Everyone, and I do mean EVERYONE in healthcare should be searching high and low to find cost reduction measures that do not sacrifice quality! Whether it be a provider, service organization, purchasing organization, software vendor, or payer, costs are too high and reimbursements simply can’t keep up. So, if you are one of those organizations, what are you doing to meet this challenge? Status quo is not good enough. If you are repeating so-called standard process, you are probably only digging a deeper hole financially for either you or your clients/patients. It is time to think differently. The life of your organization could depend on it. If you don’t believe that, read about all the bankruptcies and hospital closings around the country due to financial difficulties. Look at the number of physicians leaving their practice for an alternative career.
Quality care is reliant on multiple variables, including provider quality and proper credentialing, facilities, diagnostic equipment, administration and facility management and all the other usual suspects. But what about the dirty “money” word. How do you provide quality care without sufficient funding? In schools across America we hear cries for funding to help maintain a certain quality of education. In most schools, supplies are now the responsibility of the student’s family. Will we start asking patients to bring their own needles for blood tests?
We reside in a global economy, but many healthcare organizations, including software vendors and some government organizations (are you kidding me?) still operate as if we are in isolation. That is first and foremost a contradiction in many ways to how we have voted, not to mention the way we purchase goods such as electronics, food and clothing. Furthermore, we emulate Einstein’s definition of insanity: “Do the same things and expect different results”. That is a head-in-the-sand mentality and just will not survive. It seems to me that when a government supports a global economy and then disallows the use of global resources to provide a service, that is absolute foolishness. And when a software company touting the best technology forbids users from taking advantage of lower cost off-shore labor, there exists a major disconnect. It is as if the rules of progress only apply to others.
In healthcare, medical billing is a critical success factor. That applies not only to the financial success of a provider organization but also to quality care and patient experience. In years past it went from not being a factor at all, to a latent success factor, and now to a necessity for financial viability. And quality must not be sacrificed because true cost always has a quality factor embedded. Initial price is one thing, but true cost comes because of price, efficiency and effectiveness. There are no shortcuts without penalty. Thinking otherwise is like believing a Chevy Chevette was as high quality a car as a Cadillac. Truth is, depending on the utility, the Chevette may have been a better value than the Cadillac, but that was because the price differential was HUGE.
There are many different tasks in medical billing and as of today, not all can be satisfied with technology. Some technology companies and even clearinghouses argue that their clean claim rate is very high when it is only a factor of what passes their technology muster to get sent off to the payers. If the technology is inferior, clean claim rates may be high but rejection rates by the payers may also be high.
In the end, human intervention is still very important in the medical billing process, whether it comes in the form of software development or claims processing (payment posting, charge entry, eligibility checking and so on). Human capital is costly to recruit, on-board, pay for and retain. Turnover is expensive and disruptive. Many organizations can’t keep up with these areas and must “pay” for the work to be completed by an outside source.
So why then, do such a relatively large percentage of organizations fail to take advantage of the global economy and search for quality resources at a fraction of the cost of local resources? Is it out of concern for our domestic economy? Is it merely a stand taken by a software company or government agency as mentioned earlier? Or is it simply an illustration of Einstein’s definition of insanity. None of these reasons are bullet-proof validations of the behavior. And for the most part, these are the only reasons not to make the change. The resources exist. Yes, be careful, quality can be an issue. Find the right partner(s) when you make the switch. But why not switch? If you prefer to fight than switch, good luck! You are a heavy underdog!