Top 5 medical practice administrative challenges in 2023 and how to address them
Today’s medical practices face countless administrative challenges that make it harder than ever to focus time and attention on what matters most: High-quality patient care. Fortunately, a combination of operational strategies and the right technology can help relieve the administrative burden. Consider these top five challenges physicians may encounter in 2023 and how they can overcome them.
1. Healthcare staffing shortages
Healthcare staffing shortages continue to plague the industry, and physicians must think outside the box to come up with creative solutions.
Solutions:
Consider a cloud-based electronic health record (EHR) and practice management system to easily support remote positions as well as outsource medical billing partnerships that can actually save your practice money.
Create a career ladder for upward mobility and to increase staff retention.
Increase salaries and offer additional perks to retain existing staff and draw new candidates to your medical practice.
Invest in continuing education opportunities to promote staff empowerment and professional growth.
2. Good faith estimates
With the No Surprises Act comes the requirement for physicians to provide good faith estimates, when asked, to patients who are uninsured or who identify as self-pay.
Solutions:
Ask patients up front whether they have insurance, and if so, whether they want to submit an insurance claim for the services they’ll receive.
Invest in a price estimator tool that generates reliable out-of-pocket cost estimates at the time of scheduling. The goal? To help patients make better financial decisions before they receive any services.
Use the good faith estimate template the Centers for Medicare & Medicaid provides, or develop one of your own. The estimate must clearly identify the patient’s name and date of birth, the provider’s National Provider Identifier and tax identification number, and the location where services will be rendered. It must also list all of the expected services along with corresponding medical codes, expected charges, and more.
3. Prior authorizations
Prior authorizations continue to be a top challenge for medical practices nationwide. In fact, they have been so problematic that the Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would require certain payers to streamline the process. If finalized, the CMS rule would require payers to offer electronic processes, publicly report certain metrics, and establish policies to make the process more efficient and transparent. It would also require shorter timeframes to respond to prior authorization requests. In the meantime, providers are on their own for reducing any associated administrative burden.
Solutions:
Get organized. Create master lists of what prescription drugs and medical services and procedures require prior authorizations, and appoint a coder, biller, medical assistant, or front-desk staff person to monitor and update this list as needed.
Educate physicians. Make sure they know what information payers expect and clearly document that information in the patient’s record.
Leverage electronic prior authorizations, when possible. Many EHRs already provide this option. If yours doesn’t, you can integrate with a vendor that does. Doing so can save considerable time and resources even when some—but not all—of your payers permit it.
4. Patient communication
In an era of texting, telehealth, patient portals, and social media, managing patients’ communication-related expectations can be a huge administrative challenge.
Solutions:
Provide patients with options. Think beyond the phone. For example, can you also offer a patient portal and text messaging? If you decide to provide these options, be sure to educate patients on how to take advantage of each one and what your turnaround time is for responses.
Triage, monitor patient portal communications. For example, can medical assistants frequently check clinical messages and forward those messages to providers when appropriate? In addition, identify a front-desk staff person whose job it is to respond to requests for copies of records, schedule and reschedule appointments, and more.
Ask each patient to identify their preferred method of communication. Be specific. For example, how would they like to receive appointment reminders? What about preventive care reminders? Lab results? Then try your best to accommodate those preferences.
5. Quality metric reporting
Quality metrics affect payment, penalties, consumer perception, payer credentialing, and more. It’s important to provide the right care at the right time but also to capture that care in the form of thorough documentation and medical codes.
Solutions:
Partner with an EHR vendor that supports quality initiatives. Look for a Merit-based Incentive Payment System (MIPS)-certified vendor.
Strive to close care gaps. For example, consider enrolling eligible patients in a chronic care management program. Medical practices can also leverage the annual wellness visit. In addition, technology can surface many care gaps at the point of care enabling physicians to take action in real time.
Don’t ‘boil the ocean.’ Although payers may require certain quality metrics as a condition of participation in a value-based payment program, physicians have greater flexibility when it comes to the MIPS program. Choosing quality measures wisely can significantly reduce administrative burden. For example, consider quality measures that you already track in your EHR to minimize workflow changes and avoid manual data collection.
Conclusion
Administrative challenges won’t ever go away. However, medical practices can take proactive steps to mitigate associated burden. Get in touch to learn how edgeMED’s revenue cycle management service will create efficiencies, streamline your medical organization and get you paid more. And be sure to check the Healthy Snacks blog for more expert insights, best practices and industry trends.
