Technology strives to keep physicians focused on allergy, asthma care

Key takeaways:

• Software can reduce time spent on administrative tasks.
• Adaptive technology can streamline coding and billing processes.
• Artificial intelligence can automate manual tasks in prior authorization.

As practice management demands pull clinicians away from their patients to tend to administrative responsibilities, digital technologies are stepping in to mitigate these burdens. But keeping up with new tech can be a chore by itself.

Which analog problems have digital solutions? How do we untangle complications in coding and billing? Is artificial intelligence (AI) the answer to common quandaries?

As a partner at ENT and Allergy Associates of Florida and senior medical director for otolaryngology at ModMed, which creates software solutions for medical practices, David Lehman, MD, wrestles with these questions daily.

Healio spoke with Lehman to get the answers.

Healio: Digital tools are now standard in allergy/asthma practices, but challenges remain. What are some of the most common pain points?

Lehman: The entire health care ecosystem continues to face an alarming rate of physician burnout due to ongoing staffing shortages, an aging workforce, and a growing patient population. The allergy and immunology field has been no exception to this trend. We have 78 accredited allergy and immunology programs in the U.S., but it is estimated that only around 160 trainees complete these programs each year.

At the same time, the cost of running a private practice has increased significantly in recent years. Today’s physicians running independent practices not only face rising medical liability insurance costs, but reimbursement costs have also decreased around 30% over the past 2 decades compared with the rising costs of operating a practice.

Although many practices have taken to technology to help mitigate the effects of the challenges, many are still operating with legacy software systems that do not necessarily address the root of these issues, and ultimately slow them down.

Healio: What does technology need to do to improve these issues?

Lehman: Implementing the right technology for your practice is the first step to tackling the challenges many practices face today. An all-in-one, specialty-specific software solution, for example, can help streamline workflows and reduce administrative burdens.

An EHR system that integrates with your practice management software can significantly impact the amount of time practice staff spend on administrative tasks, thanks to built-in automation features such as patient self-scheduling, payment options such as text-to-pay and autopay, or text reminders for upcoming appointments. An integrated solution can also help improve inventory management for practices, allowing for real-time inventory tracking. Built-in “out-of-the-box” specialty-specific medical content can reduce the time a physician needs to spend repeatedly typing details into visit notes. By maximizing time and resources, these solutions enable physicians to focus more on providing quality care to patients.

Technology solutions also have to be adaptable to the provider and practice methodologies, which can vary by region, payer and provider’s unique experience and training. Elements such as user-specific adaptive learning saves providers time in documenting each visit. The means of creating templates for a typical visit can also substantially reduce documentation time. For systems to actually help an allergy practice, they need to incorporate efficiency tools like these to empower providers to practice medicine, instead of dedicating their time to technical data entry.

In allergy and immunology, there is tremendous variability in how immunotherapy patients are treated with increasing regulation such as USP 797 and insurance pressure. Technology that is designed to be flexible and configurable to fit a specific provider’s methodologies can save them hours per week in formulating allergy prescriptions and managing their patients’ immunotherapy journeys. Digitized skin test results with customizable algorithm-based test processes save time and support staff in the accurate execution of the protocol. Modern safety features such as barcode scanning can help with real-time inventory management, while also providing safety checks confirming the correct therapy is being administered to the correct patient. The mixing process should automatically produce labels capable of withstanding repeated exposure to alcohol wipes without needing additional tape or protection. The documentation should be flexible to satisfy evolving insurance demands while ensuring all relevant details per USP 797 are included. Provider-specific algorithms for allergy injection dosing that alert staff for late or reactive patients and automatically apply reduction protocols, while seamlessly posting charges, offers providers efficiency, safety and peace of mind.

Healio: We frequently hear about difficulties in coding and billing. What makes these problems so challenging?

Lehman: Successful practices need effective revenue cycle management, but medical billing and coding errors still present major challenges throughout the entire health care sector. It is estimated that 80% of medical bills contain errors that can result in delayed and denied claims. Several errors can lead to denials, such as incorrect patient or provider information, invalid or missing codes, duplicate billing or lack of documentation.

The rising rate of burnout and persistent staffing shortages have had a direct impact on coding and billing, particularly in specialties that have such complex and specific coding requirements such as allergy and immunology. Navigating this complexity can be a significant burden on a practice’s staff, especially for increasingly busy practices. The 2021 evaluation and management (E/M) coding guidelines present a potentially helpful change for physicians, as we can now code based on medical decision-making rather than documentation volume, but properly coding and leveraging those benefits requires deep understanding. An EHR system that has the 2021 algorithm built in allows for automation of the E/M code generation through capture of all the data associated with medical decisions. Such a system also can both minimize that burden on physicians and allow for more justified, accurate E/M coding.

The field is being acutely challenged with substantially increased scrutiny to immunotherapy charges. A clinic can have an extremely high volume of shots, creating an operational challenge to ensure they are all consistently and correctly charged. Billing for immunotherapy compounding has onerous daily and annual caps and allowances that vary between payers. Accurately capturing the necessary patient history for biologic ordering and administration can be complex and very expensive if not done properly. The reality is the rules and nuance of allergy billing combined with the frequency of visits is difficult to manage and only gets harder with volume.

Healio: How can these problems be solved?

Lehman: It all boils down to implementing the right technology that streamlines administrative processes and maximizes operational efficiency. An integrated EHR and practice management system that leverages adaptive technology can automatically suggest ICD-10, CPT and modifier codes based on a physicians’ clinical documentation, including E/M codes, that can then be adjusted before billing if necessary. By automating coding and billing, practices can expedite the full billing process by reducing the risk for inaccuracies and significantly reducing the amount of administrative burden placed on practice staff.

Finding solutions that go beyond automating the coding but also support workflows to ensure relevant information is captured can help mitigate denials without additional labor and management. The ability for a solution to offer flexible documentation to satisfy evolving payer requirements is also paramount to mitigating these billing challenges. Finally, tools such as scrub rules to catch and flag bills that might need additional scrutiny (for instance, a certain payer for 95165) can save time and accelerate the reimbursement cycle.

Healio: AI is now playing a role in many practices. How would you characterize its use now, and how may it evolve in the years ahead?

Lehman: AI is already playing a role in streamlining backend operations across practices, but several opportunities remain for the technology’s expansion, especially as practices continue to seek more time-saving solutions. Ambient listening technology represents an early example of a tool with enormous potential. This technology “listens” to the conversation between a provider and patient during an appointment and automatically captures notes, saving providers from typing out their own physical clinical notes. Physicians already spend nearly 2 hours every day outside of normal working hours on documentation. This type of innovation can be a transformative approach to addressing the burnout associated with documentation.

AI can also help streamline prior authorization, where insurers ask for an arduous amount of documentation explaining why a physician has prescribed a therapy or diagnostic test. Today’s prior authorization process still heavily relies on manual tasks and generates a large amount of paperwork that falls on practice staff, often leading to delays in care. AI can help automate these manual tasks, boosting efficiency and freeing up staff time considerably.

We are only just starting to see the impact of AI in allergy and immunology, but one thing is clear: AI will not replace the provider-patient interaction, but rather enhance it. Allergy and immunology will always require the human touch. AI can be instrumental in boosting efficiency and streamlining workflows so that providers can dedicate more time to what matters most, which is delivering quality care.

Healio: Are there any other areas where digital technology can improve practice management?

Lehman: Digital technology can ultimately enhance the patient experience. Practice software solutions with automated features not only save time for providers, but they also provide patients with convenient options that enable them to take charge of their own care.

As our world becomes more advanced, patient expectations continue to evolve, requiring practices to keep pace by adopting the latest cutting-edge technology that effectively meets patient needs. Leveraging patient engagement tools such as online patient portals, kiosks and satisfaction surveys is a simple but effective way to improve patient satisfaction and practice management simultaneously.

References:

• Gaffney A, et al. JAMA Intern Med. 2022;doi:10.1001/jamainternmed.2022.0372.
• Medical billing errors growing, says Medical Billing Advocates of America. https://www.beckershospitalreview.com/finance/medical-billing-errors-growing-says-medical-billing-advocates-of-america.html. Published April 12, 2016. Accessed March 15, 2024.
• Medicare physician pay fell 26% since 2001. How did we get here? https://www.ama-assn.org/practice-management/medicare-medicaid/medicare-physician-pay-fell-26-2001-how-did-we-get-here. Published July 7, 2023. Accessed March 15, 2024.
• Nearly 30% of medical liability insurance premiums rose in 2021. https://www.ama-assn.org/practice-management/sustainability/nearly-30-medical-liability-insurance-premiums-rose-2021. Published March 23, 2022. Accessed March 15, 2024.
• Pediatric allergists struggle to meet growing patient demand. https://www.healthcare-brew.com/stories/2023/02/15/pediatric-allergists-struggle. Published Feb. 15, 2023. Accessed March 15, 2024.