HHS . Assistant Secretary for Planning and Evaluation The Office of Health Policy found telehealth usage during the first peak of COVID-19 increased from less than 1% of visits to 80%.
But even if some important questions about the staying power of virtual care recently answered, telemedicine health systems and startups continue to face major challenges in navigating licensing requirements to operate across state lines. .
Whether it’s confusing, state-by-state policy, staffing shortages causing massive delays, or ever-higher demand for virtual care, health systems and startups need to find ways to reduce administrative costs and shorten time.
Healthcare IT News sat down with Eric Demers, CEO of Madaket, a provider of a provider data management platform, to discuss his views on how to streamline telehealth licensing and ensure top-level, on-demand care for the patients who need it most.
Q. In general, what are the multinational caregiver licensing challenges facing the health system and telemedicine companies?
ONE. Licensing is a complex, tangled web of varying requirements, times, and administrative procedures, regardless of state. To complicate matters further, each state has its own rules about what documents are required for verification, different document processing speeds, unique platforms for submission, and most importantly, eligibility deadlines. different before the license requires renewal.
Managing these license updates for a network of providers, whether a single clinic or a health system, is not just a full-time job – it’s a full-time job. time. However, non-clinical staff has been in short supply for many years now, with 61% of suppliers experience a shortage of qualified candidates.
This leaves many doctors, nurses, and other health professionals responsible for verifying and updating their own licenses, a task for which they have neither formal training nor time. This process not only creates inefficiencies and confusion, but mistakes can be very costly.
Once the information is sent to the state, it enters a communication black hole, with processing times ranging from a few months to more than a year. That delay could have put vendors at risk of non-compliance, but it would multiply if there was a mistake in the submission, causing the process to reset and the clock to start going back to zero.
Telemedicine companies face these challenges more often than traditional providers. With a business model built on flexible, telemedicine, telemedicine providers benefit from expanding into as many states as possible, increasing their care network. surname.
Of course, with that rapid growth comes more bureaucracy, a challenge that weighs heavily on these smaller providers.
Q. How can health systems and telemedicine companies Reduce administrative costs and shorten multi-state licensing time?
ONE. Licensing is a heavy task that requires attention to detail, long supervision, and a lot of patience. Extending that across multiple states requires an understanding of the pertinent differences that can affect verification success. This process has a small margin of error and mistakes can be extremely costly.
Automation is a valuable tool for any vendor looking to reduce that risk, and can be a huge time and cost saver. The provider data management platform serves as the central source of truth, tracking deadlines and status for all medical staff on the payroll and storing their information.
These information centers save manual processes of entering and re-entering licensing information for multiple states or providers within the same hospital network, auto-populating it with an antbank instead. existing consciousness.
Provider data management platforms also keep track of deadlines for all relevant statuses, ensuring that providers are notified of renewals with full notice and are undetected. now scrambling to ensure they comply.
Like other automation software designed to streamline government forms – such as TurboTax – the vendor’s data management platform articulates the specific requirements for each state. in a way that is easy to understand, simplifying the process and reducing the risk of sending incorrect information.
As I’ve outlined, there are real economic consequences to licensing delays. Individual vendors will not be allowed to practice until their license is approved, which can last for several months if the information provided is not accurate or complete.
All of these factors contribute to massive administrative waste in the healthcare industry. 15-30% of health spending goes to administrative spending, half of which is wasted on unnecessary tasks and bottlenecks caused by administrative bureaucracy.
And with staffing shortages across all stages of care, there will be fewer professionals trained to manage increasingly complex processes. Many locations are so overcrowded for administrative staff that the burden lies directly with care providers in managing licensing requirements, along with registration, certification, and duties. other general administration.
Automation eases the burden on staff, allowing more resources (employees and money) to be channeled directly instead of visiting patients. Doctors can see more patients each day, get paid faster, and spend more limited time practicing than doing administrative tasks.
Q. You said your company helped customers like MindStrong navigate millions of provider transactions in 2022 alone, helping to provide much-needed care to patients in multiple states. How did you do it?
ONE. Automation is not just a licensing solution. There are several other administrative burdens that eat into supplier time and profits. Each payment system has its own application process, and like licensing, delays can have serious consequences.
When a provider is not correctly registered in the payer’s system, the payer will not be able to reimburse the care provider billed for that plan. This puts providers in the inevitable situation of having to shoulder the cost of care for months, waiting for the issue to be resolved, or denying patients participation in these plans until things are resolved. alright.
And similar to licensing impediments, providers must keep their credentials in order with their medical groups, demonstrating that they are qualified to provide care before they can practice.
Licensing, certification, and registration all require much of the same information. Madaket’s platform extends the vendor’s data management ecosystem to automate all of these tasks and many more. Instead of entering the same information into several different automation solutions, vendors can enter it once into a platform that acts as a single source of correct information all the time. their administrative extension.
The breadth of the platform and its secondary functionality as a trading company also helps to validate a directory of information which eases the tasks for third parties, such as payers, vendors individuals and others. While the license may require renewal every few years, the platform’s active users update their information on a monthly basis, resulting in more accurate data pooling than other publicly available data.
For example, payers can find up-to-date vendor information that was entered during a recent validation process and use that information to keep their own database accurate and sound. Those database factors affect compliance with federal regulations that require payers and suppliers to support price transparency and limit unexpected billing to consumers.
All of these factors combine to provide full control over healthcare administration operations.
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Healthcare IT News is a publication of HIMSS Media.
