Clarity Health Services Blog

Sometimes the best way to get at a serious topic is through comedy. In case our Parable of the Muffler Shop didn’t do it for you, try this very clever video. It carries a very serious message, yet it is terrifically funny:

Is it a fair comparison? Maybe.  It suggests that coordinated customer service in the health care industry is about 30 years behind the travel industry.

Before online reservation systems, there was once a noble occupation known as “travel agent.” This well-trained sole navigated the disparate, confusing and often conflicting systems of the hospitality and travel world to assemble a trip for you that had all the pieces you needed — hotel, transportation, tickets to events, etc.

Where are the analogs to travel agents in health care? Who is your health care concierge?

Barb, a hospital administrator, was thinking about the work her staff does day in and day out with our broken health care system. She told us a story based on those thoughts. Her story is a parable of sorts, describing what it would be like if a business outside of health care treated its customers the way patients are treated when they see their physicians.  The story goes something like this…

Joe hears a noise from his car and decides he better have a mechanic look at it.  So Joe calls Bill’s Auto, a nearby auto repair business. Bill’s Auto is Joe’s designated “Primary Care Mechanic” (PCM). Joe gets a busy signal when he first calls. So, he tries again on his lunch break, but he can’t get through because the phones at his PCM are turned off. Joe doesn’t leave a message, because he knows it can take days to get someone to call him back from any auto shop, not just his PCM.

After several tries, somebody at Bill’s Auto answers the phone, and Joe schedules an appointment a couple of days out. Joe worries if the problem is serious that he could get stranded while waiting for an appointment.

When Joe arrives for his appointment, the harried receptionist tells him that the mechanic will see him but is running “a little” late, then hands him a stack of paperwork to fill out. While Joe writes down his name and address, he wonders why they need that information again since Bill’s Auto has been his PCM for years. The papers ask him to explain the problem in detail (but isn’t that why he’s here?), and requires that he provide payment details, all before he is told what the problem is and what it might cost to have it fixed.

Joe sits in the waiting room for 30 minutes, worrying when he can get back to work. Then he’s called into a service bay where he is asked to wait for his mechanic who, he is told, will “be with you shortly.”  The service bay is closed off and he waits beside his car for another 10 minutes before his mechanic joins him.

After a three-minute interview, Bill’s mechanic tells him that he needs to be seen by a Mufflerologist (a muffler specialist), so the mechanic will refer him to one he’s worked with a lot. Joe leaves Bill’s shop with his car and a small note on which the mechanic has scribbled the name and telephone number of Sam’s Muffler.  Joe is told that someone from Sam’s muffler will call him.

A week later Joe hasn’t received a call from Sam’s Muffler. So Joe calls, and Sam’s tells him that they did not receive a referral from Fourth Union Bank, which is Joe’s bank.  Joe wonders why his bank is involved now – he thought this was between his PCM and his new Mufflerologist. Joe calls his PCM and (after several tries, of course!) talks to a referral coordinator at Bill’s Auto whom he has never met.  The referral coordinator tells Joe that his bank has to approve the referral for his suspected broken muffler in advance. But even with that approval, they may not pay to the Mufflerologist and he still has ultimate financial responsibility for the costs.

Now a full two weeks after Joe first saw his PCM he calls Sam’s Muffler to schedule an appointment. They tell him that the Mufflerologist typically doesn’t deal with people who bank at Fourth Union Bank, but as a favor to Bill’s Auto, they will see Joe’s car.  Joe wonders who’s doing who a favor. When Joe gets to Sam’s for his appointment he waits for an hour, again filling out forms that describe the problem he’s having with his car. The forms also ask him for every problem he has ever had with his car and when it happened. Then Joe is seen by an assistant to the Mufflerologist who asks him all the questions that were on the forms.  Joe finally sees the Mufflerologist, who asks him the same questions again.

Later…
Now four weeks after his first visit to Bill’s Auto with muffler problems, Joe leaves Sam’s Muffler with a new muffler.  Then the problems begin!

About a month later, Joe receives a bill from Sam’s Muffler. The cost seems high; much higher than he had expected. Joe notices that Sam’s Mufflers lists a “base price” that is three times the “negotiated” rate he is asked to pay. Reading further, he sees that the discount doesn’t apply to Joe specifically, but to people who bank with Fourth Union Bank.  He wonders why?  Confused, Joe pays the discounted invoice.

Two weeks later, Joe receives a separate bill for the muffler itself from Sam’s Durable Muffler Equipment Supply.  Now Joe is upset! He thought the muffler would be covered by the first invoice – it certainly looked like enough to pay for a whole new engine!  As with the first invoice, he had to pay a lot, but it was a fraction of what was listed as the “base price” because he is a  Fourth Union Bank customer.

A week later, Joe receives yet another invoice, this one from the Mufflerologist who actually worked on Joe’s car. He notices that there is no discount on this invoice. Reading the fine print, the invoice explains that the Mufflerologist was not certified by Fourth Union Bank, so no discount applies.  Now Joe is really mad.  He calls Sam’s Mufflers but can’t get through – it was lunch time and the phones were turned off.

Copyright © 2010, Clarity Health Services

In the “good old days” of medicine, as physicians we used to get together over a quick cup of coffee or a half sandwich in the physicians’ lounge of the hospital. We’d help one another figure out the best way to care for our patients, not because we each had a particular financial stake in the outcomes, but because we knew that we’d serve our community better if we were all able to help each other deliver the best care to all our patients. In a very real sense, every patient under the care of any one doctor present was also a patient of mine, and vice-versa. We were a community of providers.

Today’s health care environment is vastly more complex than it was back then. Even so, we need to take steps towards regaining that same sense of community among our current practices. Our first step is to use tools (like Clarity) that make it easier for providers to work together across differing systems and organizational boundaries.  Beyond that we need to look toward delivery system changes. There’s a model proposed by many health care reformers known as the “Accountable Care Organization” or “ACO”. In an ACO, a defined group of providers and practices – and potentially a hospital or other facilities – takes joint responsibility for the quality, effectiveness, and cost of delivering health care to a defined population. Whereas today’s health care delivery choices are largely managed by insurers, in an ACO, it is the providers that have responsibility for all aspects of care.

We see the potential for an ACO in our area which is comprised of independent, yet inter-dependent, practices working together. In this scenerio, providers can continue to  practice community-centric medicine as independent practitioners, while at the same time, act in accordance with commonly shared core values while agreeing to be  jointly accountable for the care of their common patients.

ACOs are somewhat new and different than other delivery system models. In subsequent posts, we’ll look at the people, processes, and payment approaches that make ACOs a promising approach to some of the difficult issues we face in our health care system.

As I write this, I’m recalling my early days in practice.  There were about 90 of us on the active medical staff of the local hospital. The Physicians’ Lounge was our place to gather.  Beyond the usual banter about the stock market or last night’s high school football game, a lot of important patient care “stuff” happened there. We discussed difficult cases. We arranged referrals and consultations. We shared follow-up results. We decided on “next steps” for our patients. And we learned a lot from one another. Primary care physicians still rounded on their patients and provided the “bridge” that spanned outpatient and inpatient care. Care seemed better coordinated and our sense of professional community was pretty high.

Times have certainly changed.  Driven largely by the growing financial pressures facing most physician practices (and hospitals), care is rarely delivered that way any longer.  Primary care physicians have become much more focused on their clinic practices. Hospitalists provide the bulk of inpatient care. Patients increasingly rely on specialty care (especially in the face of a serious primary care shortage). And payers are more intrusive than ever. The result has been a rapid decline of our sense of community.  We’re physically more detached. Paper work piles up in front of and between us. Communication among us is often lost “on hold.” Physician dissatisfaction is high.

Even more concerning is the fact that patient care delivery is also becoming more fragmented.  No one seems happy.

While we can’t turn back the clock to the “good old days” in the Physicians’ lounge, what can we do to recreate community among physicians? First, we can make it easier to do the right thing. At NPN, we’ve adopted Clarity as our care coordination service in large part because it makes it easy for physicians and their staffs to collaborate on patient care and communicate more effectively about what’s clinically important, while at the same time, continuing to do the work they have to do anyway. Indeed, it’s faster, cheaper and easier to collaborate and coordinate referrals this way than the old way.  And it fosters communication and community.

Using Clarity to coordinate care is one step down the road to actually organizing ourselves in a new way, remaining independent while becoming jointly accountable for all aspects of care for our patients. I’ll have more on this in my next post.

In sports, you have to know who is on your team so that you can deliver a winning performance. It’s pretty easy to know who is on your team — just look around the field and find the players with the same color jersey.  In medicine, teamwork is essential but finding your teammates is not so simple. More often than not, the members of a patient’s care team aren’t even in the same building, and one team member may not even know another clinician is on the team!

A gastrointestinal specialty practice deals with the challenges of this “invisible team” all the time. Before they schedule certain procedures, they need to check their patients’ history to determine, for example, whether they need cardiac clearance. One particular gastro practice working with Clarity was prepping for a patient, and saw a cardiac referral in the patient’s referral history online in Clarity. This allowed them to quickly and easily contact the cardiologist on the patient’s care team, and obtain the required clearance.  Had they not had Clarity, they would have had to work back through the PCP in hopes of tracking down the patient’s cardiologist.

It’s great to know who is on your (patient’s) team!

If you missed the first half of this list, check it out. And now, with a little help from our friends, we present items #1 through #5 of the Top Ten list of

Things I miss the most now that I use Clarity:

5.  Playing Nancy Drew trying to solve The Mystery of The Impossible AIM Authorization (with chart notes written in hieroglyphics!)

Clarity takes the mystery out of referral processing, deciphering the complexities of today’s insurance regulations and procedures on your behalf.  You might like to take up Sudoku as a puzzle-solving alternative.

4. Practicing my lyrics for karaoke night with a 90-second loop of “Don’t Stop Believing” while on hold … 13 times!

While the 80’s were a great musical era, you can spend this office time following up with insurance billing to generate clinic revenue.  Hey, you can always practice your chops in the car on your way to work.

3. The security of having my call monitored for quality assurance.

Clarity provides the security you’ll need — referral documents and processing information stored safely online for immediate retrieval.

2. The invitation to call again when L&I is not experiencing a high volume of calls.

Don’t feel unloved.  Clarity loves you.   We eagerly await your questions, comments, and input to enhance our service.

And finally, the #1 thing our customers miss now that they use Clarity is…

1. The social outlet of meeting new customer service representatives after countless transfers.

There is nothing quite like being transferred through the ranks of each department in a large insurance company so much that it seems they are trying to help you not get your referral authorizations.  With Clarity you can skip the fuss and spend this time getting to know your patients instead.

Happy Thanksgiving!

I had appointments with two physicians at separate practices. The first clinic’s waiting room had a couple of signs prominently displaying these words:

If you have been waiting longer than 15 minutes, please see the receptionist.

The other clinic posted this sign just as prominently:

Due to the heavy demand for appointments, we are enforcing a $35 appointment cancellation fee.

Which of these practices is thinking about the lifetime value of their patients? Author Seth Godin wrote a short, provocative piece Embracing lifetime value and used a medical practice in his examples.  I recommend it.

So let’s look at my experience at each of these clinics.  My appointments were both scheduled for late in the afternoon, among the last appointments of the day for each physician. At the first clinic, I was escorted to the exam room after about 15 minutes, and saw the physician after a brief interaction with his nurse. The doctor was running “a little behind,” which I knew from the moment I checked in at the reception desk. He spent plenty of time with me, and I was well cared for.

After waiting for 25 minutes at the second clinic, I was escorted to an examination room and told “the doctor will be right with you.” Twenty minutes later, I was told he was running “a little behind.”  After an hour, I left the office. I won’t be back.

Which of these clinics seeks to maximize the lifetime value of their patients as customers? Which of these clinics is like yours?

With thanks to our customers for the ideas and a tip of our collective hat to Letterman for the inspiration, we present the Top Ten list of

Things I miss the most now that I use Clarity:

10. Warming my hands over the fax machine on a cold autumn afternoon.

By uploading your patients’ charts to Clarity, you reduce time spent faxing and refaxing documents.  You can also get updated patient notes immediately from other clinics on Clarity that have seen your patient … and with no paper waste.  Maybe this savings in overhead could be applied to turning up the temperature in the clinic.

9. Playing peek-a-boo with L&I: now it’s open, now it’s closed; now it’s open, now it’s closed.

Getting quick answers from insurance providers is no joke.  Clarity can seriously make your life easier.

8. Playing the odds with Tricare: Mamma needs a “Standard” plan, no whammies no whammies!

Filling out forms is time-consuming and the details can be confusing.  There is no gamble when Clarity takes on the hassle for you. Your skilled staff can be devoted to patient care rather than administrative overhead — reducing the overall cost of healthcare.  You can spend your saved time walking to 7-Eleven to get a lottery ticket.

7. Pretending to be a robot so the automated voice recognition system can understand me.

You don’t have to change what you’re doing to become more efficient.  Simply enter the referral information and Clarity will process your referral while you care for your patients.  You can talk in a robot voice when you make your referral if you like, we don’t mind.

6.  The meditative dial tone after holding for 20 minutes.

Few things can be more frustrating than holding for long periods of time only to be disconnected and having to start again.  By using Clarity, you don’t waste your time being left on hold with insurance companies, so your clinic can devote more time to patient care and patient follow-up phone calls.  Perhaps the music in the office could be changed over to that familiar tone.

Look here for #1 through #5 on the Top Ten list.

One of the first things I did when I became NPN’s Chief Medical Officer was to go out and visit with many of NPN’s primary care physicians in their clinics. These clinics — in office buildings and shopping centers, converted houses and stand-alone clinics — are the front-lines of health care in our community. The physician/owners of these clinics told me what matters to them, and why they practice medicine in independent practices.

While NPN’s primary care doctors are a diverse and independent  group, as individuals they expressed the same consistent set of values that makes them the quality doctors they are. Here’s what I heard from those docs:

• They believe in Thriving through Innovation. They all want to find ways to be more effective in their care delivery and efficient in the administration of their practices. They look to NPN as a whole and their physician colleagues to find new and better ways to deliver care.
• The Sanctity of the Doctor-Patient Relationship must not be violated. While new and innovative tools will improve the life of the physician and the health of the patient, the trust that patients have put in their doctors must never be compromised.
• They are passionate about Defending the Freedom of Healthcare Options. It’s up to the patient and doctor together — not a health plan’s guidelines or a “corporate medicine” productivity number — to determine what is best for the patient and they must be enabled to proceed along that path.
• The Passionate Pursuit of Optimal Care leads to the best outcomes for their patients. They have experienced and believe in the power of evidence-based clinical decisions, using Chronic Care Registries, e-presribing, and expert clinical support.
• They are committed to Being Rooted in the Community as Independent Physicians. This is their home. They have committed to living and working in the community and to contributing beyond the clinic to the health and vibrancy of their city and region.

In future posts, I’ll unpack these values in more detail, and use real examples to show how these values live everyday in our community.

The cost of interacting with insurance plans averages a whopping $68,274 per year per physician in America’s clinics according to this important study funded by the Robert Woods Johnson Foundation and the Commonwealth Fund, and published in Health Affairs. Administrative costs in general — and particularly those related to dealing with insurance — have been the subject of a lot of attention in the current debate on health care reform.

The study gets into the details of why it is such a critical issue for practicing physicians. Not only is it a major cost of doing business, it takes time away from clinicians that could otherwise be spent with patients. On average in each practice, the time to interact with health plans is an enormous time consumer. For each physician

• The physicians themselves spend nearly 3 weeks per year (about 3.5 hours per week),
• RN/MA/LPNs spend over 19 hours per week per physician, and
• Clerical staff spends a whopping 36 hours per week per physician!

And the time consumed varies inversely with the size of the clinic, with physicians in smaller practices (1-2 physicians) spending considerably more time on these tasks than those in larger groups. Similarly, Primary Care physicians spend the most time, and specialists spend the least.

These findings are in line with an un-sponsored, recently published report by Thompson Reuters on waste in the health care industry. NPR reported on this topic recently as a part of their on-going and extensive coverage of health care reform.

Clearly, services and tools that help physicians — particularly those in smaller practices — to avoid these cost and time sinks will help make a difference in their businesses and in the time they can devote to serving their patients.  Our Referral Management service is aimed at reducing the time and cost burden of insurance plan interaction every day.