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There is a saying “Hope is not a strategy,” and while it’s believed to be a Vince Lombardi maxim about football, it could just as easily be about healthcare. There has been so much dazzle and promise about new technologies; if it’s all true, A.I., machine learning, automation and more are all the next big thing. However, the promise of “what is to come” may be causing some to pause or delay traditional efforts to curb today’s problems today:  staffing turnover/shortages, prior authorizations, medical records fulfillment, plus document indexing, routing and abstracting.  Rather than living with current challenges and hoping for technology to deliver on those promises, an approach worth considering is to keep eyes on the maturing of advancements in health IT while keeping hands on applying smart, efficient, process-driven and effective solutions available today. In essence, why wait for tomorrow’s technology when there’s a better, and available, solution to get you through today?

Automation, machine learning and the latest software apps hold tremendous promise, but they’re not for everyone, and they haven’t yet reached maturity as solutions. Today’s technology, while possessing incredible potential and increasing capability, only solves part of the problem with growing burdens like prior authorization (PA). For example, only a portion of automated PAs are truly “one click” authorizations. The rest require additional manual steps and research, not to mention multiple contact cycles with health insurance payers. To bridge some of the product gaps that require manual intervention – and get the full extent of the benefits available from the technology – there’s often considerable set up and integration required, which mandates resources most healthcare providers don’t have. Likewise, the technology price tag is often prohibitive for the small- and mid-market provider groups.

The cost of automation for prior authorization and the inherent data gaps that remain after applying automation leave many physicians and healthcare groups to abandon improvement efforts and stick with the “old fashioned way” by having their staff members handle all the steps of PA. Some organizations have clerical or specialized revenue cycle management staff tackle the requirements of PA, but the majority, some 71% according to our research, utilize clinical staff to complete prior authorizations[i]. That means higher-dollar resources such as nurses, medical assistances, etc. are logging into web portals, making phone calls and sitting on hold with insurance companies rather than attending to the needs of patients, supporting physicians or otherwise adding value to and improving the healthcare organization.

In the current environment of prior authorizations, these valuable clinical staff members are simply dealing with the red tape to get reimbursement for services that some may argue (in far too many cases) shouldn’t have needed the blessing of payers in the first place. By using clinical staff for busywork tasks, healthcare groups run multiple risks:

  • Paying higher clinical staff rates for clerical work
  • Further burdening their staff when studies show 73% are already burnt out[ii]
  • Offering less attractive positions for new clinical staff in a highly competitive job market where clinicians can choose where they work[iii]

What’s more, healthcare organizations are in the business of healthcare – not clerical work. While it may seem obvious when stated that way, it’s not apparent in practice when so many physicians and provider groups keep their clerical work in-house. When healthcare organizations utilize their own staff, whether clinical or not, to handle PAs they often haven’t had the time or ability to develop optimized workflows, standard processes or quality training documentation, nor have they done time and motion studies to continually gain efficiencies and reduce extra steps.

Healthcare groups also don’t tend to manage clerical staff to hard-and-fast KPIs (key performance indicators) like pace and accuracy. Most healthcare organization apply a “do whatever it takes for as long as it takes” mentality to their administrative work like prior authorizations, medical records releases and document filing because – to restate the obvious – they’re focused experts in HEALTHCARE, not business process optimization.

This all leads us back to why too many in healthcare are hoping for a technology solution – because in reality, running a high-performing, lean, efficient and fast-paced clerical environment is hard. It’s especially difficult when healthcare leaders fear turnover in an economic climate that makes replacement staff scarce and where even clerical staff can be poached for $1 more per hour. Driving staff to speed their work and juggle multiple processes simultaneously can be so difficult, in fact, that those overseeing healthcare operations sometimes knowingly operate their administrative functions at a loss (slower and with less accuracy) mainly because there are no seemingly feasible fixes. But that is not necessarily the case.

 

While We Wait for Robust Technology and Automation

While some in healthcare favor (or simply accept) the status quo, we’ve decided to provide solutions to this ever-growing problem of manual tasks inside healthcare organizations from prior authorization to insurance verification to release of information to document filing. Instead of waiting for automation to swoop in and save the day, we’re focused on solving the challenges that physicians and provider groups are facing NOW.

Specifically, with prior authorization, the keys to success with administrative processes revolve around efficiency, redundancy, and yes, some technology. To be fair and transparent, most of what we do is not magical. Yes, we have some technology that allows for multiple sessions and enhances our speed, but mostly, we just have the ability to stay laser focused on workflow optimization, clerical skill development and managing to objective, measurable KPIs. We can work with available technology tools on the market or simply apply our expertise to the existing manual processes that most healthcare groups have…or both.

Probably the best news for healthcare groups waiting for technology is that if they’re willing to offload their manual processes whether PA, records processing, filing or otherwise, a partner like DataFile can, in almost all cases, reduce overhead expenses or remove the cost altogether[iv]. There’s really no downside to placing manual tasks with a specialized resource who can do them better/faster/cheaper. The struggle isn’t usually a financial one – but rather a feeling of loss of control, which is why we ardently focus on providing clients with transparency and data so they can see the work being done, track progress and realize the benefit.

 

Hoping for Technology, Waiting for Regulation, Preparing for Reality

The promise of technology is all around us. Healthcare is just one more arena where apps and gadgets and platforms abound, and new names and logos spring up at HIMSS every year only to be gone the next. Thankfully, thought leaders like Dr. Don Rucker, head of health IT for the Health and Human Services Office of Civil Rights, are trying to tackle the mounting challenges of prior authorizations at the source by relaxing payer requirements. We share the industry’s hopes for these automation advancements and regulatory improvements. However, until healthcare organizations see the shifts and realize the benefits of regulation and technology, we will serve as a valuable partner to solve these business challenges for as long as providers need us.

 

About DataFile

DataFile provides turn-key solutions to streamline, standardize and centralize medical records, health information management and clinical workflows for healthcare organizations of all types and sizes. We are a trusted partner to many of the nation’s leading EHR companies, facilitating a more timely, accurate and secure flow of health information. If your organization is struggling with the frustrations of managing your health information internally, looking to shift from a current provider of services or facing roadblocks to interoperability, spend some time getting to know DataFile.

Prior Authorization | Release of Information | Records Filing | Standard Forms Completion | Chart Abstraction | HIM Professional Services

[i] DataFile Technologies, 2019 Prior Authorization Survey
[ii] MGMA, 2018. Guarding Against Burnout in Your Practice. https://www.mgma.com/data/data-stories/guarding-against-burnout-in-your-practice (accessed July 19, 2018)
[iii] Tony Colarossi, https://www.fiercehealthcare.com/hospitals-health-systems/industry-voices-rising-salary-demands-require-a-dose-creativity-and, Feb 26, 2019
[iv] Release of Information outsourcing to DataFile can often be at zero-cost

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