Physicians face a multitude of administrative challenges that only seem to be growing day by day. At Comprehensive Physician Consultants, we work with a variety of physician practices in New Jersey, New York, Pennsylvania, Delaware and online. Here is a list of some of the consistent administrative challenges we see at physician practices and some suggestions on how you can address them.
Prior Authorizations
Despite promises to the contrary from payors, the number of prior authorization requests continues to increase, costing your practice time and money. A lack of response or no response from payers, increased time spent by your staff trying to gain approvals and a lack of automation in the process are difficulties that lead to delays in patient care and decreased patient satisfaction. Not only does this create headaches for your practice but it can lead to cases of treatment abandonment (when the patient does not follow through).
There isn’t a one-size-fits-all solution yet. But here are helpful steps you can take to minimize the burden:
Learn what payers want
Payers will have different requirements before authorizing tests like an MRI. If the payer requires an X-ray first, make a note of that for future reference and complete as many of the requirements as possible before submitting the prior authorization.
Assign a prior authorization champion
Having one staff person assigned to run point on prior authorizations will help that person learn what each payer wants and the best ways to get authorizations approved in a timely manner. This person builds relationships and minimizes patient attrition.
Keep detailed notes on each patient
It only takes one missing piece of information from a patient’s chart for a payer to deny the authorization. Always keep this in mind when documenting a patient’s condition and what tests have been done. If something is abnormal, document it.
Be persistent
Just because the first request is denied doesn’t mean you should give up. Some payers have staff with minimal medical backgrounds who review initial requests. They use key trigger words as a reason to reject a claim. An appeal most likely is reviewed by someone with more medical training.
Recruit the patient to help
Ask the patient to call the insurance company if necessary. Often, they talk with someone in a different department, may get a different answer or could gain clues on what is needed to get the prior authorization approved.
Escalate to someone with more authority
There is little point in arguing with someone over a complex medical issue if it is outside their expertise. Ask for a peer-to-peer review or, in extreme cases, to speak with the medical director or chief medical officer.
Staffing
Staffing continues to be one of the top administrative challenges for physicians across the board, regardless of whether it’s a physician-owned or hospital-owned practice. The challenge to recruit and retain support staff— medical assistants, nurses, and office staff — remains critically important for physician practices to succeed. Yet it remains challenging to manage compensation and costs in keeping with inflation.
The recipe for success hasn’t changed – increase pay and perks, have flexible work hours and listen to your team’s workplace improvement suggestions.
Here are some additional suggestions for keeping and finding new employees:
Be realistic about paying for office staff
Your clerical workers will take their organizational and customer service skills where they can make more money when they know that restaurants, retailers, or other businesses pay more than you do.
Your entire team should work at the top of their license
Maximize licensure at every level so that team members are doing the things that they were trained to do and not having to do things that other people in the practice could effectively do at a lower level of licensure.
Find ways to manage the workload
Piling more work on to everyone else if your practice is shorthanded could make the situation worse by causing your existing staff to become dissatisfied and look for new jobs. Look for other ways to manage the workload. Can you scale down appointment times or office hours or outsource work until the workload is manageable again?
Be flexible
Look for ways to make quick changes. Allow your team to brainstorm new ways to alleviate staff crunches – maybe it is patient flow or job sharing.
Be equitable and fair
Although there might be “bidding wars” and sign-on bonuses for new hires, you should not start new employees at higher salaries than staff with more experience.
Move new staff quickly to the midpoint
You might need to move recently recruited staff who are at a lower pay grade to a midpoint more quickly. And you might need to slow those at the higher part of the pay grade. Recruiting and retaining staff with minimum qualifications and less experience has become more difficult than keeping those with 10 or more years of experience who may stay with your practice for reasons beyond just the salary.
Patient Communications
Do you remember the days when the only way to communicate with a patient was in person, via landline telephone or by U.S. mail?
The explosion in technologies has provided many new communication tools such as telehealth, patient portals, text messaging and social media. Even the cell phone has presented many administrative challenges to physician practices with increased patient expectations being at the top of the list.
Patients expect the same ease and convenience in communicating with their doctor that they find when shopping or ordering a meal online. When they communicate with you, they want the convenience of connecting with you whenever and wherever they want – outside of office hours.
Your goal should be to create an approach that empowers patients to become active participants in their care.
Here are tips for using today’s technologies to improve patient communications:
- Determine what type of communication your patients prefer and use it as much as possible when communicating with that patient.
- Install and use as many different communication forms as your practice budget allows. Let patients know you have them and how to use them.
- Assign a staff member responsibility for monitoring the patient portal, including answering patients’ questions about how to use it and what information is available on it. Be prompt with triaging Portal messages and requests.
- Confirm you have the correct email address and phone number and there are times you may need to call the patient directly
CCM and PCM Coding
Providing care management services, including chronic care management (CCM) and principal care management (PCM), can be difficult.
Recent reports show that the number of patients who are going to need some sort of managed care – those with chronic diseases, those who are aging etc. – continue to grow. Added to this situation, managed care plans involve a good deal of administrative challenges around coding and documentation, so that physicians and their practices can get compensated for the time they spend on them. New codes, introduced in 2022, can benefit both physicians and patients but require understanding to make sure they are used correctly.
In early 2022, PCM codes were added. They are like CCM codes in that the work involves the establishment, implementation, revision and monitoring of a care plan for a patient. However, PCM focuses on a single condition rather than two or more. CCM involves monitoring two or more chronic conditions.
The coding and billing team at Comprehensive Physician Consultants can answer any questions you have about coding for these services.
Quality Metric Reporting
Quality metric reporting presents several obstacles. First, you must have physicians buy-in. Second, you must have a good quality and data analytics team to manage the program. Third, you’ll need a budget for expenses.
Most patients are interested in quality measures that convey information about a physician’s technical care and interpersonal skills. Typically, technical quality is measured using clinical information found in administrative databases, electronic health records or medical charts, whereas interpersonal quality is measured using patient surveys.
Quality metric reporting is useful but there is no standard definition of what constitutes a quality metric making it difficult to compare data across different organizations. Another challenge is that quality metrics often focus on process measures rather than outcome measures. This can make it difficult to assess if a particular intervention improves patient care. Also, some quality metrics may be subject to gaming, meaning that providers may focus on meeting the metric rather than on providing high-quality care.
To overcome the administrative challenges, it is important to work with an experienced partner who can help you collect accurate data and interpret the data in a way that will improve patient care.
Get Physician Practice Support Today
At Comprehensive Physician Consultants, our seasoned healthcare professionals have the experience to tackle the smallest or the most complex problem and projects. We can help your practice enhance patient engagement and access, improve outcomes, drive revenue performance and improve operational efficiency. If you have a question about your practice or our services, call us at 856-888-7796 or visit us online HERE.
