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    Last September, an MGMA Stat poll found that 73% of medical group practices reported staffing as the leading COVID-19 pandemic challenge for 2022. At the time, Modern Healthcare reported that many health systems were seeing large increases in voluntary employee turnover and more competition for lower-wage workers, which spurred some employers to raise wages, offer sign-on bonuses, boost overall recruitment efforts and/or adjust patient workflows to account for staffing limitations.
    Six months later, not much has changed. Two recent reports revealed that staffing shortages are having an impact on quality of care, from a physician and patient perspective. According to a report by Survey Healthcare Global (SHG), 34% of physicians surveyed said there was an increase in medical errors tied to staffing shortages, while an ECRI report cited staffing shortages as the top patient safety concern for 2022.
    If recruiting, hiring and staff retention continue to be an issue, which has been amplified by the exorbitant amount contract agencies have been charging healthcare organizations, practices may need to consider alternatives to on-site staff.
    The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders, “What area will you outsource/automate in the next six months?” The majority (36%) said “revenue cycle,” followed by “patient communications” (33%), “other” (23%), and “clinical efficiency” (9%).

    MGMA Stat results graphic 
    The poll was conducted March 22, 2022, with 203 applicable responses. For those who said “other,” the most popular responses were:

    • Billing
    • Call center
    • IT services

    Looking beyond staffing to meet your practice’s needs

    To help mitigate staffing shortages and reduce clinician and staff workload, practices may need to assess whether outsourcing and automating some services can help their practice control costs, boost quality and improve revenue cycle management.


    Virtual medical assistants, not to be mistaken for A.I. tools such as chatbots, can help with automated nonclinical tasks, which can give time back to staff. These highly skilled individuals provide administrative, clerical and customer remote assistance to practices. Some of their duties include appointment scheduling, insurance verification, prior authorization, refilling prescriptions, EHR management and transcription.

    Speaking of the latter, remote medical scribes can help practices tackle EHR charting, which, if not done in a timely manner, can delay reimbursement and affect the revenue cycle. They can participate in appointments through a HIPAA compliant connection and produce real-time notes while also posing questions to providers to record accurate symptoms, diagnoses, treatments and quality measures to help guarantee correct reimbursement.

    As noted by Fran Saperstein, chief operating officer, Center for Complex Neurology EDS & POTS, Phoenix, in the Dec. 14, 2021, MGMA Stat data story, virtual assistants can often serve as alternatives to full-time staff. “We’re looking at ways to continue to improve their function so that they can be even more helpful to us,” she said. “It has been pretty amazing in changing the way that our practice runs.”

    Another way to guarantee correct reimbursement is through hiring a consultant or vendor who is incentivized for timely reimbursement. This may be an important consideration, particularly now that there are fewer experienced coders in the market who may be familiar with all the payer rules regarding telehealth reimbursement.

    Coding can significantly impact a practice’s revenue cycle, so it’s important to avoid errors and down coding, which often results in claim rejection, delayed reimbursement and lost revenue. For practices struggling to find experienced coders, outsourcing may be an option, which could ultimately save time and money as some vendors guarantee 24-hour turnaround times and have access to the latest medical coding software.   

    As telehealth is utilized more frequently, practices can make use of remote medical assistants and scribes during telehealth appointments so that providers can focus on patients rather than documentation. Another option is hiring remote RNs, who can provide a comprehensive patient assessment, chart in the practice’s EHR, furnish patients with medication information and a plan of action, and answer any questions.  


    Patients have come to expect efficient digital experiences whenever they purchase goods or services. It’s no different when they visit their physician. Although many digital tools were around long before COVID-19, the pandemic accelerated their use. In a recent MGMA Insight article, Rajesh Voddiraju, group president, Health iPASS, pointed to six engagement tools that gained even more traction during the pandemic:

    1. Digital wallets: Patients can use Apple Pay or Google Pay, for example, at practice payment terminals or via its website or app. Digital wallets offer convenience and security for patients, while eliminating paper and driving cost savings for practices.
    2. Self-scheduling: Patients can submit their personal information online, reducing errors that may occur over the phone. Moreover, self-scheduling provides more privacy for patients when sharing sensitive health information, especially when they schedule appointments in a public place such as their place of work.
    3. Automated appointment reminders: Recurring, automated reminders for patients, via text message, email or phone, can improve patient engagement and satisfaction while also reducing no-shows, which helps protect practice revenue.   
    4. Digital check-in: Many patients find it beneficial to complete clinical information, disclosures, and consent forms online prior to an appointment and check in on their phone before they arrive at the doctor’s office.   
    5. Digital billing: The ability to receive medical bills via text and email provides convenience for patients to access their statements and pay online. It also means that practices don’t have to mail many paper statements, process as many mailed payments, post payments into their practice management system, or make as many phone calls to patients about balances due.
    6. Post-visit payment plans: Being flexible regarding bill payments helps practices develop a better rapport with patients, resulting in improved collections and less bad debt for collection agencies to handle.  

    In addition to these long-established digital tools, robotic process automation (RPA), chatbots and voice recognition are beginning to make their mark in healthcare. Recently, RPA has been integrated into administrative tasks, such as claims processing and revenue cycle operations, to help reduce staff workload.

    Chatbots, which are conversational interfaces, became more prevalent during the pandemic, as there was a great need for screening COVID-19 symptoms.

    Some providers have reported that they’ve saved significant time with voice recognition technology; this service can transcribe encounters three times faster than a human inputting the information into an EHR. That said, the amount of time saved will vary depending on the audio quality, speaker's voice, and the ability of the technology to recognize key words and phrases.

    These burgeoning technologies have a long way to go in clinical settings, but they are starting to become more prominent in operations, largely around patient engagement and marketing.

    Although many technologies have yet to reach their potential and vendor workforces may not always be reliable, outsourcing and automation can help fill gaps, particularly as staffing issues and burnout continue to wreak havoc on practice operations.
    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat — by texting “STAT” to 33550 or visiting — and make your voice heard in our weekly polls. Polls will be sent to your phone via text message. 
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