A Bear Attack and CMS

One of the tragic news stories this summer was a fatal bear attack at a campground near Yellowstone National Park. One person was killed and two more were injured during the rampage of a bear and her two cubs. Park officials said because the sow had tasted human flesh, she would be a constant danger.

In July, CMS was served up a tasty 32 percent discount from its fee schedule via competitive bidding. Now CMS is no more likely to back away from its attacks on the profitability of HME providers than the rampant bear is likely to return to a diet of berries.

That leaves you with three choices: 1) Get out of the woods and stay out; 2) Stay in the woods and get killed; or 3) Stay in the woods and succeed by being smarter and stronger than CMS. The first choice may be smart, the second is plain dumb and the third may be genius. However, those that succeed will make radical, expensive, fast, distasteful, hard and risky changes to every aspect of their business.

The changes will have to be centered on automating business processes that remove the high cost of human interface. The successful will be those who dig deep to harness the most powerful force on earth, the human imagination. Imagination is envisioning what can be from what is not.

We don’t currently have all of the necessary technology available in this industry but, fortunately, technology that is being used in others can be adapted. While some opportunities are highlighted here, this column is not a map to the future; it is merely a rough sketch of the destination.

• The marketing function, for example, can automate “touches” of referral sources with email. Some of the face-to-face can and will be replaced by catchy and helpful content. Rather than buying time for footsteps and miles, providers will push a button and contact everyone in their market. Offering helpful content and creating interaction on websites can develop relationships with referral sources. Many of the time-consuming in-services will be delivered via video conferencing. Providers will produce (or buy) a library of multi-media content and deliver it to multiple referral sources at the same time. The technology is in place; all that is missing is the discipline to change.
• Referrals can and should be collected via the Internet. This is already being done but on too limited a scale. A significant advance that needs to be made is that the data should go directly to billing software without human touch. To re-key the data is a waste of three to six minutes. Taking the data by phone is a waste of six or more minutes. Software should have the logic to read the data and assign the referral either to an automated authorization application or to human intervention. Similar technology is being used in financial services.
• Nearly all recurring orders should be handled by voice-activated systems. This applies first to inbound calls where the same technology that pharmacy has used for years can be adapted. Outbound calls to confirm patient needs can be automated, too. This technology is already being used by a lot of other industries. To use a 20th century phrase, “the killer app” is creating an interface between the voice system and the billing system.
• The order documentation process has already been fairly automated with respect to the output of documents. The opportunity lies with the receipt and processing of documents like CMNs. Optical Character Recognition (OCR) technology has been available for more than a decade. OCR can be coupled with the scanner and software that analyzes the document to determine if it is satisfactory or requires a human intervention. Tied to this system should be the generation of an automated follow-up requesting the return of CMNs from physicians when they are three days past the issue date.
• Applying cash has been automated as well, but there is still room for improvement. Too many paper EOBs are processed by hand. OCR applications are the foundation for automatically reading the EOB, converting it to an ANSI file like Medicare’s ERN and allowing the billing system to automate the posting.

The headcount of a company drives just about all other expense categories from occupancy to office supplies. Automation may be distasteful, expensive and hard to do, but the alternatives are worse.

Read more Better Business columns.

Wallace Weeks is founder and president of Weeks Group Inc., a Melbourne, Fla.-based strategy consulting firm. You can reach him at 321/752-4514 or [email protected].