Using Technology to improve Your ASC Colorado Ambulatory Surgery Center Association Contact Information: Medi. Gain Inc. 1 -877 -237 -9539 mel@medigain. com www. medigain. com Medi. Gain Confidential
Medi. Gain Some Technology Usage Facts Preserving Healthcare Profits Before ¯ First IBM PC is launched in 1981 ¯ Motorola releases first mobile phone for $3, 995 in 1985 • Cellular Technology Industry is formed in 1988 ¯ The world wide web as we know it today launched in 1991 • Hotmail is launched in 1996 ¯ HIPAA Introduced in 1996 Now ¯ Computer ownership in the USA – 80% of population ¯ Mobile phone ownership in USA – 81% of population ¯ Internet usage in USA – 73% of adults • Google maps show pictures of your street and house • You. Tube used to watch movies and elections ¯ More than 80% of ASC’s and Physician practices still use paper medical records Medi. Gain Confidential 2
Medi. Gain Healthcare vs. other Industries Preserving Healthcare Profits ¯ Retail Industry • Find your favorite store, clothes and sizes • Purchase online, and track shipping to your doorstep • Understands customer needs and trends ¯ Airline Industry • • Find destinations, schedules, type of airline that flies Purchase tickets online - select seat, food etc. Check status via internet, phone or text – notifies schedule changes Receive promotions based on customer preference and history ¯ Healthcare Industry • • • Medi. Gain Confidential Minimum or if any web presence Most cannot schedule appointments online – no notification on delays Minimum knowledge and tracking of information about patient habits No infrastructure to share information – loads of paperwork Medicare takes 6 months to issue or change a new provider number 3
Medi. Gain Why Utilize Technology in the ASC Preserving Healthcare Profits One of the key building blocks of an ASC: ¯ Technology ¯ Processes ¯ Resources Can provide the following benefits: ¯ Increase revenue ¯ ¯ ¯ ¯ Decrease costs Technology ASC Processes Resources Improve efficiencies Decrease errors Improve visibility to operations Use it as a strategic advantage over competition Meet government and regional mandates Meet consumer expectations Medi. Gain Confidential 4
Medi. Gain Preserving Healthcare Preserving Profits Typical ASC Structure Profits Front Office Back Office Clinical < 20% of Revenue >80% of Revenue From Cash From Insurance Patient Care Customer Service Transcription Coding Billing Collections Follow up Medical Records Scheduling Insurance Verification Patient Info Electronic Claim Processing Paper Claims and Statements Patient Forms Medi. Gain Confidential Diagnosis Procedures Dictation Inventory Management 5 Reporting Analytics Business Intelligence
Medi. Gain Potential Revenue Losses in an ASC Preserving Healthcare Preserving Profits Revenue Lost by Typical Facility Profits ASC’s Have Already Done Work and is Owed 100% -5% Patient Registration/ Eligibility Verification Lack of proper front office processes and systems impact reimbursements -4% Fee Schedules/ Charge Master Charges need to be updated and compared with national averages -10% Transcription/Coding Poor transcription and inaccurate coding can lead to denials and lost rev. -3% Claim Submission Almost 3% of claims are lost by insurers after positive receipt by clearing house -3% Secondary Insurance & Patient Portions Many do not send or follow up on secondary and paper statements -5% Payment Posting/Follow up Inaccurate posting can result in inaccurate statements, follow up, and collections 20% - 30% Potentially Lost Revenue Loss of 20% to 30% of the money you have already worked for! Medi. Gain Confidential 6
Medi. Gain What Processes Do You Automate? Preserving Healthcare Profits Pre-surgery Process Manual Solutions X Web integration to PM System 2. Ins Verification x Scheduling and clearing house integration 3. Patient Confirmation X PM Sys and Telephone/Email integration 4. Chart Preparation >82% Electronic Forms and Document Mgnt Sys 5. Dictn. /Transcription Post Surgery Claim Prep. 1. Scheduling >26% Integrated Transcription and PM System 1. editing X Online editing capability 2. Signature X Electronic signature system 3. Distribution X Web, fax and Email distribution >82% EMR and Electronic Forms with Bar-coding 6. Document mgmt 1. Medical X Scanned or electronic health record 2. Reports X Scanned or electronic health record 3. Forms X Scanned and indexed 7. Coding Medi. Gain Confidential EMR/Coding Engine X 7
Medi. Gain What Processes Do You Automate? Preserving Healthcare Profits Process Manual Solutions Post Surgery - Claim Proc. Charge Entry X Integrate Registration and EMR 9. Claim Scrubbing X Integrated coding engine and edits 10. Claim Submission X Clearinghouse integration with PM System 11. Claim Acknw. X Clearinghouse integration with PM System 12. Payment Receipt X Bank lockbox with web based doc. view 13. EOB/PMT Posting X ERA with integration to PM System 14. Denial Mgmt. X Denial tracking, automated appeals 15. Post Surgery -Other 8. Reporting X Data capture and business analytics 16. Prescription/Labs X Prescription and Lab integration with PM system 17. Materials mgt. X Integration of PM Sys. and Clearinghouse 18. Patient info. X Web portal with Integration - Med Rec &PMS 19. Marketing X Data capture through PM System/Web/Tel Medi. Gain Confidential 8
Medi. Gain Asses Current ASC Situation Preserving Healthcare Profits ¯ Technology • Age and efficiency of current systems • Tasks that are done manually but can be be automated ¯ Staff • Knowledge of IT staff, and time allocated for technology planning ¯ Management • How the organization implements and integrates technology related decisions ¯ Financial • Budget and availability of funds for technology implementation, support and maintenance ¯ Conduct needs assessment by functions • Front office – Scheduling, patient access • Clinical – Materials management, lab/pharmacy integration • Back office - Billing, Collections, Patient data gathering and distribution Medi. Gain Confidential 9
Medi. Gain Preserving Healthcare Profits Items to Consider When Investing in Technology ¯ List benefits and calculate ROI • Staff time that will be saved per month x $/hr • Increase in revenue per month i. e. reduction in claim denial ¯ Set IT roadmap and priority based on highest ROI and budget ¯ Selecting vendors • Ability to customize, web based • Customer service, and customer feedback ¯ Other key IT considerations • Capability to integrate to other systems and other facilities i. e. physicians, hospitals via HL 7 • Web enabled access for ease of management and maintenance • Data exporting, mining and reporting capabilities ¯ Phased deployment • Phase the deployment to ensure all stakeholders become familiar with new systems – MD’s, staff, patients • Set project plan and realistic timelines Medi. Gain Confidential 10
Medi. Gain Preserving Healthcare Preserving Profits Ideal ASC Workflow Profits Digital Forms Transcription Web Surgery Coding Phone Billing/ Collections Posting Insurance Reporting Analytics Patient Medical Record Medi. Gain Confidential Referring MD Inventory Management 11 Bank
Medi. Gain Preserving Healthcare Preserving Profits Example of Opportunity Profits Assuming an average ASC Current revenue generated = $5, 000/yr Conservative estimate of improvement = 10%-15% Total revenue increase/yr = $500, 000 to $750, 000 Total revenue increase/mo = $41, 666 to $62, 500 Note: This does not include any cost savings due to increase in efficiencies. Medi. Gain Confidential 12
Medi. Gain Where do you want your ASC to be? Preserving Healthcare Profits ASC Technology Maturity Model Level 1 Level 2 Level 3 Level 4 Paper records Some Scanned records Standalone EMR Manual entry Min. automation of processes Some Automated processes Some delays in billing Smooth workflow Optimized workflow Some electronic claims Min delays in billing Ave. collections Consistent collections and cash-flow Automated billing and coding Manual processes Paper claims Delays in billing Poor collections Poor cash-flow No reporting Obsolete systems Overworked staff Reactive management Afraid of IT Medi. Gain Confidential Poor cash-flow EMR accessible to patient/ext. entities Automated processes Optimized cash flow Basic reporting New but disparate systems Dashboards & Buss. Intel Some integration of systems Minimal reporting Fully Integrated systems Adequate staff levels Overworked staff Some proactive management Reactive management IT is an afterthought Embracing IT 13 Optimized staffing Leader in industry Proactive management Using IT as its advantage
Medi. Gain Questions and Answers Preserving Healthcare Profits Medi. Gain Confidential 14
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