OUTSOURCING IN THE HEALTHCARE INDUSTRY: THE BIG CHEESE IN TAILORING PROACTIVE HEALTHCARE SERVICE

Author: Sachin G Nair

ABSTRACT

Growing competency in the healthcare industry calls for devising the best strategies to derive the expansion in business without compromising the quality of service. But in a point where the profit and customer affordability fall out of balance, there is a pressing demand to decrease the capital invested at the same time customer satisfaction must be achieved. With the impending trend in business models, the implementation of outsourcing is reported to produce a clear escalation in the bottom line with the best of talent pool employed in the workforce which was otherwise unaffordable. Seeming like a patient-centric plan, this review article focuses on the current status and the prospective strategies suggested for employing outsourcing services in the healthcare industry.

INTRODUCTION

Provision of the frontline patient care stands as the primary objective of the healthcare industry that aims to outcast the impending competition in the industry with an optimal margin on the investment driven by a thought-out plan. With the advent of the digital health trend, which holds promise to serve an occupational efficacy as comparable to that of an offline clinic with a consolidation of convenience and functionality of telemedicine, but the current facilities need a more pertinent solution to outweigh the growing need for substantial manpower and resources it demands. Over an imminent predicament of rising cost for healthcare, the hospitals indeed finds the income inadequate where a 24% reduction in costs must be instituted in the hospital services to break even as predicted by a Black Book Survey in 2022[1]. However, outwitting the prediction on outsourcing in the healthcare industry as an unstable trend in 2013, this sector in the last decade grew to stand as an answer to counterweigh the perspective of the industry as a cost-driven initiative thereby making it the most apposite option to consider for the sustainable growth [2]. Therefore, the forthcoming growth expected on instituting this idea holds real promise in bringing to the greater population the best of healthcare service at minimal of costs.

OUTSOURCING: THE GAMECHANGER IN THE INDUSTRY

Expansion in business would remain stagnant if the parties ranging from pharmaceuticals to insurance companies involved in the healthcare industry don’t consider the customer experience and service quality as the fundamental benchmark to be watched over. On a note to research from Salesforce where more than 47% of consumers of healthcare reports a more industry-focused than patient-centered approach in their service, the exigency of the situation calls for a check into the operational efficacy of these healthcare brands [3]. Reconstructing the current norms in healthcare service, what seems like a sick-care patient-doctor interaction can be further modified to a seamless proactive healthcare experience. Outsourcing in healthcare implies the employment of an external body in managing one or more activities in the healthcare business, clinical and hospitality services.

In-house medical coding is a difficult, time-consuming and expensive task where transferring the responsibility to a third party has proved to increase the workflow and convenience in matters related to the medical coding requirements, depending on the agreement the hospital and the outsourcing service provider makes. Rather than investing on an office setup and marketing plans that don’t serve seemliness, a more rational approach is to employ the service from certified, skilled transcriptionists, coding experts, and billers to make the conduct of the billing and claiming process easier. Being more economical, the access to an excellent developer at an affordable cost through outsourcing provides error-free billing procedures with the most serving level of quality at work where a better quality of coding cancels outs the issues with up-coding and down-coding. Assuring a higher security in the operating environment for the clients, the investments in Information security management systems, and setting stricter control standards like  ISO27001 assures that client data and protected health information(PHI) are handled with utmost care.

The hospitals indeed find an increase in income with the savings from cutting office resources required otherwise, it increases the general flexibility of the organization with the resources freed up for crucial tasks with consistency in quality and accuracy. Offering complete transparency in medical billing records and performance summaries by making full sense of how the practice runs to their customers with decreased DNFB(discharge not fully billed). However, when hospitals choose an outsourcing service, make sure they have robust reporting frameworks and client portals to manage daily operational coordination in order to alleviate one of the major concerns of healthcare RCM operations losing control when outsourcing. In fact, the easiness in integrating the current in-housing practice management or Electronic Health Records(EHR) or by concurrently running the two different medical billing to handle their current accounts receivable (A/R), medical practice never gets interfered with medical billing complications which implies a greater focus to the growth of business and quality of healthcare service.

In spite of the question of placing one’s trust in a third party, the skilled knowledge with adequate expertise in this field makes outsourcing the best step in boosting the service outcomes in healthcare services. Despite the decrement in denials on medical claims with the service from medical billing companies, federal investigators at the Department of Health and Human Services pointed out that Medicare Advantage plans, the popular private insurance alternative to the traditional Medicare program the improper denying of claims to patients and physicians as reported by The New York Times brings out a major drawback in hindering the smooth service which is quite an uncontrollable measure from the part of healthcare industries[4]. Employing the service from a certified coder who is familiar with the ICD-10-CM, CPT, and HCPCS level II classification systems is advised to reduce the medical coding errors that would likely lead to the bill being denied or rejected where streamlining of the revenue cycle is the primal step to ensure proper medical coding. An appropriate denial management strategy is indeed crucial to examine the claims that were refused and seek potential reasons for rejections in order to facilitate the rework on denials and stop additional denials for the same reasons. Therefore, clear and precise coding is required for reducing claim denials and early reimbursements which leads to potential revenue growth and loss prevention.

FIGURE: BENEFITS OF OUTSOURCING IN THE HEALTHCARE INDUSTRY                      

Digitalization marks the new phase of data keeping where the remittance of hardware infrastructures and manual paper records provides prompt scalability and accessibility to a stacking amount of enormous data with quicker retrieval at any time. By bringing uniformity in data through the use of a proficient medical data entry service, easy approachability of sensitive information with adequate security of the information from mishandling is supported with security compliances.

Business decision-making seems rather appropriate with reliable data representation preceded by a consistent recording of data which makes the pattern of data and medical reports, an excellent reference for analytical data management. Without tampering the essentialities, a customized data reporting system provides the benefit of cutting off the training and other overhead costs in managing data entry work. Apart from the feasibility it offers, the expertized team puts a strategy to accomplish clean data with the desired quality and better representation without errors within the stipulated time, thereby increasing the Return on Investment (ROI). Particularly when in situations like a pandemic breakout, where a cumulative increase in patient record is consistent to the increasing number of the affected population, the service becomes the apparent solution in handling the dilemma adequately without compromising the patient service by the clinicians.

Rather a more steaming discussion takes over with the question on whether the technology would be able to take an upper hand over the legal and confidentiality issues with outsourcing of medical data analysis. However,  a study conducted in 2013 proposed an algorithm that demonstrated that way for external analysis without compromising the confidentiality and privacy[5]. Therefore, when any healthcare institution is planning to employ an outsourcing service, they must necessarily see into whether the firm ensures the adequate data security in their methods to safeguard their information. During the period between 2019-23, the outsourcing data entry market service is expected to show a spike in growth by 351.84 million USD from a Technavio market research with a progress of 5% in CAGR[6]. Even when such a development is expected, there is a pressing need to consider the expertise and quality of service of an outsourcing data entry job which must lie in line with the specific requirements of your institution with solid and transparent agreements. Comparing the available software systems, making a cost-benefit analysis and using quality assurance methods before the installation and implementation seems a more practical approach when healthcare institutions look forward to employ outsourcing services.

Evincing the expansion in the customer accessibility in healthcare system from a straight-to-door physician consultation to the availability of multiple service options where the rating and customer-reviews are at hand to make oneself capable to opt the best of healthcare services, there is an impending momentum within the industry to adopt the latest of trends in their business models to produce a hike in the customer satisfaction. Prompting further improvement in the sector, the Gartner study shows the high exigency in raising the performance standards at patient engagement points in current healthcare service norms[3].

Following the patient behavior cues, many healthcare providers created their strategic plan by providing the information on websites with the intention to create self-reliant patient education. But the information glut was rather a failure, as the request for assisted service over self-service fell out of balance with the mounting online resources making them redundant. Providing meaningful interactions as deploying virtual queueing to gather information from customer touchpoints to organize into a customer information repository thereby creating a singular access point for all relevant data makes way to track the next anticipated request from the customer. Engaging such a proactive notification and omnichannel customer service by the healthcare industry, communication consistency, and consumer perception is evolving into a better brand version by themselves.

Starting with IT services being outsourced in the healthcare industry, the clinical and non-clinical functions being outsourced produced a significant decrement in the workload on the hospitals to create a patient-centric approach. By focusing more on the significant factors responsible for the growth of the business, the mundane and repetitive tasks can be transferred to third-party outsourcing service providers which indeed leads to advancing medical care procedures and academic research. Using the required tools for gathering, managing, analyzing, and absorbing vast amounts of fragmented, unstructured, and structured data generated by existing healthcare systems, outsourcing service providers now minimise the work pressure on mainstream healthcare professionals by careful data handling and analysis. Thereby, a more clear picture on treatment prognosis and clinical decisions are backed with data analysis within the healthcare industry without the professionals devoting their time to a tedious job.

CONCLUSION

Considering the sprucing of the bottom line in the healthcare industry as one of the prime objectives of outsourcing, the institution must entirely do a recheck over the existing shortcomings in the system to what the service provider is offering. Because even outsourcing can at times be the biggest Achilles’ foot if not the appropriate service provider is hired. However, the development of an outsourcing decision-making model as suggested by Omid et al. gives an idea of what all parametric endpoints impact the most in decision-making [7]. Pertaining to the inefficiency in the financial sector of healthcare services, a novel study on the impact of outsourcing was analyzed in the healthcare facilities in a smart city in Eastern India which showed better management control, access to the experts, and reduction were favorable outcomes in adopting outsourcing[8]. But the study points out the lack of indices for quality measurement and loss of control over the service provider as a major drawback in narrowing its usage.  However, the strategies as mentioned above in this article provide an answer to how quality and control can be assured while opting for and implementing the service from outsourcing. The significance in early prediction and in resolving apprehensive problems is a ground-breaking stepping where the ‘decision-makers’ are responsible to devise them at the earliest. Adding further strength to this observation, the study on outsourcing in health facilities in the Medical University of Isfahan infers that in order to derive the maximum benefit, the decision-makers within the institution must see to the possible challenges and apply suitable solutions with thorough monitoring to remove the fallouts with outsourcing[9].

               Therefore, the integration of a remarkable workforce with promising growth in the business, and outsourcing when employed with rational reasons can produce a favorable outcome in giving out exceptional customer satisfaction and excellent quality of healthcare service.

REFERENCE

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