InSights 

Giving Credit to Medical Credit Cards:

According to a JAMA study, over 180,000 medical settings have contracted with financial institutions such as Wells Fargo Health Advantage (Wells Fargo), Alphaeon (Comenity Capital Bank of Bread Financial), and CareCredit (Synchrony Financial) to offer their credit cards as methods of payment by patients.

Among the most common specialties for medical credit cards are podiatry, physical and rehabilitation   medicine, dermatology, orthopedics, and radiology. The report notes that other specialties work with medical credit cards, but these are the most prevalent. An interesting side note is that medical credit card usage is highest in the northeast.

Patients use medical credit cards to pay their balances either in full or after insurance reimbursement. Practices are typically provided with training and marketing/promotional materials to promote medical credit cards to patients.

The obvious benefit is that patients can fully satisfy their balances, with providers paying a nominal fee for obtaining the bulk of what is owed. This is especially significant since patients are often considered among the highest-paying groups in the US.

Medical credit card usage can also benefit patients, with companies often offering interest-free promotional periods. A report by KFF shows that most patients don’t satisfy their medical credit card balances during those promotional periods, which is no doubt why those promotions are offered.

Click here for the JAMA Network report and here for the KFF survey.

(ADSRCM clients [1] have access to our patient responsibility estimator, [2] use our automated prior authorizations option, [3] get eligibility verifications performed, [4] receive out-of-network alerts, and [5] accept any number of payment methods including medical credit cards, gift cards, and coupons. Patient statements can be emailed or texted; payments are supported directly through either format. And patients call us with statement questions. Our clients have an array of tools to keep their patient responsibility balances tightly managed and efficiency maximized!)

CMS Innovation Center: New Strategy Launched

Just this month, the CMS Innovation Center announced a new three-pronged strategy to:

• promote evidence-based prevention including services such as exercise and nutrition for a healthier lifestyle

• empower patients to achieve their health goals with tools including healthy living, virtual/remote care, and more

• support healthcare choices while driving competition by providing data on providers and their services, costs, and outcomes

In the process, alternative payment models (APMs) would be developed and/or remodeled.

Click here for the CMS press release and more details about the initiative.

(ADSRCM clients are assisted in reporting their data such as MIPS, so they comply with various CMS initiatives.)

Preventive Care: Patients aren’t there

One of the tenets in the previous article references providers offering more on areas such as exercise, nutrition, and living a healthier lifestyle in general.

Now comes an AFLAC survey that shows how badly that’s needed. The survey involved 2,000 employed people from 18 to 65 years of age. Of them, nearly 90% delayed in getting a checkup or other routine preventive screenings.

The most missed or delayed screenings include those for cancer. More specifically the following screenings show the percentages of those that were either delayed or missed completely:

Pap smear                           33%

Prostate exam                   32%

Colonoscopy                      32%

Mammogram                    31%

Blood tests                         31%

Skin cancer exam             27%       

STD screening                    22%

There are various reasons why patients miss or delay their appointments, with age often as a factor.

Click here for the AFLAC details.

(ADSRCM clients can use our recall texting feature to remind patients it’s time to schedule whatever screenings are needed and then use our interactive appointment reminder texting so they’re not part of the percentages above!)

Altogether, AI Applications Apply Aptly

Bottlenecks may be great when drinking at a barbeque. They’re not so great when they involve staff gathered around the fax machine handling incoming faxes or when patient flow is slowed because providers are fumbling around with their EHRs or devices during encounters.

Both types of bottlenecks can be overcome if you have – oxymoronically – real artificial intelligence working for you.  

• Incoming referral faxes are auto-read; patients and their referral reasons are identified and understood.

Your patient database is scanned virtually simultaneously; faxes are digitally attached if matches are made on patient records. Records are created for new patients, and those faxes are also attached. Either way, you’re alerted as they happen.

So far, no human intervention.

Next, since records and reasons have been identified and because there’s presumably connectivity to your scheduler, your bot scheduling assistant calls patients. In a human-sounding voice and any language, the Bot introduces itself as calling from your practice, mentions the referral and the referral reason, and, because of scheduler connectivity, can go ahead and schedule the appointment.

It can engage in back-and-forth exchanges so that the patient may never realize they’re speaking with a Bot.

So far, no human intervention.

Once the appointment is scheduled, prior authorizations are automated. They’re either obtained or you’re alerted if not. Eligibility verifications are automatically performed, and out-of-network alerts are generated when needed.

So far, no human intervention.

As adjuncts, interactive appointment reminder texts can start at user-defined times; patients can confirm or cancel through their texts. In the interim, patients can be alerted to your portal to self-serve on any number of levels without disrupting staff.

Yes, all of this can be automated if you have the AI-driven technology for it.

• The ambiance of frictionless encounters is supported if you have access to an AI-driven EHR platform that recognizes natural language/conversational data capture.

In other words (pun intended), you’d be able to converse with patients naturally but with the EHR ambiently in the background recognizing only the clinical speak. The ambiance helps complete their records and encounters by entering data intelligently on the fly while you’re focusing more on patients and less on your eyes and hands on your computer screen or device.

It’s like having an invisible scribe in the exam room with you.

Recap: Two kinds of bottlenecks you don’t want can be eliminated if you have the technology for it.

(ADSRCM supports these bottleneck removals with our comprehensive AI-driven fax option as described above, and with clients having access to the ONC-certified MedicsCloud EHR with its built-in MedicsScribeAI feature for ambient conversation capture, also as described!)

Clinical Decision Support: ROOTing for Radiology

Someone must’ve won a “Name that CMS Initiative” prize for coming up with the “Radiology Outpatient Ordering Transmission” (ROOT) Act.

In a nutshell, the Appropriate Use Criteria (AUC) initiative, which covers clinical decision support (CDS), had a few deadlines and then delay dates. But it may be coming back to life in the form of ROOT, a bipartisan bill to restart CDS.

ROOT would have the same premise: to ensure that referrers who order advanced imaging studies (CT, MR, PET, nuclear) for Medicare patients must have those orders confirmed by a qualified clinical decision support mechanism (qCDSM) system before those studies are performed.

The impetus for AUC/ROOT is the same as before: to root out expensive imaging appointments thought to be frivolous.

Getting qCDSM approval would be the referrer’s responsibility at the point of care. Ideally, the EHR being used would have an embedded qCDSM option in the background, which would automatically make decisions based on the type of study ordered and the patient’s present condition, complaint, and history. If given, an approval code (G-code) would be part of the referral to the imaging center, clearing them to perform the study.  

Less preferable would be a stand-alone qCDSM forcing providers to flip back and forth between their EHRs and the disparate qCDSMs, then having to enter G-codes into patients’ records and referrals manually.

The imaging center will get denials on their Medicare claims if advanced studies are performed without those G-codes. So, if ROOT passes, you can be sure imaging centers will scrutinize Medicare patients' G-Codes orders. Referrers will find it impossible to refer their Medicare patients for imaging as described if they don’t have G-codes for those referrals.

Emotionally, should you be insulted if you truly believe one of your Medicare patients needs a CT, for example, but the qCDSM thinks differently? Probably yes. But feelings aside, if ROOT happens, the imaging center won’t do that CT. Or, you’d have to uncomfortably explain AUC to the patient and why the patient must be a self-pay.  

The American College of Radiology (ACR) supports the ROOT Act to reduce Medicare spending.

Click here for the current ROOT Act details, here for background on the AUC, and here for the ACR article.

(ADSCRM clients can access the ONC-certified MedicsCloud EHR with its embedded qCDSM option. You’d get your G-codes on the fly, without exiting the EHR. Those codes, if issued, become part of the patient’s record and can be inserted into the orders.)