Letter from the President

As I walk my dog through our neighborhood I enjoy the creativity of Halloween decorations.  One house displays two skeletons in their front yard. Every day the skeletons are engaged in different activities. I can imagine the joy experienced by the entire family as they plan the activities and put them in place every day/night!  Seeing that display reminds me of another from years ago. The house at the corner of our former neighborhood always created an elaborate display. One year they set up a graveyard, complete with various graves, vampires, zombies, bodies in various stages of decay, you get the idea.   What really set it apart was their use of motion sensors that caused moans to play and a dead body to rise from the grave when anyone walked or drove by. They setup this display in varying arrangements over the span of a few years.  One reason I remember it to this day is because it scared my dogs every morning as we walked by. It still brings a smile to my face recalling those walks with my dogs and reminds me that we are all kids at heart. 

Recently I overheard a discussion between an older individual and a teenager urging the teen to hang in there through some trying high school experiences. “Things will change when you are an adult.”  I’ve heard that statement or comment at many different times over the years. Today, as I type this letter, I really don’t believe it to be true. Witnessing the behavior of staff, friends, supervisors, even providers over the years; the individuals involved may be older, but the basic behaviors are still the same.  Perhaps these are behaviors that some adults have never outgrown. Perhaps they don’t even realize they are being inappropriate in their actions. Group dynamics play a part in how pervasive these behaviors can be to a team.  Getting to the root cause of why people behave in one way or another can help one’s attempt to limit the effect on a team dynamic in the workplace.  This is no small task.   I’m sure we all deal with this on a daily basis. Gossip, manipulative behavior, “back-stabbing”, bullying—all on full display.  But let’s think of some of other, perhaps more positive behaviors.  Those personalities or behaviors exist as well, but perhaps not as apparent on the surface.  Who doesn’t have a “class clown”, cheerleader, or jock on their teams?  How does one attempt to limit the disruptive behaviors that can create a less than desirable working atmosphere and encourage the positive?  I’m not going to lie; it’s a constant struggle for me.  My own experience has been to recognize those undesirable behaviors, at times very cleverly disguised, understand the team dynamic that is the apparent root cause, and then work to effect change within the group dynamic. Believe me, I don’t have the answers, but I will continue attempting to minimize the disruptive behaviors, encourage the positive, and strive to create happy, efficient, functioning teams. Circling back to my original thought—we are all just kids at heart—we are.  But let’s try to be better than those kids we once were, and still are. My bottom line—don’t let anyone fool you, adult life is just like high school.  The difference is that everyone is older, more experienced at exhibiting manipulative behavior and makes more money. 

If you want to learn how to create great team engagement, and maybe overcome some of those negative team dynamics, sign up to attend our virtual  summit event this month—Putting the Order Back in Disorder. Six hours of CEU credits over two mornings from the comfort of your own desk!  Hear from multiple subject matter experts sharing their wisdom on employee engagement, patient engagement, and CMS updates to name a few. All for one low cost of $99 for members and $159 for non-members, group rates are available as well. Why not invest a few hours of your time to gain some new insight and refresh your own perspective. Aren’t you worth that investment?  Do it for the kid in you!   #PAMGMACares. 

Traci Evans, FACMPE
Pennsylvania MGMA, President

Embracing A Better Revenue Cycle Strategy

Why it’s time to retire outdated manual approaches

By: Maryanne Thompson, Controller, MidLantic Urology of Pennsylvania, and Matt Seefeld, Executive Vice President and Head of Revenue Cycle, MedEvolve
[SPONSORED]

Science moves at the speed of light, and today’s physicians are quick to embrace new best practices and better approaches to medicine. When it comes to optimizing the operational bottom line, though, many provider organizations are hesitant to give up traditional manual approaches to revenue cycle management and embrace forward-thinking, data-driven models.

The reality is that the benefits of technological advancement touch every area of the healthcare industry. Revenue cycle management is no exception, and strategies aimed at improving revenue capture and cash flow through a holistic approach that engages automation and analytics with the right governance strategy should be a priority—especially as providers are facing some of the tightest operational margins in modern times.

For MidLantic Urology, a rapidly growing practice serving patients across 15 communities in Philadelphia’s suburbs, having a strong technology partner, like MedEvolve, in place to address workflow processes and financial clearance proved a game changer when COVID-19 entered the picture. With Pennsylvania being one of the first states to lock-down, the automation solutions gave management visibility into staff productivity and the ability to communicate effectively virtually as they all worked from home. Workflow automation and data transparency helped the multi-location group of more than 70 physicians maintain sound financial health. This strong financial outlook even positioned them well to attract private equity investors in the midst of a pandemic.

Financial Clearance—Capitalizing on Patient Responsible Balances

In the early months of the crisis, healthcare organizations were grappling with the “unknown” and just trying to capture as much revenue as possible to stay afloat. Elective procedures were grounded, and interaction with payers was inconsistent at best as many health plans were trying to figure out their own business continuity plans. Simply put, getting prior authorizations and referrals for life-giving therapies and injections that had to continue daily was challenging for MidLantic Urology.

The ability to collect patient responsible balances—an area that often accumulates into bad debt in today’s practices—became an imperative. Having the MedEvolve financial clearance solution in place ensured billing staff were equipped with all the information needed in real-time—demographic, insurance and benefit information—to make patients aware of their financial responsibility and collect balances prior to rendering services. Attempting to stay ahead of self-pay data manually would have required a significant increase in staff and was simply a non-starter.

A robust analytics and reporting mechanism also ensured that billing staff could identify the number self-pay patients scheduled in a month and prioritize collections up front through dashboards and reminders.

Aside from the impact of COVID-19, financial clearance strategies are paramount in today’s healthcare climate amid the rise of high-deductible health plans. While patient care is the number one priority, providers must commit to requiring that missed payments are reconciled before a patient can schedule a new appointment to ensure a sustainable future.

Improving ROI through Workflow Automation

The ability to quickly mobilize a virtual workforce was critical for maintaining a healthy bottom line when stay-at-home orders were enacted at the onset of the pandemic. MidLantic Urology’s workflow automation solution gave administrators the confidence that they could maintain control of billing activity, while optimizing communication and education.

As much as 80% to 90% of claims do not require immediate follow-up, yet many billing departments get bogged down with work that does not have potential to produce near-term return on investment (ROI). Powered by artificial intelligence, the workflow automation tools were able to drill down into claims and provide immediate visibility into activities that had the most potential to generate revenue. Rather than manually combing through hundreds upon hundreds of claims lines, MidLantic Urology could immediately identify the best use of time and assign staff tasks that will improve productivity. The team also gained invaluable insight into such areas as the value of accounts receivable (A/R) currently being worked, existing cash opportunity, claims assigned to a collector, A/R status and more.

Notably, virtualization stands to give practices a competitive advantage going forward in terms of their ability to recruit and retain employees. Consequently, practices will need to align billing strategies with these trends and gain transparency into remote workflows.

Better Patient Experiences

Access to data ensures that MidLantic Urology can proactively communicate and educate patients about their healthcare costs. Patients appreciate streamlined procedures that minimize the amount of time they spend at the front desk and eliminate billing surprises on the day of an appointment.

While having the right technological infrastructure in place to support revenue cycle is an important operational strategy, it also delivers significant ROI on the patient experience front. Forward-thinking physician practices recognize that taking steps to improve business and operations now— and creating an open dialog with their patients — is the key to long-term sustainability.

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About the Authors

Maryanne Thompson

Maryanne Thompson is the Controller of MidLantic Urology of Pennsylvania, a rapidly growing practice serving patients across 15 communities in Philadelphia’s suburbs.

Matt Seefeld

Matt Seefeld brings 20 years of management consulting experience in the healthcare industry. He has extensive expertise in the assessment, design and implementation of process improvement programs and technology development across the entire revenue cycle.

OSHA Issues COVID-19 Emergency Temporary Standards  - Mandatory Safety Measures for Healthcare Employers

By: Jaime Tuite, Buchanan Ingersoll & Rooney

On June 10, 2021, the Occupational Safety and Health Administration (OSHA) issued a long-anticipated Emergency Temporary Standard (ETS) to address the impacts and mitigate the spread of COVID-19 in the workplace. While the Biden Administration initially asked OSHA to consider rolling out an ETS applicable to all or most employers, OSHA limited the ETS to healthcare employers whose employees face the highest COVID-19 hazards as a consequence of treating suspected or confirmed COVID-19 patients.

With some exceptions, the ETS applies to hospitals, nursing homes, assisted living facilities, emergency responders, home healthcare workers, and ambulatory care facilities. The ETS does not apply to healthcare settings where there is a low risk of COVID-19 transmission, such as pharmacies in retail settings, telehealth services provided outside of a direct patient care setting, and well-defined hospital ambulatory care settings or home healthcare settings where all employees are fully vaccinated and all non-employees are screened prior to entry for COVID-19 symptoms. OSHA created a flowchart to assist healthcare employers to determine if they are covered by the ETS.

Healthcare Employers Covered by the ETS

Under the ETS, covered employers must implement various safety measures, including:

1. Adopt a COVID-19 plan, which must be a written plan for workplaces with more than 10 employees. The plan must, among other things, create a designated safety coordinator, provide for workplace-specific hazard assessments, and create policies and procedures aimed at minimizing the risk of transmission of COVID-19 to employees.
2. Provide and require the use of appropriate PPE, including facemasks and respirators.
3. Implement appropriate physical distancing and the use of physical barriers.
4. Follow cleaning and disinfecting practices per CDC guidance.
5. Ensure HVAC systems provide appropriate ventilation.
6. Provide reasonable time off and paid leave for employees to obtain vaccinations and recover from any vaccine side effects.
7. Conduct health screenings before each workday and shift and notify employees about potential exposures to COVID-19 in the workplace.
8. Remove employees who have COVID-19 or who might be contagious from the workplace, and provide them wages and benefits (subject to wage caps based on employer size) if they are unable to work remotely.
9. Provide employee training on workplace policies and procedures for mitigating the risk of COVID-19 transmission.
10. Report work-related fatalities from COVID-19 within eight hours of learning about the fatality and within 24 hours of each work-related COVID-19 in-patient hospitalization.

Covered employers must comply with most of these requirements within 14 days after publication of the ETS in the Federal Register. They will have 30 days to comply with the provisions addressing physical barriers, ventilation and training.

Voluntary Guidance for All Other Employers

For all other employers not covered by the ETS, OSHA issued updated (non-mandatory) guidance. In its updated guidance, OSHA states that unless otherwise required by law, most employers no longer need to follow measures to protect fully vaccinated workers. Instead, OSHA recommends that employers focus protections on unvaccinated and otherwise at-risk workers (workers with immunocompromising conditions, cannot get vaccinated, or cannot use face coverings).

For unvaccinated and at-risk workers, OSHA recommends that employers implement/maintain multiple layers of controls that include:

1. Separating from the workplace people who have COVID-19 or who have COVID-19 symptoms, as well as unvaccinated employees who have close contact with someone who tested positive.
2. Maintaining physical distancing for unvaccinated and otherwise at-risk workers in communal work areas.
3. Maintaining ventilation systems.
4. Performing routine cleanings.
5. Providing unvaccinated and at-risk employees face coverings and other needed PPE.
6. Suggesting that unvaccinated customers, visitors and/or guests wear face coverings.  

Finally, in its updated guidance, OSHA encourages employers to take steps to make it easier for workers to achieve full vaccination, for example, by granting paid time off for employees to get vaccinated.

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About the Author

Jaime Tuite

Jaime Tuite, shareholder and Head of the firm's Pittsburgh office, helps businesses of every size and kind resolve their employment issues. She tenaciously defends employers in discrimination, whistleblower and wage and hour lawsuits in trials. She also routinely litigates restrictive covenant cases and obtains temporary restraining orders and preliminary injunctions for employers enforcing employment agreements. In Pennsylvania, Florida, West Virginia and Ohio, Jaime’s clients represent a highly diverse range of industries, including finance, higher education, life sciences, healthcare, technology, manufacturing, energy, pharmaceutical and hospitality.

Are Wearables Exposing Your Personal Health Data?

What Consumers Should Know About Health Tech and Data Privacy

By: Julia Merrill

Wearable technology has many uses: you can count your steps, track your sleep, monitor your heart rate and get a reminder to move. With so many health benefits and the opportunity to customize a wearable to fit your style, it’s easy to fall in love with these gadgets. But do you know how your personal health data is handled by the companies that collect it? While healthcare providers and insurance companies are required to comply with the Health Insurance Portability and Profitability Act, commonly known as HIPAA, health-based tech companies don’t have the same imperative. That means every time you put on your fitness tracker or activate a health-based app, you could be exposing your data to third-party companies.

If you’re concerned about the privacy of your personal health data, Pennsylvania MGMA offers the following insight into what you need to know.

Who Is and Isn’t Required to Protect My Personal Health Information?

According to The Department of Health and Human Services “The Security Rule applies to health plans, health care clearinghouses, and to any health care provider who transmits health information in electronic form in connection with a transaction for which the Secretary of HHS has adopted standards under HIPAA (the “covered entities”) and to their business associates.” Read more.

Mondaq cautions that “... recent developments have highlighted the fact that most apps are not subject to HIPAA, which means that with broadly-worded privacy policy these healthcare apps can and do readily share healthcare and other data collected by the apps with third parties, including marketing and analytics companies, such as Google and Facebook. Some apps are sharing sensitive healthcare data even without a privacy policy.” Read more.

According to The Balance, examples of companies that don’t have to adhere to HIPAA include state and law enforcement agencies, life insurance companies, employers, schools, alternative medicine practitioners, mobile apps, and direct-to-consumer genetic testing companies. Read more.

Why Should I Be Worried?

“With the number of heartbeats, steps, and sleep history tracked, these types of ‘health data’ are not formally considered PHI unless it’s shared with a doctor, hospital, 3rd party vendors and therefore not subject to HIPAA regulations,” explains Varonis. Read more.

“As wearables become part of patients' treatment plans, device makers will look to make money by selling data generated by those wearing the devices, for example, selling data produced by the devices to insurance providers. Juniper forecasts that service revenues of this nature will reach $855m by 2023.”  Read more.

“When Google or Facebook combines its troves of non-health-related consumer data with highly sensitive medical data, it creates digital health profiles with no external validation of accuracy, without consumers’ consent or ability to opt out. As tech companies move into health care, these digital profiles will become part of our medical records, with the potential to shape the care we receive, the resources we can access, and the bill we pay at the end,” Slate says. Read more.

How Can I Protect Myself?

Webroot asserts that consumers should “always read the privacy policy of any wearable device or fitness tracking app before you use it. If the data storage and security measures outlined in the policy aren’t up to snuff, request a refund and let the manufacturer know why. Periodically reviewing your app’s privacy settings on your phone is also a good practice—just to make sure you’re comfortable with the app’s level of access.” Read more.

If you believe your personal health information has been shared in a way not allowed under HIPAA, HealthIT.gov advises consumers to file a complaint with the offended provider as well as with the Department of Health and Human Services Office for Civil Rights. However, if your health information has been shared inappropriately by a company not covered by HIPAA, you’ll need to file a complaint with the Federal Trade Commission. Read more.

What Medical Practices Can Do to Protect My Personal Information

As Experian explains, “Patient trust is at the heart of a successful patient-provider relationship.” Providers should highlight the steps their organization is taking to secure patient data and use secure log-ins to prevent unauthorized access of patient portals. Providers also need to train staff on HIPAA compliance to reduce the risk of human error leading to a data breach. Read more.

While many consumers assume that all health information is protected by HIPAA, the reality is quite different. Not only are many of the companies we share our personal health information with not bound by HIPAA, but even those that are can be subject to data breaches that put personal health information at risk. By educating yourself about HIPAA and data privacy, you can take steps to protect your personal health information.

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Julia Merrill

Julia created Befriend Your Doc to share tips she has developed to help patients be their own advocate in seeking medical care, dealing with insurance companies, and contributing to their own health and well-being.