MetahOS Helps Reduce Accounts Receivables for Hospitals

MetahOS - Finance Head

The revenue cycle is the central nervous system of any healthcare enterprise. It communicates and coordinates information about the system’s most important relationship with Patients, Providers, and Payers. An integrated revenue cycle will help healthcare systems strengthen these relationships. MetahOS Helps Reduce Accounts Receivables for Hospitals. 

What Are Accounts Receivables (A/R)?

Accounts Receivables are simply money that has already been earned but not received by hospitals when a hospital bills its insurance companies (payers) for treating their subscribing patients, resulting in outstanding payments owed to the hospital by the payers.

Who are these Payers?

These Payers typically are:

  • Private Insurance Companies: Bajaj Allianz and any other Health Insurance Companies
  • Corporates & MSMEs: Industries, Railways which contract a hospital to provide care to their employees
  • Government Schemes: Employee State Insurance (ESI), ECHS, Ayushman Bharat, Arogya Bhagya, and countless other state and central government schemes.

Understanding Your A/R Report

A hospital’s Accounts Receivables report lists all inpatient and outpatient services rendered to patients during a given period. These reports are used to determine how much a patient owes the hospital for services and/or supplies. 

A mid-size hospital’s A/R is typically 1-year of EBIDTA, and, in some cases, it might go up to 2-years of EBIDTA.

Root Cause Analysis: Why Does A/R Increase?

An increase in Accounts Receivables starts when the patient is admitted and multiplies each day for every mistake across the patient journey. Most often, the delay in Receivables is due to lapses at the Hospital end.

 

Metahos Healthcare Operating System Integrated Receivables Management System Increase in Accounts Receivables

Below are the 6 common root causes of delay in A/R

  1. Patient Admission/Registration

    1. Unavailability of Patient Checklist for Eligibility
    2. Efficient Screening Process
    3. Staff Training Issues
  2. Ward

    1. Delay in Updation of Records
    2. Incomplete File
  3. Reports

    1. Delay in Radiology Reports
    2. Delay in Lab Reports
  4. Billing

    1. Random Selection of File for Bill Processing
    2. Delay in Investigations Report
  5. Government & Validation Desk

    1. Unavailability of Patient-Centered Counselling
    2. No Requirement to Enter a Discharge Summary
  6. Claims

    1. Absence of Process Monitoring
    2. Shortage of Man Power

How to Overcome These Pitfalls

Hospitals need to bring in change through the following 6 drivers.

  1. Revenue Realization

    • Improve revenue growth by decreasing A/R
  2. Increased Productivity

    • Decrease time taken to submit claims by at least 50%
  3. Service Delivery Improvement

    • Measures to improve the flow of documents between departments
  4. Cost Reduction

    • Reduce cost by enabling single entry, multi-use
  5. Treatment of Operational Risk

    • Reduce PEOPLE dependency; increase PROCESS dependency
  6. Compliance

    • Stay compliant while improving processes, training, and enabling technology

Risk Awareness and How to Mitigate

Knowing your risks is half battle won! As Sun Zhu, the author of Art of War, says, “If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained, you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.

Some of the common risks include:

  1. Systems are not interoperable nor integrated, thereby creating duplicate transactions on multiple systems.
  2. Too much dependency on Human Resources rather than processes.
  3. Unaware of daily vital statistics to the running of a hospital.

Recommendations for Operational and Financial Gains

Identify Bottlenecks and Fix

Like a supply line in a manufacturing company, the files move in a predefined order. Still, every process creates bottlenecks if the implementor does not understand the Theory of Constraints.

Baseline Performance Profile

For consistent data to assess action areas, proceed with data collections, and Revenue Cycle improvement.

IT Optimization

An ongoing process that uses best practices and solutions to remove gaps. Also, initiate Continuous Improvement Process (CIP) and award best practices.

Patient-Centric Revenue Cycle

A Patient-Centric Healthcare System would improve care delivery and provide seamless integration across scheduling, registration, arrival, care delivery, billing, post-care, collections, and be key for revenue integrity & market leadership.

Hospitals can now benefit quickly from MetahOS Integrated Receivables Management System (IRMS), as it can work alongside any Health Information System (HIS). Along with IRMS, you also get

  1. End-to-end transformation

    Deliver comprehensive revenue cycle services, including process redesign, technology enhancement, organizational design, and performance management.

  2. Revenue cycle business intelligence

    Conduct root cause analysis of revenue leakage to identify net revenue, reduce bad debt, and accelerate collections.

  3. Charge integrity and reimbursement

    Drive net revenue improvement through an enhanced mid-cycle process.

    • Meta hOS Accounts Receivables Simplified
  4. Revenue cycle systems implementation

    Plan, design, and implement technology systems.

  5. Revenue cycle tools

    Automate workflow processes and enhance reporting capabilities through IRMS.

Currently, 80% of all Hospitals are not utilizing the power of the Integrated Receivables Management System.
The lack of integrated tools leaves hospitals frustrated with not getting paid on time and with no time to handle their receivables. This is where MetahOS Helps Your Hospitals Reduce Accounts Receivables.

The Role of Health Information Technology in Post Acute Care

Post Acute Care and Health Information Technology

Introduction
In the British Medical Journal post ‘The Stress of Sending Patients Home’, physician David Oliver recalls how he was publicly threatened by the relative of a patient in the supermarket. Seemingly, the patient had suffered from complications after he had been sent home, and the relative was unhappy with the doctor’s decision to discharge the patient. Oliver goes on to state post-discharge problems are a growing concern.

Although Oliver admits that there is no single solution to solving such problems, he suggests that post-acute care could be a panacea for improving patient care outcomes. In this context, this blog highlights the problems in post-acute care and suggests how post-acute care strategies can be developed effectively using health information technology.

Post-Acute Care
Post-acute care is defined as the ‘rehabilitation or palliative services that beneficiaries receive after, or in some cases instead of, a stay in an acute care hospital’. After the hospital stay, a trouble-free transition is essential for ensuring that readmissions are low. However, at present, a disproportionate focus is placed on the quality of care received by the patients during the hospital stay, and post-acute care tends to be overlooked.


[Transition in Care. Adapted from http://ahhqi.org/images/uploads/Revolutionizing_Healthcare_Pam_Duncan_Article_05-08-13.pdf]

Data Integration
For ensuring the smooth transition between care settings, providers undertake the process of discharge planning. This includes outlining activities ranging from follow-up tests and appointments to the usage of exercise equipment for the patients. However, fragmentation in data systems prevents providers from getting a comprehensive picture of the patients’ requirements. In order to overcome this problem, providers could use an integrated Electronic Health Record functioning across different care teams. At the same time, a real-time communication channel between different care teams could help in the meaningful interpretation of data present in the EHR. This would allow providers to get the necessary information to plan the discharge process.

 

Follow-Up Consultations
Follow-ups are essential for monitoring the disease parameters, and failing to do this could result in future complications. Evidently, the problem of irregular follow-ups has worsened due to the perception of hospitals being high-risk zones during the ongoing pandemic. To ensure the successful follow-up of patients, providers could consider the usage of telemedicine. Telemedicine can allow remote monitoring, and ensure that the patient is able to successfully manage the disease post-discharge with the assistance of his provider.

 

Patient Education
Essentially, post-acute care involves equipping the patients with the ‘skills required for caring for themselves.’ However, in a short amount of time, transferring these skills to the patients could be difficult. For making sure that this information stays with the patients, providers can make use of health information technology tools. This could include a digital record of the necessary information, along with baseline assessments to ensure that the patient understands what has been told to him at his own time.

 

 

In conclusion, it is evident that technology could help us improve post-acute care. However, to ensure widespread adoption, it would be essential that these technologies are both provider-friendly, and patient-centric.

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

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.