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Newsletter #3

Computerized Physicians not Computing

"Just thinking about all that computing power and the impact they (managed care plans) wield on the simple medical practice can make one cringe. But should it? Do these behemoths really have that much over the little guy? Physicians have computing power too. They just aren’t using it."

A few weeks back, while visiting a client’s practice I was chatting with the office manager about her HIPPA compliance efforts and the updated software package she’d been forced to buy, when she mentioned a doctor in the same building who had been boasting to his colleagues about not having to worry about the pending deadlines for HIPPA technology compliance. “Excuse me?” I asked. “Doesn’t everyone this side of the Canadian border have to comply?” No was her answer.

It seems this doctor does not use a computer. Let me repeat that. He does not use a computer. Instead he is the last of the last – a dinosaur still sending type-writer generated paper claims. This office manager and I laughed at how this doctor would get his when paper claims processing was finally put out to pasture – something we’ve both been hearing since the early ‘90’s.

On my way home, I couldn’t help but think of that doctor - the one who does not use a computer. It occurred to me that he really is not so far apart from his colleagues. I could count on one hand the number of physicians I had worked with over the past fifteen years of my career who could sit down to their computer - the one with the expensive billing software package - and generate a simple payer report about their practice.

So what is it that doctors are getting out of their expensive systems? By and large, they are using them for bill consolidation, electronic filing, and some basic A/R reports. To be fair, some use an electronic scheduler rather than a calendar book and a few have gotten fancy and rigged their software to an add-on system that calls patients by phone to remind them of pending appointments. That’s it. So are practices really getting their value out of their computers? No. The doctor who is sending paper claims may have to wait a few extra days (allegedly) to receive his A/R, but he isn’t paying $350 a month either.

Why is this true? It isn’t that they can’t use computers. Today’s generation of docs grew up with Bill Gates. The top reasons that physicians don’t take advantage of their systems are time, interest, ignorance, and inclination. The first two in this list are self-explanatory. The latter two go hand in hand. If you know what you’ve got, you’re more prone to use it - kind of like puberty. We’ve all heard, or at least imagined, the huge computer systems that managed care companies are allegedly using to carve out creative ways to keep from paying doctors for some or all of their claims. Others are at a minimum alleged to be delaying remunerations for services rendered. Just thinking about all that computing power and the impact they wield on the simple medical practice can make one cringe. But should it? Do these behemoths really have that much over the little guy?

Physicians have computing power too. They just aren’t using it. Take a moment and think of all the computer data entry fields the typical receptionist completes for every patient who visits a medical office. To just touch the basics, he or she fills in geographic data, demographic data, insurance source data, procedure data, and charge data. And when the EOB comes back, the A/R manager fills in payment data write-off data, time-outstanding in A/R data, etc. The short of it is that physicians have loads of information right on their desks. So why don’t they use it?!

Most office systems today have pre-designed reports that can provide a host of useful information. The better ones even have report-writers included - software that allows one with the “inclination,” to tweak the database to generate reports most any way the user asks. Used properly, a decent practice system should be able to answer most questions the physician or manager could wish to know about their business – aside from how much their competitors (aka their colleagues) are getting paid. So how should this problem be addressed?

To start, practices should invest a quick hour or two to review their computer’s practice software to see what it is they really are paying for under the hood. A review of the paper manuals and on-line menus can do wonders. If that doesn’t help, give the vendor a call. Ask them three questions: One - how do I access the list of pre-designed reports? ; two – does the software have a report writer: and three – when can you come show me how this thing really works so I can get my money’s worth? Raw as it may sound, don’t be afraid to ask the third question. Your vendor is still smacking his lips over those back-to-back Y2K and HIPPA upgrades he charged you a premium for on top of the basic package you bought maybe a year or two earlier.

Unfortunately, many software vendors don’t have a clue as to what practices really need to see. Oh yes, they may think they do. Most will fall all over themselves telling you about their pre-packaged monthly report designs that show everything from revenue by doctor, to charges by code. But when you ask them if they’ve got a report that will tell you what five zip codes are providing you with the highest volume of patients, and how much revenue is that exactly for the past three months (so you can target a mailing and not overpay); or, which managed care plans have A/R days in excess of industry standards (so you can wean yourself from your resource draining, low paying plans), expect either a blank stare or dead silence on the other end of the phone.

When you get this kind of negative reply, realize you must take control. Jump to question two – does the software have a report writer? Half of you may get a “yes,” the other half a “no.” If you get a no, ask if they can write you some custom reports. Either way you still should use your data, or most of the value of the computer is worthless to the practice - like water over a dam. You may as well go to paper claims while you still can and save yourself $350+ a month.

The reason computers are not being used to their potential is primarily inertia. In the early days of the computer, few practice systems had report writers. Those that did were cumbersome. They were incredibly expensive and few people took the time to really learn how to use them. They had practices to run. Fortunately, time has passed and more often than not an easy-to-use report writer is included with the package. But ironically they are still not being used. Why? The simple answer is, because no one did before. And what would be the value of them anyhow?

To paraphrase the analogy from above - “Until you know what you’ve got, you never will know what you’ve got.” This may sound stupefyingly redundant, but it’s true. If you don’t know the information exists, from a business perspective, your practice is ignorant. It is making decisions with less information than it has to.

So go on. Find out what you’ve got. It will be worth it – I promise. Pull those books and/or call your software vendor today. If you don’t get satisfactory improvement call a consultant – not a computer consultant, but a business consultant – someone who can access that information and show you how to put all that information you have to work to your benefit.

When it’s all pulled together, you’ll be amazed at what you didn’t know. You’ll be making intelligent business decisions about staffing, patient flow, A/R and managed care contracting based on facts. The best part is you’ll be making decisions that pay off for you now and forever more. The worst part will be looking back wondering why you waited so long.

In summary, use your office software package like you use your head. Tap its potential. Mine your information, and make intelligent business decisions like big business. It’s worth it. After all, it’s what you are paying for.

Art Pellett, MBA is Principal of HCF Enhancement, LLC, a medical practice consulting firm based in Nashville, Tennessee.

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