Tips on Lowering your Hospital Medical Bills

Jill finally had a smile on her face. Not only because the scars from her cardiac surgery 3 months back had all but disappeared and her skin color was almost indistinguishable, but also because of her recent victory in the law suit against her health care provider.  2 months after having returned home from hospital to recover from her major surgery, Jill almost had a second heart attack on finding that her insurer had disputed several of the charges mentioned in her long form medical bill.  She suddenly found herself in a position where she would have to foot thousands of dollars from her own pocket.

Luckily, Jill, an educated woman who also ran her own brokerage firm, had researched extensively on her laptop about her medical predicament, as she lay in the hospital bed for weeks before being finally discharged.

A quick review of her itemized bill showed glaring discrepancies in the services she had received and the charges levied.  The icing on the cake – the hospital had affected a bogus augmentation charge to a woman who had only received emergency cardiac surgery following a sudden attack at the age of 57.

A quick letter from her lawyer ensued to the hospital within a fortnight.  When the health care provider did not respond satisfactorily, she sued.  Cue one month later and one of the biggest hospitals in Los Angeles had settled the case with a very handsome compensation in favor of Mrs. Jill Hathaway.

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Negotiating a Payment Plan, Rebates, Financial Assistance and Crowd Sourcing

If you’ve planned for hospitalization in advance (surgery, pregnancy etc.); it pays to research online to find out how much it could potentially cost you.  Information is power, so compare the costs at your hospital with other health care providers to make the best choice.  Contrary to popular belief, hospitals do negotiate charges in the face of overwhelming evidence against phantom fees.  This is because no reasonable business wants to draw itself out in protracted lawsuits which would cost thousands of dollars additionally in legal fees.  Not to mention the damage to reputation.

If the charges are reasonable but outside your budget, try and negotiate a systematic payment plan with your hospital.  You’ll be surprised at how many hospitals are opting for the same these days. Some tips that will help:

  • If you are making payment upfront or all at once, ensure that you get a rebate out of it.
  • If you are eligible for hospital financial assistance, don’t forget to avail the same.
  • Financially challenged patients can turn to crowd funding websites such as GoFundMe.com to support their medical bills.

The A, B, Cs of Prudent Medical Financial Management

Always, always insist on an itemized bill without fail.  Routine items such as gloves, blankets, lights etc. cannot be charged separately.  They are part of the facility fee. Ensure that double billing does not happen.  Unless a second opinion was garnered, doctor’s readings should only be billed once.  The same goes for anesthesiologists etc.

The In-Network Doctor and Hospital

When you’re inside a hospital for yourself or a relative, ensure that the doctor looking after you participates in your insurance plan along with the hospital.  This is one of the most common reasons behind phantom charges in medical bills as most patients automatically assume that in-network hospitals also provide in-network doctors.  Nothing could be farther away from the truth.  If your physician does not participate in your insurance plan, your chances of getting phantom charges on your bill will be higher.

If however you had already mentioned in writing your preference for an in-network doctor but your hospital could not provide you one, you can later on negotiate the charges levied by the doctor.  The same rule applies when your hospital outsources tests to external labs.  Always ensure that all tests are done by participants in your insurance plan and document the same to your hospital in advance.

The ER Services

If you availed ER services, please note that hospitals charge the same by levels.  Level 1 signifies minor injuries such as nosebleeds etc. and level 5 represents major trauma such as heart attacks etc.  Always ensure you were charged a level appropriate to the services you availed.  Ask for a written explanation if you have to.

ER doctors also charge by levels ranging from 1 to 5.  Ensure that your doctor charges you for the appropriate level.  Hospitals can never charge you for a level higher than that of the doctor so flag the same if it happens.

Medical Billing Advocates and Legal Recourse

Even after taking every precaution, if you are unlucky enough to find yourself at the receiving end of exorbitant charges on your medical bill, don’t lose heart just yet.  You still have a few tricks up your sleeve.

These days, many aggrieved patients are actively seeking the services of medical billing advocates – professionals who will negotiate your bills on your behalf with the health care providers and charge you a percentage on your eventual savings.

Of course, when all else fails, consider hiring an attorney to alleviate your situation in a court of law.

Avoid an ER Trip this Holiday with these 5 Tips

Jenna looked at all the holiday greeting cards spread over her dinner table and sighed.  The advent of Thanksgiving heralded the festivals’ season and soon the house would be abuzz with the noise and clatter of her extended family – her cousins and relatives she was used to seeing only once every year and even then it was one too many.

Contrary to most people who eagerly looked forward to the holiday season, Jenna dreaded this time of the year.  It was one thing to host the gamut of the McKinney family for a whole weekend at their winter retreat in Florida because her father, in addition to being a successful businessman who owned premium beach property, was also the eldest of all the brothers.  Quite another to endure the relentless clamor of uncles who wanted to know which college she was planning to apply to after graduation and aunts who wanted to know the name of the cutest guy at her school.

It all started 5 years ago. An otherwise chirpy and energetic pre-teen at the time, the twelve year old Jenna had pleaded with her dad to cancel the festival reunion that year owing to the deteriorating health of her mother suffering from cancer.  Both her parents had declined the proposal – her father because it was family tradition and her mom because she was convinced it would only serve to lift her spirits.

Sure enough, Jenna found her mom immensely happy in the company of her siblings.  She hadn’t seen her mother this jovial since her diagnosis with the terminal disease 3 years ago.  That weekend, the lady of the house had thrown caution to the wind, disregarded her strict dietary and medical regimen in favor of mirth and merriment, drank and ate freely and danced and sang well into the wee hours of the morning.  After all, how much could a few days of deviation from her routine hurt her?  She would be back on her strict diet before long and it would be like she never digressed at all.

Sadly, that was not to be. After 2 days of irregular or skipped medication, Jenna’s mom took to bed on Sunday afternoon.  Later that evening, she was rushed to the ER.  In the wee hours of the morning the next day, Jenna’s mom passed away.

After that, Jenna had always hated the holidays.  The next year and the years after that, when her cousins came over, she would mostly lock herself up in her room citing unfinished assignments.  The only time her extended family would see her pretty face would be around supper.

But that was so many, many years ago and Jenna could sense a closure in her heart this year.  This is why she insisted with her pleasantly surprised and overjoyed dad that she send out the invitations this year.  As she diligently hand wrote and signed each invitation herself, Jenna sighed that she hadn’t done this sooner.  When you lose a loved one, nothing comforts you more and helps you find inner peace again than the realization that you have an entire family to fall back on.

Holidays, sadly, are one of the busiest times of the year for ER attendants in hospitals.  Here’s what you can do to ensure you and your loved ones stay safe this festive season so that the doctors and the nurses at your local hospitals also get to spend more time with their own families!

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Don’t get carried away by the moment

Sure, it’s the holiday season.  If you could ever forgive yourself for your indiscretions, now’s the time.  However, pay heed to your pre-existent conditions.  Make sure you’re allergies are in control.  Do not discontinue regular medication if you have diabetes, asthma or other health related issues that require constant monitoring.

Substance abuse

More alcohol is consumed during the festive season than the whole year around.  The same, unfortunately, is true of harmful drugs and chemicals that can have catastrophic consequences upon your body even in the short run.  If you are young and spending the holidays with your peers you are especially susceptible and vulnerable to substance abuse.

Spend the holidays with your family.  If you are spending it with your friends, make sure you do not partake in any activity that you would not permit yourself any other time of the year.

Overindulgence

The festive season is a time to party non-stop.  However, make sure that you are getting enough sleep in between all the fun and enjoyment.  Also, don’t forget to drink plenty of fluids to keep your-self hydrated. Eat regularly to keep your energy up.

Melancholy

Did you lose a loved one during the festive season?  How about a family member you desperately wanted to spend time with but could not be together?  Are you prone to stress, anxiety and depression?  Holidays can be tough on people who have lost loved ones, living away from family or are generally introverts.  Make sure you exercise, eat, drink and sleep regularly.  Do all those activities that keep you motivated year round.

Injuries

The holidays are Christmas time for all kinds of injuries, big or small.  Do you know how many paper cut victims end up in ER while wrapping or opening presents?  Well, thankfully not that many but hospitals are flooded with broken bones, bloody gashes and dislocated shoulders during the festive season.

Have fun during the holidays but do not forget to listen to your spider senses when they start tingling signaling that something has or is about to go wrong.

Reducing Physician Burnout due to EHRs

Technology is aimed at making our lives easier and simple – however, the transition stages seem to make life more difficult and tough.  A typical example is the Electronic Health Record (EHR) system.  While EHR use has definite benefits for patient safety and quality of care, it is also causing frustration amongst physicians and other medical professionals.

EHR use has found acceptance across the country with 97% of hospitals and 75% of physicians already using it.  Even though EHRs are here to stay, its use seems to be contributing to physician burnout and interfering with patient care.  According to surveys, primary care physicians and emergency physicians feel that their facilities are not effectively addressing physician burnout, with EHR use and time pressures identified as the biggest causes for frustration.

A recently published survey result from The Annals of Internal Medicine, reports that nearly 50% of the office time for physicians is spent working on EHR inputs.  Compare this to a mere 27% that is spent with patients directly.  And this does not end at the office – doctors spend an average of one to two hours at home completing and updating EHRs.  A similar finding by a Medscape survey, reports that 57% of physicians stated that EHR use reduced face-to-face patient interaction while 50% said that EHRs limited the number of patients they could see.

Exacerbating physician burnout; the mounting pressure from frustrated clinicians and management, in turn, is impacting health IT workers’ stress and job satisfaction.  A recent HealthITJobs.com survey found that 55% of health IT workers are stressed with 38% citing high or extremely high stress.  However, healthcare organizations can prevent provider burn out; improve clinical workflow efficiency and job satisfaction by optimizing their EHR and other clinical IT systems.  Organizations can identify and quantify the daily challenges their providers are facing and then through a careful assessment of IT systems and processes, design strategic solutions for high-quality patient care.

Negative repercussions of EHR burnout will likely influence the future of healthcare industry. Some examples of these repercussions could be:

Declining physician pool: According to a survey by Physicians Foundation, almost 50% of physicians plan to cut back on their working hours, retire or opt for non-clinical jobs due to burnout.  This is likely to cause a shortage of physicians and with the aging US population, seems to be heading for a disaster.

New or future physicians: Burned-out medical students are more likely to engage in patient care misconduct and endorse unprofessional behaviour, states a study by the American Medical Association.  Burnt-out medical students, who typically practiced with physician mentors, were also found to hold less altruistic views of their role as physicians in society.

Care quality: Physician burnout may also lead to lower care quality, increasing medical error, risks of malpractice and patient dissatisfaction, which can end up reducing payment under value-based care reimbursement models.

Pessimism: Most medical professionals are pessimistic about the future of their profession, according to the survey, with one-third indicating they wish they had chosen a different career and nearly 50% recommending different career paths to their children.

However, providers are not completely opposed to EHR use and agree that some features do increase satisfaction to combat burnout.  According to a survey of more than 15,000 physicians across 25 care specialties, nearly 62% of physicians deemed e-prescribing as the most useful EHR feature, while 57% ranked easy review of patient information as the second highest,. Standing third at 49% were the ability to share patient records and lab results, conduct drug/allergy checks and incorporate clinical lab test results. The survey also found that 56% of physicians believed that EHR use effectively improved the documentation at their practices with 81% planning on keeping their current EHR system.

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EHR usability is one of the main stressors for both health IT staff and end users.  Organizations can implement vendor scorecard metrics on patient-provider interaction time and after-hours documentation and then analyze data to identify excessive EHR-related usage time to improve patient care and physician/patient experience.

More intuitive user interfaces and templates to support efficient clinical workflows and physicians’ natural thought patterns will improve EHR navigation.  Aligning processes with industry best practices for structured-form workflows, and working with vendors for task sequence customizations to fit work habits, will go a long way in helping EHR use.  Documentation requirements and actual end-user entry need to align, focusing on standardization and simplification of only the most meaningful data.

Health IT staff must properly train and transition end users to be comfortable with and invested in the EHR system.  All stakeholders need to feel they are within a culture where they are inspired, valued and vital to the overall organizational goals and enterprise-wide patient care experience.


References

  1. 2016 SURVEY OF AMERICA’S PHYSICIANS. (2016). Retrieved October 24, 2016, from http://www.physiciansfoundation.org: http://www.physiciansfoundation.org/uploads/default/Biennial_Physician_Survey_2016.pdf
  2. Kyle Murphy, P. (2016, March 28). Ensuring Physician EHR Use Doesn’t Lead to Physician Burnout. Retrieved October 24, 2016, from http://www.ehrintelligence.com: https://ehrintelligence.com/news/ensuring-physician-ehr-use-doesnt-lead-to-physician-burnout
  3. Liselotte N. Dyrbye, M. M., F. Stanford Massie, M., & Anne Eacker, M. (2010, September 15). Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students. Retrieved October 24, 2016, from http://www.jamanetwork.com: http://jamanetwork.com/journals/jama/fullarticle/186582
  4. Medscape EHR Report 2016. (2016). Retrieved October 24, 2016, from http://www.medscape.com: http://www.medscape.com/features/slideshow/public/ehr2016
  5. Stoltenberg, S. (2016, October 07). Tips for Reversing Physician Burnout Caused by EHR Use. Retrieved October 24, 2016, from http://www.ehrintelligence.com: https://ehrintelligence.com/news/tips-for-reversing-physician-burnout-caused-by-ehr-use

 

 

Medical Chart Audits in a Primary Care Setting

Audit – the very word brings visions of men in suits pouring over your records, looking for the slightest evidence of a mistake or wrongdoing.  However, not all audits are external or scary. Internal and self audits are in fact, a rather helpful tool to enhance both the profitability and efficiency of your work.

Handling hundreds of patients can be quite a chore.  To evaluate the efficiency of their performance, identify areas where improvement can be made and measure the quality of care provided; a chart audit is one of the best tools in a primary care’s arsenal.  Helping monitor and measure performance in areas like research, compliance, clinical and administration, a chart audit can serve many purposes.  Any and all aspects of a medical record can be audited through the use of this tool.

Quality improvement initiatives can be easily mapped and monitored through the use of chart audits.  For example, a practice might review charts to see how often a particular vaccine is offered, given or declined. If the audit determines that the vaccine is not being offered or given as recommended, then there is room for improvement.  The same practice could review the panels of individual physicians within the group to see if they differ in performance on this measure and to give focus to their improvement efforts.  Along with patient surveys, billings/claims data, discharge summary reviews, employee feedback and other similar data sources; chart audits are used for quality improvement efforts.

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Although there is no fixed linear process to a formal chart audit, there are typical steps that occur in setting one up.  The basic set up for a chart audit consists of:

  • Selecting a topic
  • Identify and define measurement parameters
  • Identify the target group / patient population
  • Determine sample size – it should be statistically valid for a chart review
  • Create simple audit tools that can be used by non-clinical staff too
  • Start collecting data based on your parameters of size and time
  • Summarize the results by collating the collected data
  • Analyze the collated data and compare the results against set benchmarks
  • Plan the next steps if required and put the plan into action

Chart audits can be useful tools in performance improvement and safety efforts.  However, it is essential to define what you want to measure and the criteria by which you will measure it.  Sample sizes can be chosen informally or determined in a statistically valid fashion – remember that too small will not provide enough data and too large a sample size can be overwhelming.  Summarize your data keeping the parameters in focus – after all, you do not wish to lose focus on what you want out of the audit.  Analyze the data to find out problem areas if any, scope for improvement and other areas of concern.  Work out a plan to counter the problems and put the plan into action.  Regular chart audits will certainly make a positive difference to your work, practice and your patient’s welfare and care.


References

  1. Barbara H. Gregory, M. M. (2008, July). Eight Steps to a Chart Audit for Quality. Retrieved October 26, 2016, from http://www.aafp.org: http://www.aafp.org/fpm/2008/0700/pa3.html
  2. Chart Audits in Quality Improvement . (2016). Retrieved October 26, 2016, from http://www.patientsafetyed.duhs.duke.edu: http://patientsafetyed.duhs.duke.edu/module_b/quaility_improvement.html
  3. Improving Your Office Testing Process. (2016). Retrieved October 26, 2016, from http://www.ahrq.gov: http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/office-testing-toolkit/officetesting-toolkit9.html
  4. Managing Data for Performance Improvement. (2016). Retrieved October 26, 2016, from http://www.hrsa.gov: http://www.hrsa.gov/quality/toolbox/methodology/performanceimprovement/part3.html