Providers’ Guide to Best Practices for Revenue Cycle Management

Healthcare industry doesn’t only have hospitals and large medical practices. There are some medical practices that function in only one specific medical area and consult medical billing companies for reimbursements.

P3 healthcare solutions being a medical billing company has years of experience in medical billing services. We have come across many independent or stand-alone medical practices and well-established hospitals.

How Independent Healthcare Providers Are Coping Up With Changes?

One thing we understood in all these years is that the norms of the modern healthcare industry are changing. The focus has shifted to a value-based healthcare system instead of volume-based care services.

It also leads to structural changes in the progressive healthcare industry. According to the American Medical Association (AMA), physicians having independent clinics cover less than half of the total US doctors’ population. However, this trend of owning personal medical practice was high back in the 1990s.

Reason for Reduced Rate of Independent Healthcare Practices

The declining practice of independent healthcare providers owes to many reasons.

Some observers of the healthcare industry state that independent healthcare providers are forced to join larger healthcare systems as the earned revenue is not sufficient for survival.

Why medical billing companies Can’t Support independent healthcare providers?

Independent healthcare providers don’t meet up with their cost expenditure due to inflation and price surge. The increased administrative burden of MIPS QPP increased the price of surgical hospital admissions, emergency room visits, and drugs, which has caused major problems for independent healthcare providers.

Thus, in recent years, due to low reimbursements, around 22% of the independent clinicians reduced their office support.

Impact of Low Reimbursement Rate

Low reimbursement rate from insurance companies has also damaged this industry. Even hospitals and large medical practices are not safe from the changes in the healthcare industry.

The healthcare providers when unable to cover expenses within earned money, get in-touch with huge healthcare networks. Thus, the amalgamation of large and small healthcare practices has led to low competition in the healthcare industry.

In addition, often patients don’t pay deductibles or the extra amount other than their insurance benefits to independent medical practitioners. This way, independent healthcare providers never really compete with bigger healthcare organizations.

Reservations of Solo-Medical Practitioners

One concern that solo-healthcare services show is about the unreasonable reimbursement standards of insurance companies. Big healthcare organizations can better negotiate their demands with the increased volume of patients, which is a profit source for insurance companies.

All these issues make it impossible for small independent healthcare providers to stay in the industry. MIPS QPP has also fueled the declining trend of independent health services. Patients want access to top-quality healthcare, which a separate-working medical provider may not be able to provide. Consequently, the doctor doesn’t find a large share of incentives and bonuses.

To keep an independent medical practice, most solo-physicians function as a group outside the hospital circle. It has also helped medical billing companies to get high reimbursement for them as well as offered shared administrative responsibilities and resources over the network.

This might be the only surviving option left for independent healthcare service providers.

As large medical practices are dominating the healthcare industry, it is evident that revenue cycle management has not remained easy for solo-practitioners. However, with little adaption to change and a professional medical billing company, independent healthcare service providers can work their way up the success ladder.


Medical billing services constantly fight with the monster of denied medical claims. Denied claims top the list of factors that restrain efficient revenue cycle management. These have been a constant threat making the efforts of medical billers and coders to go in vain.

The claim rate has cost millions of dollars to the healthcare industry. Insurance companies reject hundreds of claims each year over minor issues. Not just big established medical billing companies do this mistake, but small practices also have a huge share in it.

Having said that, denied medical claims can be recovered with little care and organized follow-up services.

How to Accelerate RCM?

Hospitals and medical billing services can manage to increase revenue by eliminating all the reasons that cause denied claims.

Medical billing companies appeal for the denied claims, but it requires a lot of time and investment. It can also lag behind the rate of creating new medical claims.

How can medical billing services manage Denied Claims?

A simple solution is to recognize areas that are causing denied medical claims. Medical billing services can never optimize revenue cycle management unless they rectify those problems.

Given below are three easy ways to avoid denied medical claims.

Verify Insurance Benefits

One of the major reasons for denied medical claims is the problems in the patient’s benefits. Moreover, there are also some other reasons such as, deductibles, copayments, and secondary insurances that shake up the claim’s status.

To avoid all these issues, medical billing services need to verify the patients’ demographics along with the credentialing status of the physician. Also, checking all the information given by the insurance panel is mandatory.

Verify If Healthcare Provider is among the Insurance Network

Sometimes, the healthcare providers’ are not in the network of the insurance company. It can be a problem causing revenue leakage.

In addition, clinicians don’t know about the variance of the reimbursement rates in the insurance plan. There can be many factors that affect the variance.

For Example,

  • Location of the healthcare provider
  • Number of medical claims
  • Medical expertise

Medical billing services should check the insurance payers’ contract with the physician. These contracts specify under what rules and guidelines, the insurance company will pay. Coverage policies, referrals, pre-authorizations are also included in the contract, clearly stating the benefit plans to the patients.

The insurance payers’ contracts are legal documents but are negotiable. For maximizing the revenue cycle management, healthcare providers should efficiently explain their expertise to the insurance companies.

Keep Track of Accounts Receivable

A healthcare facility can’t run smoothly when they have pending accounts receivable. Keep track of the claims if they are paid or not. Follow-up services play a crucial role in revenue cycle management.

If a claim is not being paid within 60 days, medical billing services should directly get in touch with the insurance company. It helps in determining the status of the processed claim, or the claim will end up as a denied claim. Moreover, it also helps in reducing the rate of wear-out medical claims.

If the claim has been paid, record its date, if rejected, go for the appeal process.

The responsibility of medical billing services is huge. Denied medical claims disturb revenue management of not only physicians but also the medical billing companies. To decline the rate of medical claims denial, above-mentioned tricks reduce administrative errors. Consequently, investments and efforts are not wasted unnecessarily.

Follow this link to learn how a professional medical billing company looks like


At P3 Healthcare Solutions, our processes, people, and all-around performance stand alone in leading the business services industry. We focus on helping the patients and providers who form the backbone of the healthcare world, but more importantly, our team has the exact ability to save time, lives, and resources that never fall short in quantity or quality, even while customer service expectations continue rising.

Our innovative, efficient, and unique solutions range from risk analysis and audit to credentials, enrolling, and technical assistance. In short, P3 Healthcare Solutions has a track record of providing stand-out success that facilitates patients’ and providers’ experiences, making us one of the best billing services companies of the year.

Clutch, a B2B research and reviews agency, recently analyzed dozens of BPO companies, including our company, for service providers with the strongest market presence, industry experience, and client feedback around. We’re ecstatic to share that we took home a spot within the top 10 firms in our entire field, and knowing that our team has earned such well-deserved recognition means a lot to us.

They’re highly responsive, answering questions or concerns no matter the time or day. Healthcare is a complex field, but they understand it well and implement best practices,” raved one of our satisfied customers. “P3 Healthcare Solutions enables our providers to get paid faster, and they make billing consistent and reliable … They’re knowledgeable and understand our complex field well. They’ve managed to bridge a gap between running a medical practice and making medical care personnel for patients who are suffering.”

Beyond our billing services, the range of our capabilities has also turned heads due to our versatility, reputation, and strength of performance. The Manifest and Visual Objects, two of Clutch’s sister companies, have also featured us in similar industry-wide listings and company comparisons, particularly touting our HR services and digital prowess.

The Manifest, a business news website, included us in a list of the top 50 human resources firms anywhere, while portfolio curation platform Visual Objects now showcases our team, experience, and project management success on its website in a profile of our own.

We’re thankful for all of the support from these sources and from everybody who has been a part of our journey thus far, but we can’t wait to continue expanding and growing as we take on new challenges and clients to broaden our horizons and better our team. If you’re interested in hearing more about what P3 Healthcare Solutions can do for you and your business, please connect us. We’d love to see what we can do together!


MIPS 2019 reporting doesn’t cost you much but it is a progressive path.

The success of a clinician depends on efficient reporting because they are reaching out to CMS with proof of their performance.

P3 Healthcare Solutions and other Qualified Registries are on a mission to promote quality over quantity. Clutch ranks companies like P3Care on their leaders’ matrix. To see the names of successful companies in the health IT sector, the following link is worth a look –

When you don’t have benchmarks or companies to look up to, it is difficult to reach a goal or achieve a target. P3Care sets the tone of success for other medical billing companies to follow.

MIPS 2019 Reporting Needs Critical Thinking

As a MIPS Qualified Registry deals with only the registry-associated measures, every submission type has its own list of acceptable measures.

Merit-Based Incentive Payment System is one of the tracks of the Quality Payment Program (QPP) with Alternative Payment Model (APM) as the other one. Both these value-based reimbursement models have their own benefits. However, if you go for MIPS 2019 reporting, it is the more frequent path chosen by eligible clinicians (ECs).

What do the reviewers say about P3? reports P3 Healthcare Solutions as a leading organization. Reviews are an interpretation of the quality and performance of an organization, and if they are in favor, the company is worth your time and money.

Founder, SunCoast RHIO, Lou Galterio says, “P3 Healthcare Solutions enables our providers to get paid faster, and they make billing consistent and reliable”.

He continues in his interview with Clutch and talks about efficiency and responsiveness.

“They’re incredibly responsive, answering my questions on the weekends and at night. We’re a few hours ahead of them, but they still answer our calls, even when it’s early in the morning for them. They’ve also trained some of our internal team to understand their products.”

Client satisfaction is the maximum output of a company – The ultimate criterion that matters in the end.

Essentials to Report Quality Measures in 2019

Quality is one of the four performance categories of MIPS 2019. It carries 45% weight in the final score. Back in 2018, it was 50% weight, and that was 5% more than the current weight.

Why is that?

It is an effort to reduce the burden of MIPS 2019 reporting requirements of eligible clinicians according to the proposed rule.

First, to fulfill the Quality category, ECs have to undergo MIPS 2019 reporting over a span of 12 months.

Second, there are four ways to submit quality measures:

  • Electronic Clinical Quality Measures (eCQMs)
  • MIPS CQMs (Previously “Registry Measures”)
  • Qualified Clinical Data Registry (QCDR) Measures
  • Claims-based measures for small practices

To report collected data for Quality for at least 6 measures or a specialty set is what is required. One of those six measures is an outcome measure or a high-priority measure.

MIPS as a Group

With the condition to report as a group of 16 or more clinicians, under the 200 Medicare beneficiaries criteria, the administrative claims-based all-cause readmission measure will automatically count as the seventh measure.

Therefore, in order to stay on top of MIPS 2019 reporting, go for at least one submission type. If you report a measure through more than one type, the best score for that measure will add to the final score.

Moreover, P3 Healthcare Solutions connects you with the patients which are your first preference!

With P3Care as your third-party intermediary and reporting on your behalf, you, as a healthcare professional, can focus on your patients. We become part of your cure to people in distress.

The Case of Specialty Measure Sets

MACRA MIPS never falls short of requirements. ECs, as individuals and groups, have the flexibility to choose between a specialty and subspecialty measure set.

In any case, they must tend to data on at least 6 measures within a specific set. If a set has less than 6 measures, the clinician or group should report each measure in the set.

CMS Web Interface users have to report all the 10 required quality measures for the full year (January 1 to December 31, 2019)

As value-based care enters the third year successfully, CMS tones down the reporting requirements for clinicians. It is in response to physician burnout because MDs and other professionals are not able to look after their patients. The lack of patient association and engagement is attributed to difficult EHR handling.

Follow us on LinkedIn for a solid knowledge base in American healthcare.

What do you think is a common problem clinician’s will likely face in MIPS 2019 reporting?


The modern healthcare industry is the amalgamation of technology and medical services. With this growing trend of health IT, data security and privacy have become the main concern for physicians. Be it, medical billing, MIPS, MACRA, electronic healthcare records (EHRs), digital collection and storage has taken the paramount place.

To take advantage of technology and to support MIPS in healthcare, pharmaceutical companies are interested in going cloud-based. However, they want surety to have a secure transition, which is not as simple as it seems.

The professional mapping of the data flows, frameworks and technology implementation require amazing efforts. While doing all this, a proactive approach, anticipating the potential threats is compulsory.

What steps should be taken to have a safe cloud-based technology?

  • Take Measures for Security Breaches

Same as physicians have to protect patients’ data, and other sensitive information from hackers in the MIPS program, the pharma industry has to pay attention to security threats.

It is estimated that during the shifting process of the hand-written data to the cloud-based database, many incidents of data breaches will be experienced. Security experts that are well-aware of the data sensitivity and actively take measures against breaches are one of the major hurdles in implementing this migration.

A connected and heterogeneous cloud-based storage system is a complex process. Therefore, not just secure database is to be designed but also with an efficient backup system.

Security failures can only be prevented when there will be the right personnel with the right expertise for this job.  Therefore, before moving towards cloud-based technology, the pharma industry needs to have a proper execution plan.

  • Be Prepared To Manage Risks

Translating the manual database to a cloud-based database may disturb the entire pharma company. Therefore, calculation of the internal and external risks is equally important for the effective functioning of cloud-based technology in the pharmaceutical industry.

A reasonable solution is to convert data step-by-step until the whole staff gets comfortable with it. Test the cloud technology implementation and highlight errors that don’t meet the standard. Manage risks and measure return-over-investment.

  • Research about the Implementation Protocols

Pharma industry will not just face problems regarding the right technology.  In addition, it needs to research all the pros, cons, and the working process of technology implementation. Vulnerabilities come across as major setbacks in an efficient running system. If there will not be a proper channel or sequence of operations to enter, fetch, and share data from the system, what will be the point?

In order to support MIPS in healthcare, that is one of the leading value-based incentive programs, pharma companies need to have a front role in understanding all the implementation details.

Healthcare industry is already sensitive, and pharma being its part can’t be separated from its rules and obligations. There is a reason that the regulatory authorities highly govern this industry.

SaaS – Software as a Service model is getting popularity in the pharma industry. However, there is a need to develop the understanding that implementation of the cloud-based services without seeing the capability of the system will cost more than ever.

Thus, flexibility is required but with the hint of sensibility to predict different case scenarios and the associated cost to check if this is the best-suited solution.

Surely, the pharma industry should move forward with the changing times. Nevertheless, the change should be transitive and be able to generate constructive results while making sure of all the security aspects.

In your opinion, what steps should be taken to ensure reliable implementation of cloud technology in the pharma industry?


The article lists technologies to look out for in 2019, according to Bill Gates. After analysis of the MIT Technology Review’s yearly content around emerging technologies, he was able to select 7 of them with the most impact. These special applications have a future in healthcare because they come from none other than the maestro himself.

Bill Gates besides the selected bunch of applications wrote:


“For now, though, the innovations driving change are a mix of things that extend the life and things that make it better.”

Healthcare IT makes the use of technology for better outcomes. Such applications will facilitate the reimbursement process and providers in general. P3, as a MIPS consulting service, assimilates with technology to report on behalf of the providers and value-based care will only benefit from these technological marvels. Please follow us on LinkedIn for a vitalized experience and find the latest information on the Merit-based Incentive Payment System (MIPS).

The revolution is in their essence, and, nobody will be able to deny their absolute magnificence once the rollout of the benefit in public.

  1. The $10 Blood Test

We attribute this invention to the bioengineer, Stephen Quake of Stanford University.

What does it do?

Physicians will be able to identify women who are set to deliver before time.

Extraordinary, as it sounds, it will ease the pain of the parents, especially the mothers. Children born prematurely have a less chance of survival, but, due to this test, the survival rate is going to increase, big time!

When we talk in terms of MIPS Quality measures, such creations can improve, the mortality rates and reveal better population health outcomes. Patient satisfaction levels will go up while keeping healthcare quality-driven.

  1. Screen Environment Enteric Dysfunction (EED) Disease

The probe developed by Guillermo Tearney, MD, Ph.D., and a professor at Harvard Medical School, physicist and pathologist at Massachusetts General Hospital in Boston is going to show you evidence of this degenerate disease.

What does EED do?

It slows down or stops the absorption of nutrients.

Furthermore, the probe will replace the expensive endoscopy used in gastrointestinal cases.

Amazing, isn’t it?

The third world or poor countries have a reminiscent amount of EED patients. Therefore, this goes out to you – time to heal is soon, very soon.

  1. German Cancer Vaccine

The next invention comes from Germany, and, it is against cancer that has spun the world over its head. In 2019, BioNTech and biotech giant Genentech are having clinical trials for the first cancer prevention vaccine. It is going to destroy cells with cancerous elements attached to them.

Tremendous achievement, as it is, we are one up against the illness, and, now cancerous growth will find a legitimate challenger to stop things from going south.

  1. Reduce Greenhouse Gases

The next invention is going to reduce greenhouse gases and slow down the process of climate change. Intense weather conditions, too much heat or too much cold are weather conditions attributed to climate change.

David Keith, Ph.D., a climate scientist at Harvard University in Cambridge, Massachusetts implements ways to store carbon dioxide from the environment and convert it to synthetic fuels. Public health has only one way to go, and that is up!

  1. Toilets with Cleaner Outputs

Time has come for toilet wastes to stay away from disposal into water resources. Energy-efficient toilets are in focus as an effort to stop contamination of the environment. One of these models comes from Tampa, University of South Florida and the other from sanitation enterprise Biomass Controls.

The two toilets are self-sufficient and don’t need water to move fecal waste to the disposal site.

Water contamination causes the disease to spread from one population to another.

Nevertheless, with the help of these innovative waste stations, we will be able to process waste without using water and put an end to water-borne illnesses.

  1. Alexa – The Amazon’s Marvel

Despite intense marketing campaigns for the device, Alexa proves to be a helpful companion for real. The voice-enabled assistant has features which benefit hospitals and practices to understand speech in both emergency and normal situations.

The artificially intelligent gadget can be the difference between sickness and wellness, expanding its role in patient care.

We would love to see you come up with healthcare inventions we’ve missed in the comments below.


Healthcare industry is moving at a fast pace via Healthcare Information Technology (HIT). Everybody knows that electronic healthcare records (EHRs) are the most advanced practice of innovation in the healthcare industry. The meaningful use of EHRs (MU) is not limited to a certain sector of healthcare, which is capable of heavy investment. In fact, it is widely accepted by physicians of every scale and expertise.

Healthcare Chief Information Officers (CIOs) are making sure that their organizations maintain a certain standard of interoperability. Only this way, the actual progression in the industry will be observed.

HIT leaders’ investments in EHRs are not substantial only for today’s use, but they have an eye on the future of meaningful use of EHRs. EHRs are already an advanced form of technology, making patients and physicians empowered.

So what is the Future of Electronic Healthcare Records (EHRs)?

According to the officers of Healthcare IT and the leading EHRs vendors, automation, telemedicine, and advanced analytical tools will have a huge impact on EHR technology.

Impact of Automation and the Advanced Analytical Tools

The automation in the care services in diagnostic, treatment procedures and in administrative processes have cut down cost. It helps physicians to focus their attention towards the work of their expertise, rather on managerial issues.

Same is the case with Genomics – Informed Medicines which require the genomic information of a patient for his treatment. This approach is quite useful in understanding the diseases’ causes and their impact on patient’s health. This type of medicine also facilitates in preventive medicines. Thus, the dimension of reporting of medical records will change drastically.

Telemedicine is the discipline, in which patients and physicians are not present in front of each other. As this technology will strengthen its place in the near future, the way one access, and views EHR will be changed. The virtual delivery of healthcare services has transformed, and this will affect the outcomes of the interoperability measures.

In short, there are different ways to leverage healthcare services. Thus, the devices and algorithms to process or detect illnesses will require a different recording method.

For Example,

How EHR will react towards diagnostic procedures conducted in a home setting, but the tests result been given back to the medical organization, especially, when they are to be given to an algorithm or machine as well.

How Increased Interaction Influences Meaningful Use of EHR?

With technology advancement, the virtual diagnosis will move towards increased interaction and user satisfaction. In addition, it will reduce unnecessary cost expenses.

The accommodation of innovation techniques will be difficult to manage as tangible results. Thus, Meaningful Use of EHR in the future will be helpful in recognizing serious health areas, and it will be using machine learning and predictive models to support the latest technology.

Developing such, intelligent EHRs will be challenging when there is a big issue that is the complexity of EHR system to handle a large amount of data.

Health IT leaders predict that human-centered designs will resolve this problem. Cloud-based service and aligning work operations to support mobile services will increase the efficiency of electronic healthcare records (EHRs).

With cloud-based EHR platform, interoperability will also increase via improved security features and the HIPAA-Compliance will be possible to a greater extent.

Mobile-Based EHR Systems

Even today, many professional EHR vendors have developed systems that offer specific functionality of EHRs on smartphones. Everybody knows the accessibility and the scalability of mobile-based systems. By completely incorporating this method into reality, medical records will be at fingertips and the physicians-patients engagement will be easy.

The main purpose of EHR technology is to support a large population of data without any redundancy. The second purpose is to streamline artificial intelligence to increase a better understanding of healthcare data and remove vulnerabilities in the healthcare system.

Get Ready for the Highest Level of Interoperability via Meaningful Use EHRs

Cloud-based APIs will have a great say in the progressive healthcare system. Smart applications and the additional medical components will form the base of a more secure healthcare system.  The only need is to accept change with open arms.

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The talk about podiatry or medicine that relates to podiatry is common in households in the US. We have a growing amount of aged population, and that means the feet and ankles are at risk. Moreover, the younger generation needs help in this regard at times. Since it is our health on the line, we want the best podiatrists in New Jersey and the best medical care in general.

In an era of value-based care, podiatry has to deal with the Merit-Based Incentive Payment System (MIPS) before anything else. The track offers MIPS Quality measures and measures for other performance categories for podiatry. To enable maximum participation of podiatrists in MIPS 2018/19, P3 Healthcare Solutions facilitates reporting duties for them. If you are a podiatrist in New Jersey, please find and follow us on LinkedIn –

MIPS in 2018/19 – The Differentiating Factor

 In order to remain the best podiatrist in New Jersey, you ought to revisit your participation level in MIPS. MIPS in healthcare is an evaluation criterion of your credibility as a physician and a healthcare professional. The Quality Payment Program – QPP’s final score at the end of each evaluation period publishes on the Physician Compare portal and influences your authenticity as eligible professionals.

The Best Podiatrist in New Jersey vs. Participation in MIPS

The 2019 participation and a score above 70 out of 100 can get you incentives and a vote of confidence in 2021. Despite the selection of the best criteria for measures, talking to qualified HIT consultants paves the way for incentives and bonuses. Therefore, staying in touch with organizations trained to provide value to your practice under MIPS turns out to be a wise decision.

How to Find the Right Podiatrist in NJ?

The million-dollar question that is worth answering any time of the day!

We have an authorized entity in the form of CMS – Centers for Medicare and Medicaid Services. At a time when the MIPS track of the Quality Payment Program impacts healthcare outcomes, the Physician Compare portal is worth a shot. You’ll be able to pinpoint top-rated podiatrists nearby. It is a way to materialize your search for the best doctor.

Find the best podiatrist through – An official Medicare resource of providers who currently bill Medicare and participate in the MIPS 2018/19 program.

Your health deserves the top podiatrist and nothing can make you qualify for anything less.

Authoritative Websites to Facilitate the Search for Podiatrists

One of these websites is  Here, you will find the top providers registered and credentialed and the State of New Jersey back them up in the best interest of the locals.

If the weather shows minimal snow and zero warnings of a snowstorm, it is easy to head out to the nearest practice.

Foot and ankle centers in New Jersey have a knack of curing patients, especially the ones found through these portals. The stamp of authenticity is enough to satisfy the patients while the cure speaks on behalf of the treatment.

American Medical Association (AMA) supports DoctorFinder and finds the best doctors in town for patients in NJ.

As patents, they don’t need any introduction and Google promotes them significantly.

Big Names in the Industry

The US healthcare industry passes through a critical time when the clinicians gradually ascend towards value-based care and adopt the cost-saving methods nationwide.

MIPS Quality measures for podiatrists include obligations that are mandatory for every physician with a few exceptions. We will cover them in detail in the upcoming articles.

According to Google and webpages on the first page, there are many physicians making the list of top podiatrists in New Jersey.

The foot and ankle specialists of New Jersey include names like:

  • Dr. Eric J. Abrams
  • Dr. Craig A. Shapero
  • Dr. Jordan Drucker
  • Dr. Stephen Guiliana
  • Dr. Nicholas R. Taweel
  • Dr. Jerry A. Silberman

The top 6 podiatrists according to, another gem of a website mentions them with grandeur.

The deadline for MIPS 2018 data submissions, April 2, 2019, continues to be a constant reminder. If you are a podiatrist who has MIPS reporting pending, call 1-844-522-3227 for immediate assistance.


Virtual reality (VR) has taken over the digital world. It was supposed to revolutionize gaming, but it has also entered into a sensitive field like healthcare. Physicians are using various technologies to provide high-quality medical facilities to patients. From assisting remote patients to medical billing to MIPS submission methods, technology is giving a new dimension to this field.

VR has opened new opportunities for clinicians to analyze diseases and severity of illnesses via 3D modeling. Moreover, it is a source to lessen pain caused by chronic diseases or severe burn injuries.

VR is Reliable

With successful research and trials, VR has proved itself a reliable technology in healthcare. This trend is not in its testing phase but is operational in some areas. Thus, it hasn’t remained a research-based project but is facilitating in a number of ways, changing human perception for improving quality of care services.

For Example,

Cedars Sinai is a non-profitable healthcare organization in Los Angeles that is successfully running a clinical VR program for more than 3,000 patients.

Despite the numerous benefits that virtual reality offers to healthcare, some challenges also exist while implementing this technology to the full potential.

How the healthcare system uses this technology?

According to physicians, virtual reality can provide a different environment for the patient’s healing process. It has the ability to take patients away from the clinical setting through an interactive experience. Via VR, patients are able to reduce their stress and pain and learn new techniques that may help them afterward for a better lifestyle.

The purpose of VR is not to create a fantasy world for patients but making them able to learn new skills to cope with real-world problems. Hence, it serves as therapy.

In what capacity virtual reality works in healthcare!

Currently, VR is working in three different sectors as follows:

  1. Stimulates Relaxation and Calmness

Virtual reality helps in achieving the same goals, which are derived from cognitive behavior therapies. Depressed, traumatized patients with intense situations, mentally ill, or people with phobias can seek solace and get back to their regular lives.

  • Relieves Pain

Doctors have tested several virtual reality techniques against abdomen pain, back pain, and more. The results were astonishing. A pain-specific application, Pain RelieVR has shown great effects in this context. The result showed around 24% of reduction of pain after 10 minutes.

Moreover, patients can be taught to cope with pain via special techniques and generate positive change in their habits.

  • Sharpens Memory

VR is a survival tool for patients with dementia or memory loss. It enables connecting patients with reality and sharpens their memory via therapeutic exercises.

In addition, it also helps in differentiating between reality and hallucinations.

The struggle for controlling a craving is real. VR can also support the process of damping signals that might be harmful to you as in weight management.

Impact of VR on Medical Practices

To utilize this technology, physicians and hospitals require special training to streamline this technology in the real world. VR not only help in above-mentioned healthcare sectors but can support other healthcare applications as well.

VR is an amazing technology that benefits patients but also physicians. With the implementation of VR in the medical practice, quality of healthcare is improved which consequently fill up physicians’ pockets. Moreover, physicians can also earn incentives and rewards for utilizing new technology via MIPS.

It’s set up and the equipment placement remains the issue. However, with efficient planning and investment, it can be solved. Moreover, patients complained about the headsets being uncomfortable, but who knows with the passing time, VR gadgets become smart, and the healthcare system becomes more advanced.

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Value-based healthcare services have not only changed the patients’ healthcare standard but also the physicians’ payment model. Value-based reimbursement models encourage clinicians to adopt methods that make healthcare easy and efficient. Programs like MIPS, MACRA, and more depict value-based care system and allow physicians to achieve rewards and bonuses. The purpose is value-based reimbursement models are to;

  • Straighten up physicians’ revenue cycle management
  • Make patients empower the healthcare system where they choose their desired service

We have heard many of the benefits and the need for value-based healthcare models, but the proper information about the available models is not very common. Let’s review that.

What are the Available Value-Based Care Models?

There are a few types of value-based payment models with a variety of risks attached and the benefits.

1. Accountable Care Organizations (ACO)

It is a system of hospitals, clinicians, and other healthcare providers to provide organized and high-quality services to Medicare beneficiaries. It was started to help patients receive up-to-the-mark services at the most appropriate time. It means that in case of emergencies or other scenarios, patients don’t have to wait to get to the relevant doctor.

This organization ensures that patient only bears expenses for those services that are absolutely necessary to treat an illness. Redundant medical services are reduced by eliminating medical errors that occur while diagnosis or treatment.

Healthcare providers volunteer in this program to get shared savings if the ACO fulfills the standardized healthcare criteria with reduced expenditure.

Risk Factor Involved in ACO

It is not like ACO volunteers always end up adding a bonus to their revenue cycle, but the financial risk is also involved. When able to meet the requirement, physicians have a jackpot, but on the other side, they also have to bear shared losses if any.

For shared loss, healthcare providers have to pay Medicare as compensation for not delivering value-based care to patients.

This value-based reimbursement model is not just about value-based medical procedures but also support volume-based services. However, the evaluation is based on quality, safety, and experience.

2. Bundled Payment for Rendered Services

This payment model pays physicians not for each service but as a whole series of services. Clinicians receive collective reimbursement for treating a medical condition, including all the charges for physicians and the types of rendered procedures.

For Instance,

If a patient undergoes a surgical procedure, CMS (The Centers for Medicare and Medicaid Services) sets a collective payment for surgeons, an anesthesiologist. It then pays a total amount rather than paying separately to each clinician.

Risks Attached with Bundled Payment Model

A certain level of risk is also involved with this type of payment model same as the ACO. Physicians get to full their pockets when they collectively reduce the incurred cost. Otherwise, they get will have to bear the loss.

Thus, this practice requires standardized procedures so that, all stakeholders get the rightful reimbursements.

3. Patient-Centered Medical Homes (PCMH)

It represents the healthcare payment model in which a primary care physician coordinates the patients’ healthcare. This payment model manages and handles all the needs of the patient in a centralized setting.

It’s certification highlights that the physicians are capable of providing healthcare in a patient-centered setting with team-based methods. Moreover, it also ensures consistent care quality for patients.

Patients are allowed to develop a one-to-one relationship with their physicians, and it governs on the medical and environmental factors.

This payment system has shown great potential in reducing the un-necessary cost expenditure. According to a Maryland – based PCMH, via the efficient practice of this reimbursement model, they were able to save up to $98 million and enhance their quality standards by 10%.

Alternative payment methods other than the fee-per-service are not very popular practices. However, physicians are unable to meet their financial requirements. Thus, they are devising ways to incorporate new technologies into their system to speed up the workflow.

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