NCI, Inc. (“NCI”), a leading provider of advanced information technology (IT) solutions and professional services to U.S. Federal Government agencies, announced today that it has entered into an exclusive partnership with Columbus, Ohio-based CrossChx, Inc. Under the partnership, CrossChx will work with NCI to bring its artificial intelligence (AI) commercial capabilities to government customers, enhancing NCI’s quality of premier solutions while simultaneously creating new opportunities for NCI employees.
“We look forward to partnering with CrossChx to bring our customers an innovative new solution to increase efficiencies while delivering greater mission success,” said Paul A. Dillahay, president and CEO of NCI. “Our solutions will address human capital needs, especially for functions that allow people more opportunity to manage rather than manually operate those processes. This helps to remove elements of human error, boost workforce focus on solutions and innovation, and ultimately result in better outcomes for both our customers and employees.”
NCI’s AI capabilities will be unique in the market through a focus on scaling humans, an AI approach that uses continual machine learning and automated processes to build greater workforce and organizational results. Through this partnership, NCI intends to explore opportunities to improve the efficiency of its current operations, providing true interoperability and collaboration between customers, employees and AI systems.
NCI launched seven pilots in August 2017, utilizing the CrossChx AI platform to provide proof of concepts across areas such as fraud, waste and abuse, cybersecurity, machine-to-machine communication (M2M) and patient care coordination. NCI plans to deploy these capabilities in several customer environments beginning in 2018 and will have a patient care demonstration available at the HIMSS18 Conference and Exhibition in Las Vegas from March 5-9, 2018.
“CrossChx is excited for the opportunity to help NCI build out their AI capabilities,” said Sean Lane, co-founder and CEO of CrossChx. “We anticipate implementing AI solutions across all of NCI’s operations in order to help them increase speed and productivity for their clients. After finding immense success in helping healthcare facilities adopt operational AI with our solution Olive, we are eager to bring this technology to the federal government where we think it will make a significant impact.”
About NCI, Inc.:
NCI is a leading provider of enterprise solutions and services to U.S. defense, intelligence, health and civilian government agencies. The company has the expertise and proven track record to solve its customers’ most important and complex mission challenges through technology and innovation. With core competencies in delivering cost-effective solutions and services in areas such as agile digital transformation; advanced analytics; hyperconverged infrastructure solutions; fraud, waste and abuse; and engineering and logistics; NCI’s team of highly skilled professionals are expanding their portfolio to include game-changing technology offerings such as artificial intelligence for their government customers. Coupled with a refined focus on strategic partnerships, NCI is successfully bridging the gap between commercial best practices and mission-critical government processes. Headquartered in Reston, Virginia, NCI has approximately 2,000 employees operating at more than 100 locations worldwide. For more information, visit www.nciinc.com.
Founded in 2012, CrossChx is building operational artificial intelligence, which empowers humans to achieve more than ever before. Olive, the company’s AI solution, acts as the intelligent router between systems and data by automating repetitive, high volume tasks and workflows providing true interoperability for organizations. Headquartered in Columbus, Ohio, CrossChx has a mission to scale humans by allowing AI to operate existing systems and letting it do what machines do best. For more information, visit www.hireolive.com or email firstname.lastname@example.org.
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It is estimated that missed appointments cost the healthcare industry $150 billion each year. While the blame for this issue is often directed toward patients, inefficiency at the practice and clinic level can also be a cause.
This paper outlines the most common reasons patients miss their appointments, provides benchmarks by speciality, highlights the impact on revenue, and reviews the tactics that practices and physicians can employ as a solution.
Missed appointments by type
To understand the pervasive nature of missed appointments, it is important to know the variance among practices and specialities. For example, no show rates can range from the low end of 2 percent all the way to 50 percent.
Below are several average rates according to the type of practice:
It should be noted that patients with chronic conditions are more likely to not show for a scheduled appointment, as the challenges associated with their condition can make it difficult to maintain a time commitment. Unfortunately, this group of patients are also the ones who stand to gain the most by showing up.
Another group of patients that contribute to higher-than-average no show rates are those with Medicaid insurance. One reason for this can be due to socioeconomic reasons, such as a patient relying on public transportation or living in a rural area far from where their physician’s office is located.
Common reasons for no shows
A patient may miss their appointment for a variety of reasons, however, the most common causes are:
• Lack of reliable transportation to the appointment
• Too much time between the scheduling and the appointment
• Emotional barriers such as a negative perception of seeing the doctor
• Belief that staff do not respect their time or needs
Interestingly, in reviewing the scores of satisfaction surveys, the friendliness of the staff is more important to the patient than the actual outcome of the care that is delivered. This could be due to a lack of clarity the patient has around measuring the quality of care they received. However, it is easy for them to know whether they felt respected or were met with kindness by practice staff.
There is also the belief among patients that they are doing a practice a favor when they cancel an appointment. A patient may think they are giving staff time back in their day or that a new appointment can easily take it’s place, when in reality it creates lost time and resources for practices.
Impact on the bottom line
There are approximately 230,000 physician practices in the U.S. Of those, 47 percent of them are group practices, meaning there is at least more than one physician or doctor at the location. Patient no shows cost this group more than $100 billion dollars each year.
Patient no shows cost group practices more than $100 billion each year.
In a study on one practice, the average rate of appointment no shows was 18 percent, which resulted in a daily loss of $725.42. When employing tactics to reduce the number of no shows, the practice was able to recoup between 3.8% to 10.5% in revenue,
or $166.61 to $463.09.
In another study, a multi-physician clinic had more than 14,000 patient no shows in a single year, resulting in an estimated loss of $1 million dollars in revenue. In single-physician practices, revenue losses can be as as much as $150,000 each year.
On average, a primary care practice earns $143.97 per patient visit, whereas a non-surgical specialty practice earns $78.43 per patient. While these examples outline the revenue a practice stands to lose, they do not take into account other negative impacts, such as increased wait times or patient dissatisfaction. Therefore, the benefit of seeing more patients must be weighed against the risk of increased patient waiting time and staff overtime.
Current solutions and tactics
When considering possible alternatives to decrease the number of patient no shows, practices and clinics have employed several tactics. These include text messages, direct mail, live phone calls, and automated phone calls.
While all these tactics have proven to be successful in reducing the number of no shows, it is important to implement a solution that is cost-effective and complements existing practice efforts. Depending on the goals and objectives, a combination of solutions may be the best option. Below is a baseline introduction to these tactics:
Many software solutions for healthcare practices offer a way to send text messages to patients to remind them of upcoming appointments. These messages also provide an opportunity for a patient to confirm they will keep their appointment, such as replying with a ‘C’ for confirmation. If a patient does not reply or responds with a cancellation answer, this signals the practice staff that there is a need to reach out directly to the patient to either confirm or reschedule their appointment.
Text messages are opened 99–100% of the time.
Depending on the solution, the cost of sending text messages can be free or included as part of a larger software package or service offering. Additionally, text messages have a 99 to 100 percent open rate and reach a patient directly via their mobile device.
Another option practices and clinics use to remind their patients of appointments is direct mail, often in the form of a simple postcard. A printed piece can cut through digital clutter and offers space to include additional information or callouts.
While printing costs can be relatively inexpensive for postcards—averaging $0.15—0.32—they also rely on having accurate addresses for patients. Another drawback is the inability to have a patient immediately confirm they will keep their appointment. A postcard makes the patient aware but a follow up phone call, either by the patient or practice staff, is required for a confirmation.
Live Phone Calls
A call made by practice staff to a patient is a direct and personable way to reduce no shows. The live phone call also allows the patient to reschedule immediately if they are unable to make their appointment.
However, this is a very manual process, requiring a dedicated staff person to devote time and energy to making and completing calls. A patient may not be available or answer when called, requiring a voice message be left or another call be made.
With this in mind, the benefits of speaking directly to a patient versus the resources spent must be weighed against one another.
Automated Phone Calls
An alternative to live phone calls is an automated service that calls patients on a list, using a prerecorded voice. These services can run in the background with minimal maintenance required by staff.
While these calls can be made indefinitely, they can give the impression of being highly impersonal. A patient may not always listen to the length of the call as well, choosing to hang up as soon as they recognize it as an automated call.
Additional measures to take
Missed appointment fees
As an alternative to appointment reminders, some practices have opted to implement a fee when a patient misses their appointment. This can be due to an outright no show or instituted if a patient cancels their appointment too late, such as within forty-eight hours of their scheduled appointment.
While a fee does act as a deterrent, this can also cause a negative perception of the practice as a patient can feel penalized for missing an appointment for a legitimate reason.
Another option to overcome no shows is to overbook an office’s scheduled appointments. When this is done, an additional patient is already present in the event that a patient does not show up for their appointment.
However, the process of overbooking can be highly unreliable as it relies on predicting whether or not a patient will show up. If an unconfirmed patient does show up for an overbooked time slot, this can cause crowding in a waiting room, resulting in longer than normal wait times and a lower quality of service. If a patient’s wait time is severe enough, this can force the practice staff to fall behind for the day and struggle to catch up. Not only can service levels be negatively impacted for patients throughout the day, but this can also force the physician to cut appointments short, sacrificing face time with the patient.
The process of overbooking can be highly unreliable as it relies on predicting whether or not a patient will show up.
With this in mind, overbooking can solve the issue of no show patients and potentially increase revenue, but could create new problems in its place. Therefore, the benefit of seeing more patients must be weighed against the risk of increased patient waiting time and staff overtime.
It is clear that patient no shows represent a significant problem to the healthcare industry, in both the primary care and speciality office space. However, just as the issues with missed appointments impact patients and providers alike, the solution must also be one that accommodates both parties.
For example, one solution may be economically viable for a practice, but not effective or utilized on behalf of the patient. By engaging with patients in the way they prefer, the foundation for an ongoing relationship can be established. Over time, the conversation moves beyond simple transactional communications and becomes more valuable to the patient and practice.
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Berg, B., Murr, M. et. al. (2013). Estimating the Cost of No-shows and Evaluating the Effects of Mitigation Strategies. National Center for Biotechnology Information. Found online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153419
Toland, Bill. “No-shows cost health care system billions,” Pittsburg Post-Gazette. Feb 24, 2013. http://www.post-gazette.com/business/businessnews/2013/02/24/No-shows-cost-health-care-system-billions/stories/201302240381
Gold, Jenny, “In cities, the average doctor wait-time is 18.5 days,” The Washington Post. Jan 29, 2014. https://www.washingtonpost.com/news/wonk/wp/2014/01/29/in-cities-the-average-doctor-wait-time-is-18-5-days
Lacy, Naomi. “Why We Don’t Come: Patient Perceptions on No-Shows,” Annals of Family Medicine. vol. 2 no 6. Nov 1, 2004. http://www.annfammed.org/content/2/6/541.full
Evans, Melanie. “When revenue is a no-show,” Modern Healthcare. Nov 3, 2012. http://www.modernhealthcare.com/article/20121103/MAGAZINE/311039954
Mckee, Shawn. “Measuring the Cost of Patient No-Shows.” http://www.poweryourpractice.com/practice-management/measuring-cost-of-patient-no-shows
Molfenter, Todd. Reducing Appointment No-Shows: Going from Theory to Practice. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962267
The American Journal of Medicine. The Effectiveness of Outpatient Appointment Reminder Systems in Reducing No-Show Rates. http://www.amjmed.com/article/S0002-9343(10)00108-7/pdf
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MGMA Cost Survey: 2014 Report Based on 2013 Data. Key Findings Summary Report. http://www.mgma.com/Libraries/Assets/Key-Findings-CostSurvey-FINAL.pdf?source
Ineligible patient insurance coverage is responsible for over 75% of all claim rejections and denials by payers. Though some insurance eligibility checks can now be completed online, many practices still waste hours on the phone with insurance companies, or searching their websites, to verify patient coverage.
This paper outlines the severe financial burden that health care systems face as a result of manual insurance eligibility verification, details the time spent by doctors, nurses, and clerical workers each week on insurance-related tasks, and highlights the immense amount of insurance paperwork that comes along with each patient visit.
The importance of checking patient insurance eligibility
Practices may easily assume that when a patient schedules an appointment, the patient has already checked that their insurance covers that practice and/or the procedure or appointment type. Practices may also assume that if a patient hands them what appears to be a valid insurance card, they will be covered and that the insurance verification process can reasonably begin after the appointment.
This, however, is not always the case—some patients are not aware of verification requirements, or may not check for coverage for their particular appointment type. Additionally, if a patient’s insurance provider changes, they may not realize that they are no longer covered at particular practices or for particular procedures. In some cases, patients may even present fraudulent insurance cards—causing major complications if the error is not caught immediately.
Once presented with a patient’s insurance information, healthcare organizations will then begin the tedious and often time-consuming task of verifying their eligibility. This may be done online, by calling the insurance provider directly, or in some cases, not at all. If a patient passes this check, they can then be passed through the system with a bill eventually being sent to their insurance provider and/or themselves (in the case of copays).
If a patient does not pass this check, however, the organization is typically faced with three options: bill the patient the full amount of the appointment or procedure, write off the appointment or procedure, or deny the patient service (if the check is done prior
to the appointment).
Per physician, practices spend an average of $68,274 each year interacting with insurance providers.
Insurance eligibility checks are a very important and necessary part of the schedule-to-appointment process, as failing to complete them can lead to further complications for the organization. Manual verification can be extremely time-consuming and frustrating, as well
as a costly drain on the organization’s human capital. Integrated verification tools can help,
but still require a good amount of human input in order to function properly.
The cost to practices of insurance eligibility checks
With each patient that schedules an appointment should come a subsequent eligibility check. Typically, such a check requires obtaining the patient’s insurance information, calling the insurance provider, waiting on hold, and finally verifying the patient’s coverage. Insurance verification does not always fall only onto clerical staff—physicians and nurses also spend hours each week interacting with insurance providers, taking away valuable time that could be spent on patient care.
Below are the average times spent per physician in a practice on insurance company interaction.
Aside from causing healthcare employees stress and frustration, time-consuming insurance company interactions cost practices thousands of dollars each year in lost productivity. Per physician, practices spend on average $68,274 each year interacting with insurance providers. Overall, this costs the U.S. $23–$31 billion each year—a significant chunk of the national health care burden of over $3.2 trillion (as last measured in 2015).
Paperwork and human capital associated with insurance eligibility checks
In an increasingly digital world, a surprising amount of health information and data is still processed manually through paper forms. Many insurance companies still require practices to print out forms for patient visits, complete the forms by hand, and fax them back to the insurance provider. Aside from being wasteful of resources, this process is also incredibly
Dependent upon the care setting, time spent on paperwork can even match time of patient care. Below are the ratios of patient care time to paperwork time:
To allow nurses and physicians to focus on patient care, healthcare organizations may hire one or more eligibility specialists, whose entire bandwidths can be dedicated to insurance eligibility verification. These employees, however, can be costly, and are naturally prone to human error. On average, an eligibility specialist earns at least $34,000 each year, not including healthcare benefits and other employer-incurred costs associated with hiring an employee. More experienced eligibility specialists earn more per year, though even they are also prone to human errors such as miskeyed or misheard information. Every human-caused error causes a practice both time and money to resolve.
Current solutions and tactics
Currently, many practices still check patient eligibility manually, either through searching an insurance company’s website or by calling the insurance company directly. 38% review websites while 20% call directly, meaning that over half of all providers still spend a sizeable amount
of employee time verifying patient eligibility. Inaccurate or unupdated websites, as well as frustrating phone prompts, can make these processes last up to an hour or more for a single patient in some cases.
Every human-caused error causes a practice both time and money to resolve.
When considering ways to streamline the insurance eligibility verification process, providers are not left with many options. Current solutions include close to real-time eligibility software that integrates with older systems, or solutions that are tied to EHR vendors. These tools can help staff run through insurance eligibility checks at a much more rapid pace than before, as they automate certain steps in the process.
These tools, however still require human input, and often, human control to carry out. While some of the eligibility process may be automated through integrated systems, employees will typically still need to input the patient’s name, insurance provider, and procedure in order to begin the process. Additionally, providers must spend time and money upfront to train their staff on integration tools.
Patient insurance eligibility checks are a time-consuming, frustrating, and costly drain on health care systems of all sizes that can leave providers and patients equally upset. Future solutions geared towards solving these problems must aim to streamline eligibility checks in a manner that not only speeds up the process as a whole, but also improves first-time accuracy without requiring timely staff training to implement.
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Ability Network. (2015) ABILITY network survey shows nearly 60 percent of providers rely on incomplete eligibility verification. [Press Release]. Retrieved from https://abilitynetwork.com/wp-content/uploads/2015/07/ABILITY-Network-survey-shows-dependence-on-incomplete-eligibility-verification1.pdf
Casalino, L. P., Nicholson S., Gans, D. N., Hammons, T., Morra, D., Karrison, T., & Levinson, W. (2009). What does it cost physician practices to interact with health insurance plans? Health Affairs, 28(4), 533-543. Retrieved from http://content.healthaffairs.org/content/28/4/w533.full
Eligibility specialist salary. PayScale. Retrieved from http://www.payscale.com/research/US/Job=Eligibility_Specialist/Hourly_Rate
Morra, D., Nicholson, S., Levinson, W., Gans, D.N., Hammons, T., & Casalino, L.P. (2011). US physician practices versus canadians: spending nearly four times as much money interacting with payers. Health Affairs, 30(8), 1443-1450. Retrieved from http://content.healthaffairs.org/content/30/8/1443.full
NHE fact sheet. Centers for Medicaid and Medicare Services. Retrieved from https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html
Pricewaterhouse Coopers. Patients or paperwork? American Hospitals Association. Retrieved from http://www.aha.org/content/00-10/FinalPaperworkReport.pdf
Zamosky, L. (2014). 5 tips to improve your practice’s financial management. From insurance eligibility checks to sound collection strategies, medical practices must build processes for dealing with patients’ financial issues. Medical Economics, 91(12), 34-36.