Efficiency in Scheduling Surgery

After the events this past month, I need to vent with a back-to-the-basics post.  Let me start by telling you what happened.

A relative of mine, we’ll call her ‘the patient’, had major elective surgery. About a month ago, the surgeon’s office staff told the patient that they would take care of everything. They said there was no paperwork for the patient, someone from their office would call the patient with a surgery date. Easy enough, right? NO, it inefficient.

When the surgeon’s office called to provide the surgery date, they didn't tell her anything but the date. That left the patient (and me) with multiple questions…pre-op clearance from other doctors involved in her care? What about taking medications prior to surgery? What about post-op care? How long will she be in the hospital? Does she need another pre-op visit with the surgeon? The surgical scheduler had to call her back after asking the doctor. How inefficient!

About two weeks later, the patient receives another call from the surgeon’s office asking why the patient hasn't had pre-op testing.  The patient explains that the hospital has not called her to schedule the testing. Only now, surgeon’s office tells the patient that it is the patient’s responsibility to schedule testing – the hospital will not call her. Unfortunately, the surgeon’s office did not have the correct telephone number for the patient to call and schedule. So, they instruct the patient to look up the phone number on the hospital website. Really? What if the patient didn't have access to a computer?

The patient calls the hospital and testing is scheduled. The hospital representative asks the patient if her insurance requires precertification. Of course, the patient does not know and ultimately calls me to ask what to do. I explained that her insurance, Medicare, does not require precertification and neither does her supplemental with Medicare primary. Since when do patients understand precertification?

From there much of the same confusion continues. But rather than boring with all the details, let’s look at the problems here.

First, the patient was not given anything by the surgeon’s office. No printed materials about the surgery itself, no instructions on what medications to take or discontinue prior to surgery, NOTHING. When questions like this arose, the patient (and family) had to call the doctor’s office to ask one-off questions.

Next, the patient was not given correct pre-op instructions regarding testing, clearance, etc. This resulted in the surgeon’s office having to call and follow about where the test results were and the patient having to call the surgeon to ask more questions. 

To the hospital: Seriously, do you really expect a patient to understand precertification? That’s YOUR job! BTW, you’re welcome for my consultancy on that topic – that’ll be $500 payable by the hospital.  

Ok, I am going to stop ranting now. Basically, everything about this situation was wrong. Now, let’s talk about why it was wrong and how to fix it. Here are the back-to-the-basics every doctor’s office MUST know:

Patients are scared. When a person is sick, they cannot think straight. They don’t know what to ask during their pre-op visit with the doctor; even the common sense questions don’t enter their mind because of fear. All a patient can think is “what if I die.”  As a healthcare worker, your job is 99% compassion and 1% everything else. Compassion is understanding how the patient feels and helping to ease the patient’s mind. Sure, you cannot promise that the surgery will be successful, but you can ease the patient’s mind by showing the patient that the surgeon’s office is in control of the administrative/business part of the situation.

Not only is this important for the patient’s piece of mind, but it is also important to your business. For most surgeons, word-of-mouth is their primary means of advertising.  Do you think that the patient I mentioned above is going to rave about her doctor after such hassle?

Healthcare is confusing. Patients do not understand the health part, let alone the business part. Precertification, billing, coding, etc. It is all outside of their world. Patients depend on healthcare workers to understand the business and help the patient; the same way you depend on your accountant to help you with the tax code. Think about it, if your accountant told you to call the IRS to get your answers, how long would it take you to find another accountant. Why is healthcare any different?

Time is money. Each time someone has to call to follow up or ask questions, something else (likely something profit generating) is not being done. If you do not provide the all the right information the first time, you are wasting time and money.

The solution is one word… Training. Doctors, Office managers, administrators, please teach your staff to recognize these three basic principles. Patients are scared, healthcare is confusing, and time is money.

A simple way to address these problems is to create and distribute patient-friendly surgery packets. The packets should contain information such as:

1. Patient to-do check list with due dates: For example, the instructions might contain reminders like "Stop taking your Coumadin X days before surgery" or "See your PCP 2 weeks before surgery for pre-op clearance" 
2. Instructions for complex pre-op to-dos: provide the patient with detailed instructions for things like bowel prep. 
3. Easily understandable documentation about the surgery: Krames has wonderful, patient friendly booklets that can be purchased and distributed to patients. 
4. Frequently asked questions: For example, "How are pre-admission tests scheduled?" or "when can I expect a call from the hospital to tell me when to arrive on the day of surgery?" and "what is precertification and what do I (the patient) have to do for precertification"
5. Important phone numbers: These might be the hospital phone number, like for the pre-admission testing department.
6. Reliable sources of on-line information: You know many are going to research, so make sure you guide them to good information like the Mayo Clinic or WebMD

These are not complicated to create. You can even create a fill-in-the-blanks template that is generic enough to use for multiple surgery types in Microsoft Word. Even the documents that are surgery specific aren't too hard as most surgeons only perform a handful of surgery types depending on their specialty. You’ll be amazed how such a small step can help to reduce phone calls and set the patient’s mind at ease. 

Android

I love this!

Augmented Reality, Google Glass, and the Holideck

Ok, be forewarned… I am about to reveal my geekish side.

Growing up, my mother use to tell me that anything we can imagine can be done – maybe not today, but as we advance, anything imaginable can be done. You are probably thinking, wow, she has a cool mom… and yes I do. Few adults can brag that their mom is more tech savvy than they are. I suppose she is why I am so fascinated with tech today.

In light of the ‘anything imaginable can be done’ mentality, I grew up a Star Trek fan, wondering when (not if) the holideck would become a reality. For those not familiar, the holideck was a place on the Starship Enterprise where crew members could go for a virtual reality experience. The holideck created an entire virtual world of sight, sound, smell, and touch, designed according to the user’s preference.

Fast forward to the early 2000s and introduce sites like Second Life where a person can create and “live” in a virtual world through their computer. I admit that this was an interesting concept, but still weak in comparison to a holideck. Fast forward again to present day and introduce augmented reality.

Of late, I have become fascinated by Google Glass. Imagine it, walking around with glasses that fill in the gaps, connect people, and explain things.


While Google Glass is still in its infancy, I see so many possibilities for how technology such as this will transform the way we interact with the environment and the people around us.

I think, from this point it is only a matter of time before mainstream implantable devices create constant, bigger experiences; experiences that include sight, sound, touch, smell, and even emotion, as it collects data to continuously refine the experience.

Think about big data for a second. Think about all the places from which data is collected and how many more data sources will be collected in the future as more and more devises and people connect. This may include information about the population in aggregate as well personalized information, even real-time health monitoring. Think about how that information could be used to augment individual reality.



Not only would this change every person’s reality but something like this could have a huge impact on healthcare. Connected doctors and nurses may be able to receive real-time, individualized instructions for patient care. Doctors would have access to deeper, more detailed patient records including life-style information. How about real-time, personalized care instructions for patients? How about if a patient being able to know about predispositions to and/or extremely early signs of illness?

My mother was right; anything that can be imagined, can be created. I know that this could start a huge debate of the good versus the evil of such technology, but this post is just pointing out the interesting factor – not discussing the philosophical debate…So, those are my thoughts for today...

Don't Leave Your Accounts Receivable on the Table

I found these AR tips courtesy of Medical Billing Star

Don't leave your accounts receivable’s on the table ! from ango mark

People and Technology

This isn't going to be a full post, I just found this really great video and thought I'd share. It really gets you thinking about how we interact with man versus machine.

Here's a good question. Do you know your neighbors?

What is Big Data?

A lot of people are talking about Big Data these days, but what is it and why is it important. Throughout the day, I talk to a fair number of customers and get the impression that many really don’t understand what big data is or what it can do and why it is important. So, I wanted to use a post and try to clear that up.

In short, big data is just what it sounds like; it is a lot of data stored in a database and ultimately used to create reports that tell a story. Because there is so much data, the story it tells is generally pretty accurate. The bigger the data, the more accurate it is likely to become.

With that basic definition done, lets back up and define a couple of terms. First, what is data? Data are pieces of information. For example, data would include names, purchase history, medical information, internet searches, etc… really any information.

The next term to define is database. A database is an organized ‘holding bin’ for information. For example, you can think of your iPod as a database of music or your phone’s contact list as a database your friend’s contact information. The important thing about a database is that it is well organized. Each data element is in its own field so a person can report on each element or report on various combinations of the elements. 

As a visual person, I find the best way to understand databases is by thinking of Microsoft Excel.  As you probably know, Excel has rows and column that can be sorted, searched, etc. (among other things). You can think of a database as a giant Excel sheet where each column has a title in the top row and each field down that column contains a distinct piece of information. We’ll use a phone’s contact list as an example (yes, this is a sample of my real contact list, haha):

Notice how, in the example, each individual piece of information is in its own box. The column headers tell us what is in the fields below. Now, you might say, ‘my contact list doesn't look like that’ and you’d be right. When information is displayed to the user, the information is pulled from these organized tables and displayed in a prettier way. That is called a user interface.

Now, with that defined let’s go back to big data. You see in my example above, I have only 6 rows containing 9 columns of specific information types (first name, last name, etc). With big data, those rows and columns would be almost innumerable but still well organized. With that much information, you can generate massive reports that tell a story. For example, the story the contact list above tells us that all of my contacts live in Nowhereville, CA. That is a story. If the database were bigger, we might be able to see the percentage of my contacts that live in Nowhereville as compared to other places where I have contacts. With enough information, one may be able to predict the probability that the next contact I add to my list will or will note live in Nowhereville, CA.

With big data there will be more and different columns (and definitely more rows). Those might include things purchasing history, terms searched on Google, medical things… you name it. With enough data, other, bigger stories emerge. For example, we might see that people in Nowhereville, CA all buy a particular type of widget or people in Nowhereville tend to get a particular disease.

This quantity of data can help to find correlations that no one knew existed. In medicine, for example, we may find that a particular type of person, with particular habits, with a particular disease, and taking a particular medication, have a higher rate of ear infections than people who do not meet the same criteria. How is that valuable? Well, if we know what specific factors contribute to a disease or condition, for example, we can work to proactively prevent it thus improving length and quality of life.

Big data is not only useful in medicine, it can also be used in business and marketing to identify buying behaviors and develop predictions that help marketers to “speak” the right language to the right people to improve sales. In law enforcement, trends can be identified that may predict crime before it happens. The possibilities are as enormous as the data.

The next logical question is where the data comes from. That’s simple – you are on it right now. The data comes from computers. They are everywhere and can record everything. For example, when you buy something at the store, there is a computer at work recording the details. The credit card company gathers data about the purchase such as the product, the store and location, etc. What if you pay cash? Haven’t you ever had a store clerk ask for your zip code, phone number, or email address? Do you belong to any store’s discount or rewards club? It’s all data. What about driving? Your car more than likely has a computer in it. Do you have E-Z Pass? Do you use GPS? Data. Internet searches – data. Social media posts – data. Cell phone usage – data…. Data is recorded EVERYWHERE. According to IBM, we create 2.5 quintillion bytes of data every day.  That means 2,500,000,000,000,000,000 bytes or units of information. Put it all together, and voila, you have seriously BIG data.

The challenge for big data providers, obviously, is getting all that data in to one centralized database. First, the data is so huge that normal computers cannot accommodate it so massive numbers of huge and powerful servers are used. Also, it is spread all over the place. Still, big data companies are making progress. Who are these providers? Well, while many others may exist, the big companies like IBM, Oracle, and SAP are the first that come to mind.

Now that a simplified foundation is laid, if you want to learn more about big data, I recommend visiting IBM’s website. They have a great definition and some examples of use cases that may help to make it all clear. 

Also, here are some articles that show big data at work in a variety of industries: 

Big Data in Employment

Big Data in Video Games

Big Data in Education

Big Data in Finance

Big Data in Law Enforcement

Big Data in Healthcare

Big data in Marketing

Pediatrics: Sick and Well Visits on the Same Day are NOT Double Billing

The other day I read a blog post about physicians double billing. The article was posted on a blog of a reputable company  but the content was outrageous and it has driven me to a reply. First, about the article to which I am referring…

The author complained that when he took his child to the pediatrician for a well visit and an ear infection was discovered during the visit, his insurance was double billed. He claimed to have called the insurance and was told it was a legitimate practice. Regardless, the author blogged a complaint saying that the  physician was double billing in a blog post.

First, I want to take a second to talk about the technical aspects of what happened in this situation and why the physician’s billing practices are completely legitimate. Following that, I will point out the common sense perspective.

When a child sees their pediatrician for a well visit, the physician is responsible for performing and documenting a physical appropriate to the child’s age. A physical for a child generally includes various measurements (height, weight, etc.) and examinations to make sure that the child is growing and healthy. The physician will check through the child’s history, make sure that all necessary immunizations have been administered and make recommendations (or answer questions as appropriate) on nutrition, sleep , exercise, life-style, etc.  During the well visit, the physician is examining the child for physical health, mental health, and developmental health. The physician is responsible for documenting all of this and, if documented, well visits are a complete service which can and should be billed.

If the physician happens to find a problem, the physician must address that problem and a distinct sick visit begins. A sick visit also has specific requirements for the history of the present illness, review of systems, history,  examination, and medical decision making. All this must be performed (or if already performed it must be reviewed/considered in the context of the sickness) and documented. As the sick part of the visit is a distinct and separately identifiable service, it is separately billable with the modifier 25.

So, why is this practice legitimate? Because two separate services were performed. Think of it this way (here’s the common sense part). If you take your car in to the mechanic for a routine oil change, the mechanic will bill you for the oil change (a well visit). Now, what if, during that oil change, the mechanic discovers that there is a crack in the oil pan. If the mechanic repairs/replaces the oil pan to fix the problem (a sick visit) would you expect that repair for free since he/she was in there anyway? No! You would expect that the mechanic would bill for BOTH services. If you wouldn't expect a mechanic to give away free services, one cannot expect a physician to perform additional services for free.