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Wednesday, April 14, 2010

Mission & its influence on staff performance.

The challenge we administrators always face is to retain the
satisfaction levels of our customers - the patients.
All would agree, that while its very difficult to attract new patients,
its so easy to loose them.
A major reason for the same is often the lack of good communication by
various categories of personnel including the front office, Nursing and
even the doctors.

So how to counter this problem?
I think the most essential element missing in various training sessions
or the approach by various staff while handling patients is that the
mission statement of the organization is never on the conscious level of
any staff's mind.
Actually a training session to orient staff on importance of Mission
statement and how each and every staff including the housekeeping
personnel can contribute in achieving the Mission Statement, is hardly
conducted.

I remember, during our audits, one of the housekeeping boys was
interviewed by an external auditor to assess if he was aware about the
Mission statement. The auditor hardly expected a positive reply.
The Housekeeping not only explained the interpretation in the local
language about the Mission Statement, but further explained (when asked)
how he contributed to achieve the same.
He confidently replied that his good cleaning practices of the toilets
and other floor areas would create good impression of the hospital,
would impress upon the users including doctors and patients and thus
influence the patients and doctors to like the hospital.
It would be an understatement that the external auditors were surprised
to hear that response.

The ingraining of mission statement I feel is the most essential
component of training, and should be "made to understand" for better
delivery of services.

In my next blog as a continuation to the introduction of this blog, I
would write about certain areas which can be looked into for better
customer satisfaction.


Sincerely,

Dr Akash S Rajpal,
AGM Operations,
Dr L H Hiranandani Hospital, Powai.
NABH Accredited Hospital.
ISO 9001:2000 Certified (DAR & NABCB accredited)
"IMC Ramkrishna Bajaj National Quality Award" Winning Hospital.

Tuesday, April 13, 2010

Insurance Claims Process - The future?

What started off as a query from Arijit M - Insurance Professional -
Manager Claims (National Level) at Reliance General Ins Co. Ltd on
Linked-in with the topic 'How can we use the mobile technology in Claims
servicing, Health top, renewals, premium quote' actually made me think
of a possible ideal future of the claims processing process between the
service provider & the back office of TPA/insurance.

Except for premium alerts, notices, and status update of the claim
stage, mobile technology is of not much use as a large amount of work is
done with interaction with personnel from provider and payer.

So how can technology & IT help in faster claims processing, the biggest
grouse of every stake holder including the provider, payer, and the
claimant (patient)?

I feel a web based service instead can be used for live claim
processing, input of data and attachment of scanned medical records by
the service provider for faster processing. Digital signatures can be
used to authenticate the files.

A network among all TPA/insurance back offices can prevent duplication
of claims for which original documents are sought from patients (which I
feel is waste of paper and time) on lines of CIBIL rating for loan
processing.

There were thoughts whether an integrated system which captures real
time data information like condition of the patient, proposed/final line
of treatment, day to day billing will bring about faster turn around
times in claim processing?

But then how will this real time capture of EMR bring in value and
expedite the claims process?

The medical treatment is not always as per the proposed line of care.

In India still the consultants have a 'problem' of data entry when it
comes to using computers (it's still better than the US where clinical
EMR penetration is very low).

Capturing of EMR (Forget real time) cannot happen until the application
and data entry is standardised across all insurance network hospitals.

Standardisation even if willing (by hospitals) will be a problem because
various software's would have various programming intricacies built in
to their existing software's which would make the modification &
integration difficult and leading to unnecessary cost overloads.

So what is the possible ideal future for the claims processing?
I could only think of this: I would propose an online simple web based
claim process form where all necessary claim related fields are filled,
and scanned copies of medical records are attached by the service
provider. But this should not follow a sending of hard copy as that
would mean duplication.

A CIBIL (Credit Information Bureau (India) Limited) like network would
prevent duplicate submissions where all claim processing back offices of
TPA/Insurance can log in & check the insurance history of patients akin
to the loan/credit history of the borrower. Patients can log in and see
how they fare & make appropriate amendments.

Sincerely,

Dr Akash S Rajpal,
AGM Operations,
Dr L H Hiranandani Hospital, Powai.
NABH Accredited Hospital.
ISO 9001:2000 Certified (DAR & NABCB accredited)
"IMC Ramkrishna Bajaj National Quality Award" Winning Hospital.