BMN Blog

MAY 25

When the Birmingham Medical News asked me to write a blog, they told me I could write about anything. Anything? Anything. 

So, I began thinking about a topic. Quality? Revenue Cycle Management? HIPAA? Covid? Value Based Reimbursement? Patient Engagement? I am not an expert in any of these things. I know about them and I know most of the details, but I am NOT an expert in all these subjects. Then I had an epiphany: I don’t know anyone who is. I know several experts in certain subjects, but no one knows everything.

I recently attended the Alabama MGMA meeting in Birmingham where I saw many people I knew along with plenty of new faces. Alabama MGMA always has a strong program with current topics and issues addressed and this year was no exception. There was lots of important information. And I felt so lost. Again, it struck me that this is typical healthcare – with information overload.

During this meeting, I saw a “retired” practice administrator, who like me, had continued education beyond the MBA and was also a Fellow in the American College of Medical Practice Executives. He had a simple comment when we spoke: “I don’t think I could know all the things that I would need to know to be an administrator now.” He is correct. But he is not the only one.

Why did YOU get into healthcare? Are you the altruistic type? Are you interested in technology? Maybe you love coaching people to reach a common goal? Do you like being able to perform more with less, and do it better than before? Or, like one person told me: “I get paid well and it allows me to provide for my family in the way I want to.”

It occurs to me that all of the above and more are good answers, but these are certainly not the only answers. In fact, be prepared for ALL of the above because healthcare has evolved so quickly that every day can be a challenge.

I don’t know anyone who is for fraudulent billing. But we have the policies, regulations, and criminal cases to suggest otherwise. So there are a few bad apples that use the system for ill-gotten gain. But it leaves the rest of us with an avalanche of information to filter through and put into action. Please don’t miss anything or it may cost you dearly.

Practice management has become a nightmare for the uninformed, and a headache for those who are informed. It amazes me that there are practices that are treating patients right now with no Notice of Privacy, no electronic EHR, no social media platform, and no concern of any government audit. Their only concern is taking care of patients. It is arguably the way to operate. If you want to truly take care of your patients and stay out of trouble with the government/insurance payers/licensure board/legal system/etc., you have a struggle ahead of you.

In many ways, trying to manage every aspect of a patient’s care is very demanding, and that is for the compliant patients. The non-compliant patients are a nightmare. I recently heard a patient complain that they could not get their medicine called in to the pharmacy. It did not matter that they missed their last two appointments or that they haven’t paid anything in years. It likewise did not matter that their provider was sick and in the hospital. What mattered was that they wanted their medicine, right then, because they said so.

So, in utopia, patients will always receive quality care in a timely, efficient manner from their provider and the provider’s staff. They will be engaged with their provider and staff, who are always available through the patient portal, or text, or any method of communication. The provider will always know everything about the patient, including the things the patient will not be truthful about. Every encounter will be clearly and carefully documented with all the appropriate standards of care followed. The appropriate charges will be submitted and the payment received in a matter of days. And the patient will always be happy with every outcome. Utopia would be a boring place.

Reality, on the other hand, is the challenge. The patient may have trouble getting through to the office. The instructions you gave were misunderstood. The man who just buried his spouse of fifty years is finding out he has metastatic CA, because he was too busy with her care to come in for himself. The drug seeking patient will act out in your waiting room because you will not give them their narcotic of choice. Your staff are tired, you are tired, and the avalanche keeps coming.

Nonetheless, we carry on and through it all, I hope you see the best in everyone, receive the best in everyone, and do the best for everyone.

Richard Stroud, MBA FACMPE is the Revenue Cycle Manager for Whatley Health Services.

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