Pegasus Knowledge Center
How to Insulate your Practice from the Rapidly Changing Healthcare Environment
Recently we were discussing process optimization with a Radiologist and after a few minutes of discussions he expressed his frustration. "When I was in school, I never even thought about being a businessman, I wanted to be a radiologist and diagnose patient problems by studying their x-rays." He went on to say that it wasn't until he had to deal with all the billing challenges, governmental regulations, and staff related issues that he realized he was a businessman whether he wanted to be one or not.
Managing a medical practice today is far more complex than most other small businesses, and the pace of change in the healthcare industry is only increasing. Medical Practice Managers are searching for some way to insulate their practice from the business related changes occurring in the industry, so they can focus on the medical changes that are occurring.
Figure 1. Internal and External Pressures on Medical Practices:
Many practices today have taken the first step to insulate their business against the internal and external pressures that are buffeting them; they have outsourced their billing operations to Revenue Cycle Management (RCM) Companies. These RCM companies can help shield the practice from some of the impacts of the staff training issues, and some of the impacts from the Public and Private Payers, but in general they are only a partial solution and there is still a great deal of externally generated turmoil that the healthcare professionals have to deal with.
As the CEO of Pegasus Blue Star Fund, a private equity fund specializing in Healthcare Services Investments, I have over 20 years of experience investing and managing Healthcare Services companies in the areas of Cancer treatment centers, Surgery centers, Practice management, Medical Group Purchasing Organizations, EHR, Medical Revenue Cycle Management, Patient Portal, Claims Optimization, Claims Authorization, Patient collections, Bad debt collections etc. In the last 2 years I have seen the industry begin to craft the ultimate solution by the most innovative players in the healthcare support field. One of my Healthcare Holdings, Constellation Healthcare Technologies (CHT) is well on the way to delivering the ultimate solution to insulate the medical practice from the hurricane force winds of change that are blowing through the industry today. I started my career in business as the owner of an IT based management consulting practice that provided services comparable to the then "big six" consulting firms. I am now applying my experiences coaching and guiding Fortune 500 executives in global process and technology optimization initiatives to the development of a holistic, integrated and fully automated solution for the healthcare practice of the 21st century. The major components of the CHT solution will change as technology and business requirements are refined, however there is already a list of industry needs that must be accommodated by support service providers if they are going to be able to perform the task of truly insulating their client's practice from the industry changes.
The optimal Practice Management (PM) Partner in the 21st century will be required to provide a broad range of fully integrated services at a price point well below what can be achieved by large practices and hospitals today. The list below is not complete, but it does provide a good conceptual overview of the holistic solution required.
- Patient Scheduling, demographics, and pre-authorization,
- Symptom analysis and diagnostic support,
- Coordination and scheduling of test procedures and lab analysis,
- Treatment Planning and Prognostication support from Artificial Intelligence Tools and Databases,
- Use of Government and Private Knowledge Warehouses to assist with the diagnosis and treatment (e.g. Pharmacies, Centers for disease control, etc.)
- Electronic storage of patient record storage and retrieval,
- Voice recognition and automated transcription,
- Automated coding of procedures based on automated transcription,
- Automated quality control and coding audit,
- Automated claims with payers,
- Automated payments and denials,
- Comprehensive Security and Compliance Assurance
- Complete integration of accounts receivable with treasury functions and accounting
- Complete integration of HR, Payroll, Benefits, Finance, Treasury, Accounting, Taxes, Financial Reporting and Controls, Purchasing and Logistics
- Electronic Data Interchange with suppliers and partners (Radiology, Labs, Payroll, Billing, etc.)
- Business Intelligence and Management Reporting
These services must be fully integrated and automated to eliminate redundant data entry and provide on-line drill down reporting of the most granular details of each medical procedure and business activity performed by the practice.
Figure 2. Insulated Medical Practice using PM Partnership model: