If you’ve been running your own private medical practice for some time, you’ll have a good idea of what to expect in terms of patient volumes, revenue & expenditure on a weekly, monthly & even seasonal basis. These expectations have become the accepted status quo for many practices & a culture of ‘if it ain’t broke, don’t fix it’, has given healthcare professionals the time they need to focus more on patients.
However, according to Devan Chinsamy– Healthbridge’s National Sales Manager, this strategy has proven to be a costly mistake for many practices, so much so that he has coined the term ‘normalised pain state’ to describe practices that believe they are doing well, but are unknowingly leaking cash & jeopardising their longevity.
We sat down with Devan to find out how & why so many medical practices across South Africa are having revenue leaks & why they don’t even realise it.
The status quo
Healthcare professionals are obviously well educated, astute & capable of running a business. But there are some who understand the basics of running a practice to achieve their primary goal of treating patients, & there are others who know they need to intentionally build their business to ensure longevity.
“One way to recognise if your practice may be in a ‘normalised pain state’ is to ask yourself which category you fall into. In other words, do you think your practice is ‘fine’ if your revenue covers your expenses?” asks Devan. “For these practices that are ‘getting by’ they may be losing hard-earned revenue which will sometimes, only come to light, if there is a shift in the revenue to expense ratio due to external circumstances (think COVID & riots) & often it will be too late for them to remedy” concludes Devan.
The cause of the pain state
Devan explains that the root of the problem has a lot to do with practices not following best possible practice processes. He used the example of practices that collect a stack of files & then, at the end of the day, send claims for these patients retrospectively in the hope that they’ll get paid – which is quite risky indeed.
“Practices might have gotten away with it in the past, but with mounting financial pressures on patients, this is now a flawed process. We know that patients are buying down on their medical insurance & exhausting medical savings by the end of the first quarter,” continued Devan. “By not performing benefit checks, for example, you might not realise that you’re seeing patients pro bono.”
“In fact, lots of practices are operating like ATM machines that don’t verify if you’ve got ‘funds’ in the account, but allow you to make withdrawals anyway,” said Devan. “Processes like automated benefits checks, real-time claims submissions, automated reconciliations, SMS payment reminders are not only necessities to make sure you get paid, but will expose the false sense of security in a practice’s ‘normalised pain state’.
“To make it real, we’ve seen many practices whose ‘normalised pain state’ was exposed as a result of rapidly growing expenses due to external extremities.” continues Devan. “Practice owners that were just getting by month-on-month were at a high risk of either closing or selling their practices. Some healthcare professionals had to, at least in part, return to the public sector. This could have been avoided.”
Future-proofing your practice
The question on many healthcare professionals’ minds is how do I pinpoint where my ‘pain points’ are & what can I do about it?
“We recommend that healthcare professionals consult a third party for a non-bias review of their current practice processes. For example, we offer a complimentary practice assessment to private healthcare professionals before we recommend any solution. Our goal when conducting this assessment is to get to know your practice from your actual day-to-day workings. We don’t ask for financial statements, but doctors who are serious about their business will share relevant financial data,” says Devan. “We spend time speaking to the practice team from the receptionist, to the accounts department, to the practice manager, to understand the patient & practice process flows from start to finish.”
Devan explains that the purpose of these complementary practice assessments is not about exposing any individuals but rather exploring areas of improvement. A receptionist who’s on hold for 20 minutes trying to verify a patient’s medical aid details – whilst 10 more patients are walking in the door & lining up – can’t be held accountable for a poor patient experience & unpaid consultations down the line. The objective is to understand the admin burden & any other operational inefficiencies that are hindering the practice from operating optimally.
Once the Healthbridge team has concluded this assessment they can then determine whether a practice is running optimally or not.
“Optimisation is an ongoing process, but there are leading indicators of where to start. If claims are being rejected due to capturing errors – we can optimise that process with intelligent automation. Manual systems are fertile grounds for error & fraud. Our end-to-end solutions virtually eliminate the possibility of fraud,” continues Devan. “We also look at the reconciliation of the number of patients seen & the number of claims submitted. Doing this reconciliation manually can be time-consuming & prone to errors. The difference in cash can be tens of thousands per month, so we look to automate that process, too.”
Devan goes on to say that ultimately, Healthbridge is addressing the pain points of healthcare professionals & putting a monetary value on the ‘cost of the problem’. Healthbridge helps practices to grow their businesses, not only by increasing their ability to see more patients, but by improving their cash flow potential.
“The money is usually there, but we often find it in the losses. For example, a doctor submitting R300k in claims every month might be reimbursed for R250k. My question to them is where did the other R50k go? They might be using a system that is marginally cheaper than Healthbridge, but they’ll only recover a fraction of the R50k & have to write-off the rest to bad debt,” explains Devan. “We are giving doctors the system & the tools to mitigate loss – & that’s just one area where Healthbridge offers true value for money.”
Devan concludes by saying that: “The practices that thrive are those that have the right systems, processes, & staff in place. They have actively looked at their productivity, people, & patient experience to identify & ‘de-normalise’ this silent pain state & build their practices & profitability to the point of longevity.”
Healthbridge has been helping healthcare professionals run their best practice for over 20 years. We are the technology partner of choice for over 5 000 medical practitioners because of our intuitive, user-friendly systems that takes the guesswork out of running a profitable medical practice. For a free practice health assessment for your business, click here.
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