BTE: It sounds to me like you guys are focused squarely on the medical business and improving the physicians bottom line above all else, with the secondary focus on improving data liquidity?
David LaBorde: We believe it’s both, because when you tell somebody you can improve their business they are going to listen, and then when you tell them you can also improve outcomes they are really listening. Because they have this solution at the point of care that does this front-end revenue cycle management piece it also is a more efficient way to keep track of your patient lists and bringing greater visibility to the data, making it more available in more places because its cloud-based.
So now that we have this structured database we can look at outcomes, we can look at complication rates, and infection rates, because that’s all now in the data and its centralized. What was before a little pocket of information in this location, another pocket over here, and yet some more over there, is now unified in one easily accessible location by all relevant parties. We are truly integrating the data from the perspective of the physician, allowing him to have complete access to his patient data from any location on any device.
When paper processes are used to capture charges, there is a definitive time lag between when data is captured in the hospital and when it is delivered to the physicians’s home office billing staff, which is where the charges are posted to the payors to begin the reimbursement collections process. In total, this process can often take more than 90 days. One contributor to this significant time lag can be manual paper processes, which continue to be in widespread use.
Because the hospital EMR systems do not talk with the physician private practice’s back office billing systems, paper billing forms are still used, even in EMR enabled settings, to capture the billable episodes of care. These paper forms then have to be delivered to the billers, a process that is fraught with inefficiencies and can take as long as 30 days or more in some cases. To make matters worse, some of these forms never get created by the busy physician and even if they are, a subset are lost or misplaced and never reach the billers desk.
As if that were not enough, a good percent of the charges that do make it through this haphazard process end up getting denied, which can be for a multitude of reasons. There are a bevy of problems, but the point is it is extremely important to capture all of a physician’s billable charges in real time and to capture them correctly the first time. It is also why replacing the paper process with a mobile digital solution is such an elegant and can drive so much value.
The billing people are always chasing physicians trying to get them to turn their billing cards in, which in and of itself is an unnecessary and inefficient process. But when practices begin to realize how much this inefficiency is costing them from a cash flow perspective – remember the more cash flow a business generates in a given year the more valuable that business is – and so from a cash flow perspective those days are very costly. One important piece of the problem is charge capture, how do you capture those charges that are not getting claimed for whatever reason, which is fundamentally a revenue problem. So there is the cash flow piece as well as the lost revenue piece which we are able to improve with our charge capture feature.
We are essentially trying to accelerate the process and eliminate the inefficiencies between the point of care in the hospital and a physician’s billing solution. We want to take practices from 14 day lags in charge capture to less than one day through visibility of data and eliminating the manual go-between.
BTE: Do you foresee an opportunity to integrate your software into the prehospital and ambulatory care settings?
David LaBorde: We certainly see opportunity in a number of ancillary markets, such as nursing, home care, etc. We need to prove our model first on a small scale which demonstrates that our solution first helps doctors quickly and concisely sum up the financial condition of their practice, literally handing practitioners a diagnostic report. We are currently working really hard to get that piece up on our website so doctors can simply visit and insert some basic information to get a better sense of how their business is being effected by the various challenges we have discussed today in terms of charge capture and receivable backlog. There are tons of downstream opportunities.
We really just need a revenue number and some sort of estimate on the total lag in receivables to find the baseline and figure out what our product can do to improve the bottom line of your practice.