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Synopsis - Integrated Solution for Revenue Cycle Management and Medical Records

Essay by   •  November 7, 2010  •  Case Study  •  680 Words (3 Pages)  •  1,652 Views

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Synopsis - Integrated solution for Revenue Cycle Management and Medical Records

Overview

Physician practices are being called on to do more than ever before. Today's physicians must treat more patients, document interactions more meticulously, wrangle with more complex managed care rules, keep track of an ever-expanding array of drugs, submit and track claims and pay rising malpractice insurance bills. In many cases, physicians must treat 20 percent more patients than they did five years ago to generate the same revenue. In the face of these burdens, some practices are struggling to remain financially viable. For many practices, the biggest impediment to meeting these challenges is continual administrative burden, a lack of automated clinical documentation, and inefficient practice workflow systems. Despite the dramatic advances in many areas of healthcare technology over the past several years, most physician practices--especially small and midsize ones--are still using the same manual and paper-based office management systems they've used for decades. With mounting pressure from insurers, government agencies, and patients, physician practices need to reexamine the ways they work and interact. As physicians see more patients and insurers demand reformed documentation for rapid processing of claims, the manual healthcare systems that were adequate in the past will become less and less able to meet new demands.

The problem

The paperwork burden among solo/small group physicians' is immense, adversely impacting the quality of patient care. In addition a common glitch in all the revenue cycle stages are inefficiencies, resulting in delays and loss of recoverable revenue.

The consequences

Revenue Cycle Management Medical records

* Disproportionate amount of working capital tied up in receivables

* The highest cost of collection in comparison to other industries

* The average M.D. physician has more than $150,000 in outstanding accounts receivables at any given point in time

* Spend $7-$12 in direct expenses to file each paper claim

* Accounts receivable cycle is in excess of 45 days * Physicians do not have the relevant information to select the optimal treatments for their patients

* Medical orders and prescriptions are handwritten and often misunderstood

* The above leads to occurrence of preventable medical errors and reduces the quality of patient care

* Inefficient paper-based routines (e.g. filing prescriptions, searching for patient histories, coding etc) have burdened physician's schedules and bred inaccuracies

Business Opportunity (USA)

* Significant majority of physicians are in solo/small group practice (63.3% of total physicians in non-federal practice are either solo or in groups of upto 3)

* Physician's ICT spending will grow from 6.44 billion USD in 2004 to 8.5 billion USD by 2008 at a CAGR of 7.2%

* EMR investment by small group physicians' practices will grow from 366 million USD in 2003 to 829 million USD in 2008

* Currently only 25% of the 1.8 billion claims submitted by physicians are in the form of scanned documents or in electronic form

* Only 5% of physicians in solo or small group practices of three or lesser in size currently use some form of electronic

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