage the patient journey 

Budget 2021 and Digital Health

In the 2021 budget, healthcare has been the key focus area. With an increase of 137%, the amount earmarked for healthcare for 2021 is Rs 2,23,846 crore. Specifically, the government wants to strengthen its focus on ‘preventive health, curative health and overall wellbeing’ for all the citizens of this country. 

 

The 2021 budget has given an enormous boost to the initiatives of m16 Labs. From our inception, we have worked on making healthcare more accessible in Tier II and Tier III cities. And in the process, we have worked to reduce healthcare costs and improve quality in care provision.

 

Since our technology integrates all aspects of care provision, it enables reduction in healthcare costs through avoiding the duplication of efforts in care facilities. On the other hand, it improves care quality for patient through enabling coordination among providers, and by making information accessible to patients across the care continuum. The use case of a PHC in Karnataka is a testimony to how our solutions can make care accessible to the last mile, while improving quality and reducing costs. 

 

Use Case: A PHC in Karnataka   

Dr. Sathish Pai, Consultant Dermatologist at a super speciality hospital and, Mr. Harish, Chief Pharmacist at a Primary Health Care Centre decided to provide free teleconsultations using WhatsApp for the villagers in a remote region of Shimoga District in Karnataka. 

 

Due to the lack of hospitals in the area, the villagers would have to travel a long way to consult a specialist doctor in the city. Initially, Mr. Harish collected the patient data, such as the patient name, previous history, symptoms, and pictures of the affected area. Then, he sent them to Dr. Sathish via WhatsApp. After a thorough analysis of the pictures and symptoms of the patient, he established a diagnosis and sends across the prescription, only if the ailment is treatable through teleconsultation or else the patient is asked to either consult him in-person or is suggested to see a doctor nearby in their area. 

 

The process was strenuous and required to keep multiple documents on a day-to-day basis like patient details, diagnosis, and physical consent forms which the Government has made mandatory for the patient to sign to show they are willing to receive teleconsultation.

 

With Primary Health Care Centres now providing easy accessibility to super speciality services, patients suffering from diseases need not travel to hospitals in the city to seek treatment instead can stop by the PHC and obtain quality treatment free of cost and once cured can resume their day-to-day work without causing a hindrance to their survival. Given the current situation, it won’t be wrong to say that telemedicine has indeed augmented health care delivery in India especially in such trying times.

 

Supporting Patients across Continuum of Care

As every healthcare provider knows, each time you conduct a patient encounter, it is important that you gather information about your patient in order to treat them properly. The Enterprise Master Patient Index (EMPI) is the industry’s leading methodology for recording and treating patients with multiple medical needs. EMPI improves outcomes and patient care through seamless treatment of patients across the continuum of medical care while improving efficiency in processes, promoting practice strategy alignment, and improving compliance with individual regulatory agency requirements. EMPI leverages all critical information gathered in the clinical setting including demographics, diagnosis, problem list, medications, procedures performed and more. Using EMPI you can bring all potentially relevant patient records for a given encounter into one place-helping to facilitate delivery of seamless care.

Enterprise Master Patient Index

 

An enterprise master patient index or enterprise-wide master patient index is a database that is used across a healthcare organization to maintain consistent, accurate and current demographic and essential medical data on the patients seen and managed within its various departments. The patient is assigned a unique identifier that is used to refer to this patient across the enterprise. The objective is to ensure that each patient is represented only once across all the software systems used within the organization.

 The essential patient data includes name, gender, date of birth, race and ethnicity, Aadhar number, current address and contact information, insurance information, current diagnoses, most recent date of hospital admission and discharge (if applicable), etc.

EMPIs are intended to solve the common problem where multiple systems across the organization gradually become inconsistent with respect to the patient’s most current data when the patient’s information changes, and only one system is updated, i.e., the changes are not propagated to others.

 

Key Identifiers

Last Name, First Name

Date of Birth

Administrative Sex

Address

Types of patient identification problems that compromise the integrity of the EMPI typically fall into one of the following categories:

  • Duplicates: Two or more medical record numbers for one single patient.
  • Overlays: Two or more patients are assigned one record number.
  • Overlaps: Patients seen at multiple facilities have overlapping medical record numbers at each facility within an enterprise or integrated delivery network.

The EMPI is adaptable to a variety of healthcare architectures, including Health Information Exchanges the others. 

EMPI services should include:

    • Data Cleansing
  • Data Normalization
  • Data Standardization
  • Recognize at all points of service
  • Improve quality of care by accurately locating and linking demographic information
  • Improve clinician satisfaction by providing more trusted and accurate patient identification at the point of service
  • Quickly create applications powered by patient data that can be used to solve standalone problems or can be embedded into existing applications

Build a foundation for growth with a highly scalable solution that can be extended to include a single view of providers, healthcare organizations, etc.

Approach:

  1. Business Process Understand the business processes and existing infrastructure
  2. Training  Train the users / developers on how to use or build an EMPI system
  3. Technology Work with existing technology or provide a framework to establish query response with the EMPI engine

Algorithms and Identifiers:

EMPI needs to use various algorithms to establish a single patient index, the most frequently used and the one that we recommend is levenshtein, also along with the algorithm there needs to be a an identifiers setup which will determine and index the patient.

Jaro Winkler: https://en.wikipedia.org/wiki/Jaro%E2%80%93Winkler_distance

Levenshtein: https://en.wikipedia.org/wiki/Levenshtein_distance

Referral Management Systems: Will they ever Rule the World?

 

Background 

In most countries, the two main types of care facilities include clinics and hospitals. As gatekeepers, clinics are expected to provide services for uncomplicated cases. From the clinics, the more serious cases are referred to the hospitals. This pyramid of care facilities results in reducing costs for the payer and improving quality of care within the health system. Apart from the transition from primary to specialist care, referrals occur from specialist to specialist care or from an inpatient setting to emergency care. This post looks at the challenges and enablers to electronic referral management systems. 

Referral Management System 

The WHO defines a referral ‘as a process in which a health worker at one level of the health system […] seeks the assistance of a better or differently resourced facility at the same or higher level to assist in, or take over the management of, the client’s case’. Broadly, the usage of referral management systems is carried out to improve health outcomes by monitoring the patient’s journey across the care pathway. 

 

Since the need for referrals occurs due to the escalation in need or change in diagnosis, referral management systems play a critical role in effective care provision. 

 

Challenges to Referral Management Systems 

The key challenges to referral management include: 

 

  • Care provision in clinics is considered to be of a lower quality. This results in people seeking care directly at the tertiary facility.
  • Impersonalized system of record keeping, which results in patients feeling lost. 
  • Paper records result in difficulties in data collection and storage. Because of these problems, there is a lack of accurate information. 
  • The presence of different languages and standards in healthcare creates difficulties in making use of stored information to improve health outcomes.
  • The presence of different record keeping mechanisms results in the fragmentation of information.
  • Difficulties in managing care systems.

 

Enablers of Referral Management Systems:

To a large extent, problems in referral management systems can be overcome with the usage of electronic patient records. 

 

  • Electronic record keeping mechanisms result in increased transparency in care systems.  This increases patient trust.  
  • Information is streamlined through different languages, standards, and record keeping mechanisms in order to improve health outcomes. 
  • Maintaining both provider directories and patient records is easier digitally. 
  • Communication between care providers is streamlined through the use of a single platform. 

 

In conclusion, referral management systems are effective tools for improving quality of care provision, and reducing costs. Despite its effectiveness, several challenges hinder the effectiveness of referral management systems. However, these problems can be overcome with the usage of technologies, which streamline information to improve outcomes. 

 

Sources:

Bossyns P and Van Lerberghe W, 2004, The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger, in Human Resources for Health 2004, 2-1, available on line at: http://www.human-resources-health.com/content/pdf/1478-4491-2-1.pdf

Cervantes K, Salgado R, Choi M and Kalter H. 2003 Rapid Assessment of Referral Care Systems: A Guide for Program Managers, published by the Basic Support for Institutionalizing Child Survival Project (BASICS II) for the United States Agency for International Development, Arlington, Virginia, available on line at: http://www.jsi.com/Managed/Docs/Publications/WomensHealth/PNACW615.pdf

Department of Health, Republic of South Africa, 2003, The Clinic Supervisor’s Manual, Version 3, see Section 6: Referral System Guidelines, available on line at: http://www.doh.gov.za/docs/factsheets/guidelines/clinical/index.html 

Barnett M, Sirui S, Landon B. Trends in Physician Referrals in the United States. Arch Intern Med. 2012; 172(2): 163-170. doi:10.1001/archinternmed.2011.722. 

Large number of Small and Mid size Hospitals in India Lack The Basic Hospital Information & Management System

The platform for Small and Mid size hosptials

Small and mid size hospitals today are under tremendous pressure – Too much patient load, not enough resources and a host of information technology issues. They are now looking for ways to make their lives easier without compromising on patient care. MetahOS Healthcare Operating System – Designed by doctors for doctors aims to do exactly that! Today’s healthcare system is heavily dependent on IT and the clinical staff have little say in the way their medical practice runs. It is not uncommon to see dedicated specialist clinicians having to struggle with basic computer administration, software maintenance and internet connectivity. This puts a huge strain on them in their day job, which is already stressful by itself. Smaller hospitals spend most of their revenue on expensive proprietary systems that don’t scale well.

 

Healthcare is an evolving sector

The middle class population is moving towards mid-sized cities with better lifestyle factors like in India region. This gives rise to demand for scalable technology solutions which can be used across the healthcare verticals providing efficiencies and standardisation at regional levels. Having said that, we have launched a Healthcare operating system which will provide a platform for small & mid sized hospitals and providers to adopt and scale up their operations effectively.

In the past few years there has been an increase in the number of hospitals owned by Clinicians and Doctors. This is really good for Healthcare Industry as it has given control in the hands of the people who actually take care of patients on a daily basis. The downside to this trend is that these small and medium size hospitals lack infrastructure, technology and resources to run a hospital effectively. Now MetahOS is addressing this issue by making state of art healthcare operating system available to every clinician across India with a monthly subscription.

What is needed

The small and mid size hospitals need a convenient and simple way to manage their healthcare team, patients, assets all in one place. Many hospitals use paper workflows which result in huge losses of revenue and business opportunities.

At m16labs, we’re excited to announce the launch of our Early Access Program for Meta hOS (Healthcare Operating System). We believe the future of healthcare is digital and cloud connected – that every patient should have a 360 degree view of his or her own health information and clinicians should have the tools they need to deliver safe, high quality, coordinated care.

Contact us

Do check out the paper on poor standard of care in small, private hospitals in Maharasthra by Padma Bhate-Deosthali, Ritu Khatri, Suchitra Wagle.

Health Information Systems are being Phased Out

The Hospital Information Systems a.k.a Health Management Information Systems in India were not built to last for Healthcare, they were ERP’s that were retrofitted to do Order Entry, these Enterprise Resource Planning systems were built for Supply Chain and Manufacturing companies and in the early Digital Transformation 1.0 during 2013 onwards the software companies modified their applications to meet Hospital IT requirements.

This got the hospitals to use the HIS, however they were just using it for order processing and billing and the rest of the features that were built without considerable Healthcare Domain left a bad after taste to Clinicians and also to the rest of the users who were not in Billing.

After working for nearly 2 decades in the US Healthcare IT and interviews with various hospitals and hospital users it was clear that Indian Healthcare IT has not evolved or rather hospitals are now scared to upgrade because of the bitter experience they have had.

The need for a Healthcare Operating System is evident in Indian Healthcare IT, as the industry battles quality of healthcare delivery, availability of trained resources.

The Meta hOS (Healthcare Operating System) built with a lot of due diligence and users feedback is expected to deliver what was lacking in the industry.