Despite Medicare being a target in common for both Democrats and Republicans during the past elections, there are many bigger problems plaguing our healthcare system. Now, in order to bring healthcare inefficiencies in check amid the specter of a Fiscal Cliff in January, it is going to be incumbent on Washington politicians and healthcare executives to tackle these larger issues, such as unneeded care, a glut of paperwork and other waste. To say that all of these are costing us dearly is an understatement.
In fact, a recent report by the Institute of Medicine said that the U.S. healthcare system wastes $750 billion every year on those areas. This amounts to 30 cents of every medical dollar spent. Oh, and by the way: it’s even more than the Pentagon’s annual budget! To put this into more perspective, it would take 10 years of the Medicare cuts outlined in the Patient Protection and Affordable Care Act (a.k.a. “Obamacare”) to save the same amount. How can hospitals and healthcare providers assess where cuts can be made—and then execute them in a manner that doesn’t just cost more money?
New technologies are enabling healthcare organizations to revolutionize the ways they cut costs, respond to regulations, enhance the customer experience and manage change. Healthcare organizations are now able to instantly adapt to each situation and customer, and work easily within their existing architecture to promote seamless interactions across all channels and streamline work from end-to-end. Adopting business software that consolidates and automates processes in a way that makes them easy to understand—cutting redundancies and improving efficiency for doctors, agents, patient advocates, billing departments, and even the hospital’s IT professionals—could ensure that more time is spent caring for patients than locating and finding their medical records.
Cutting Down on Unnecessary Care
There are a lot of factors that play into whether a patient requires a test, treatment, or procedure. Sometimes, however, tests are repeated unnecessarily. But don’t take my word for it: just look at this article to see how inexact and wasteful repeat testing can be. While there is some truth to the idea that one can’t be too careful when it comes to health, redundant and unnecessary health practices can cost a patient, and healthcare professionals, both time and money. In many cases, a simple sweep of medical records—for known allergies, family histories, even recent doctors’ appointments—can tell a doctor all he needs to know about a particular issue. Mention of a pre-existing condition should instantly bring up care information tailored to it, so that certain options and treatments may be ruled out quickly. If a blood test was administered only a week before, why tie up the lab and charge the patient for repeating that test, when it’s highly unlikely any changes would be evident in the results? And, a note that a patient has no family history of a certain hereditary syndrome should immediately indicate that tests for that condition are likely unnecessary.
Problematically, most people see several doctors: an independent practitioner here, a specialist within a hospital system there. And currently, it’s incumbent on patients to bring their medical histories with them. So you need to remember what the name of that prescription you’re taking is, why another doctor ordered tests (and which ones), etc. If the patient forgets something or is ill-informed, the new doctor could end up prescribing or ordering something completely unnecessary. It’s not her fault: she did the best with the information that she had.
But the more quickly that electronic medical records (EMRs) can be adopted, the better, more efficient, and ultimately, safer, this process can become. Even if your two doctors work for two completely different health systems and doctors within those systems are collaborating openly, sharing records can be done relatively easily , taking the onus of remembering off of the patient. So now last week’s blood work doesn’t need to be replicated for this week’s appointment.
Removing redundancies in healthcare doesn’t just make patient care easier and more efficient; it makes it better. Efficient, easy-to-use software makes it easier to monitor a patient whether in or out of the hospital, for instance by cutting back on unnecessary and sometimes traumatic re-hospitalizations or avoiding the exacerbation of a disease that requires careful management. A rash that may seem alarming to a doctor without a thorough patient history may not concern another doctor who has access to records indicating a patient’s grass allergies are likely to blame—take two Benadryl and call him in the morning. There’s an added bonus to this, of course: a doctor with his patient’s full records at his fingertips can spend more time listening to his patient, and less time trying to make sense of disparate or missing medical records. He’ll get to know his patient, not his paperwork, and care will naturally improve.
Shortening the Paper Trail
It’s not just redundant and unnecessary procedures that can be eliminated through software implementation, but redundant and unnecessary paperwork and administration. The IOM report stated that $190 billion of the $750 billion overspend can be attributed to excess administration costs—managing the paper trail of intake forms, insurance information, bills, and more. There’s absolutely no reason for a patient to fill out the same form every time he comes to your office—or any doctor’s office. What matters are the things that are different, not the things that have stayed the same. And even the things that have changed should be handled expeditiously. A change of address can be noted in one place instead of three. If a patient indicates that she is taking a new medication, the system should automatically flag any other medications that could cause counter-reactions. Insurance change? No problem—both your insurance and billing coordinators get that information at the same time—and they can send patient information to the new insurer automatically, without worrying about missing deadlines or jeopardizing a patient’s coverage due to office inefficiencies.
Smart software should help healthcare practices run faster and more efficiently, so that practitioners can focus on quality of care and administrators can concern themselves with customer satisfaction. As the Patient Protection and Affordable Care Act places an emphasis on quality of care over quantity of patients seen, it’s worth asking, why can’t it be both? If doctors, nurses, billing coordinators, hospital administrators, patient advocates, and everyone else in the hospital or clinic can spend less time concerned with dotting their i's and crossing their t’s in triplicate, that frees up more time for the patients. The appointments might not be any longer, but the time in the waiting room will definitely be shorter.
Implementing Changes to Implement Savings
The idea of completely re-vamping legacy technology will always be met with push-back. It’s too expensive to roll out a new system, some may say. Or why fix what’s not broken? The 2014 EMR mandate deadline is a strong push in the right direction—but depending on how EMRs are employed, they may prove to be an added layer of cost and inefficiency instead of a solution to the overage problem. Will the system you’ve chosen make it easier to send records to or receive records from other doctors? Or will you still have to print, sign, and fax or scan? Do you have the flexibility to make changes to your database, or do you have to put in a change order with your IT team or developer?
Healthcare, much as many practitioners hate to admit it, is about business as much as it’s about the patient. So deploying software solutions that help make the business run smoothly—by taking a comprehensive look at a patient’s records or by allowing doctors, and not IT specialists, to determine the best way for those records to function in the database—can make the business part run smoothly so that the patient part can remain the focus. An investment in new software solutions will pay itself off very quickly.
And if this can cut costs to doctors and patients alike (and possibly help to stave off some of those politically-charged Medicare cuts), implementation seems like a no-brainer.
Keith Dayton is senior director of healthcare for Pegasystems.