The actual healthcare arena is ever changing and the best way to assess the future of this business is by using the available information as a data gathering exercise to determine which path to follow.
By the Numbers
Ninety percent (90%) of the hospitals that participate in the American Hospital Association’s RACTrac Survey experienced some level of RAC activity during last year’s fourth quarter.
Overall medical records requests went up nearly ten percent (10%) quarter-over-quarter, to 720,590, compared to 662,710 during the third quarter of 2012.
Cumulative claim denials reached 1.3 billion through the end of 2012, up from 1.1 billion at the close of the third quarter.
Sixty three percent (63%) of participating hospitals spent at least 10,000 during the fourth quarter to manage RAC activity, which included tasks such as hiring attorneys and purchasing relevant software.
Based on these numbers; what are you going to do different? If you are simply going to point that the information above is only relevant to hospitals I will simply thank you for reading up to this point and ask that you stop reading as this is not for you.
If you are still with me let me provide you with additional information. Effective January 1st, 2013 BCBS reduced payment to Psychologists by thirty percent (30%). Durable Medical Equipment companies are also been hit hard by Medicare reductions to the point that within a few months we will see a lot less of them. Contracts for private companies to audit healthcare providers as it relates to HITECH have already been awarded. Meaningful audits are already under way to those that received incentives for Electronic Health Records implementation. The number of claims been denied due to medical necessity have been increasing and with the additional implementation of software and data sharing the same will continue to rise.
Believe it or not, the above information does not mean that the sky is falling and we are all going to lose our shirts. On the contrary, information is information and it is up to you to decide upon how to use it. What I see in the horizon is opportunities for those that take a stake in their future and want to control their own path. It is time for us healthcare professionals to look at our offices as businesses and consider costs (overhead, profit, loss leaders, marketing, etc.).
Let me get to my plan of action as it is up to you to follow:
Golden Rule: he who has the gold rules. Where is the gold/resources going to be in the future?
What service do you want to provide and who are your clients?
Remember the golden rule and the cost of providing these services to them
What is the return on investment?
3. How will you attract those clients you want to serve?
A business and marketing plan at this stage could be quite useful.
4. What is your exit strategy?
Don’t get into anything that you cannot get out of.
5. Get professional assistance
You don’t need to know it all. Find someone knowledgeable you trust and engage with them.
The worst think you can do is nothing and become a future statistic so think about your future and take action now!
The above article was written by Dr. Jose I Delgado, President of Taino Consultants Inc. Dr Delgado may be reached by e-mail at [email protected].