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Jeff Lin
Host of Payment Matters
Payment Matters is a monthly radio show focusing on real issues happening in healthcare payments. Jeff chats with industry experts and thought leaders to bring fresh perspectives on how providers, payers and consumers are all tackling the evolving healthcare payments market. Join the conversation on Twitter with #PaymentMatters.

On this episode, Jeff Lin talks with Bethany Williams, Senior Vice President of Product for Office Practicum. They discuss the current healthcare environment, especially as it relates to pediatric practices.

Listen to the episode or read the transcript below.

Jeff Lin: My guest for today’s episode is Bethany Williams. Bethany is the Senior Vice President of Product for Office Practicum, which develops EHR software for pediatricians. Bethany, thank you so much for being here today. Would you mind telling the listeners a little bit about yourself?

Bethany Williams: Yes, absolutely. As you said, I am the Senior Vice President of Product at Office Practicum. I like to say that I fell into healthcare early on in my career. I lived in San Diego for a while – you said you were on the West Coast. I worked at Sharp Health Care for a long time, and then I joined the ranks at IDX. I worked there for 11 years and kind of grew up in software and payments and in revenue cycle. It’s been a fun run, and I am privileged now to work with a group of amazing pediatricians that are solving the world’s problems for pediatric practices all across the US.

Jeff Lin: That’s great. Products are a critical component here. Could you share a little about what Office Practicum does for pediatricians?

Bethany Williams: We’re a market leader, and we do electronic health records as well as revenue cycle management for thousands of pediatric offices across the United States that touch somewhere between 7 to 10 million patients. So, in our care, ultimately, are millions of cute little kids waiting for their doctor to take care of them.

Jeff Lin: That’s great. It’s important software. I have two young boys, a four-year-old and six-year-old. I see the value, especially with pediatricians, of the automation that’s happening out in the market. Unfortunately, we’re in a pandemic right now, with COVID-19, and I think pediatricians are seeing that upfront.

I’d love to understand your point of view about how this pandemic has impacted the pediatricians that you support day-to-day.

Bethany Williams: Yeah. I don’t think that I truly appreciated how vastly different care for children is because I spent 17 years in the adult market and then converted to the pediatric market. I don’t think I fully appreciated the fact that this group is on the front lines. It’s almost the same as what the hospitals were facing. They are out there on the front lines facing the pandemic, treating children and dealing with this on a daily basis. I don’t know that any of us were really ready for this. It increased the use of technology in a way that we didn’t see coming, throughout the entire continuum of care. Our community was immediately impacted.

We had to swing into action and do things that we never thought were going to be market needs. For instance, we immediately started getting questions about checking people in from the car. Practices needed to assess patients in the car, because they didn’t want them to come inside. So, we had to create a solution we call curbside check-in. Actually, we worked with InstaMed to take care of patient payments before they even get to the office. We had doctors strapping on personal protective equipment, head to toe, walking out to cars after the patients check in. Dealing with this is something we never saw happening. They had to skip the waiting room and care for patients differently.

Think about if you take your son in – you are not going to want your pediatrician, who maybe just saw a sick patient, to now see your son who is there for a well encounter. So, they also had to change all the schedules and the way they accommodated care. On top of that, they were dealing with decreased visits. That was a very crazy time.

Jeff Lin: Yeah. As I look at this technology – we’ve been talking about technology for years, right? Like meaningful use, EHR adoption, and all these things were supposed to bring on a new era of change. I think COVID-19 has really changed that significantly. You see the electronic adoption.

As the millennials are having more kids, technology adoption might be affected by how parents that are bringing the kids in or grandparents that are bringing the kids in to the pediatrician are more apt to use technology. What’s your opinion of the adoption of a curbside check-in or these new things that you’re rolling out? What are you hearing from your customers?

Bethany Williams: I think it’s a one-way street. We’re never going back to the world we lived in before. Imagine if you wanted to take your asthmatic son in and you were able to do a telemedicine encounter which meant you didn’t have to miss four or five hours of work and you didn’t have to pick up the kids from Grandma’s house. Imagine if you saved five hours on your schedule, had a 20-minute telemedicine encounter, got the medication he needed and saw the update in the portal. Are you ever going to want to go back to never having a telemedicine encounter? Patients are forever changed by the way they are now able to communicate with the doc. And those physicians who didn’t really want you to schedule online, or didn’t 100% adopt telemedicine, are having to adopt it at a pace that is unheard of in adoption.

Jeff Lin: Yeah, it’s almost like the stick is so strong, electronic adoption is happening regardless of whether you want it or not.

Bethany Williams: Some of the things that used to be barriers – for instance, insurance companies who didn’t or mostly didn’t pay for telemedicine; they didn’t pay for telephone encounters. They immediately started changing regulations and started paying for some of these encounters. We had to create what we call a non-direct care billing center so we could allow our practices who are struggling financially with their lower visit numbers to be able to bill for telephone encounters and telemedicine encounters. We had to roll out new templates for treatment plans, because you don’t do the same steps if the patient is not there in front of you.

So yeah, it was a struggle, I would have to say.

Jeff Lin: It sounds like you’ve not only made it contactless, you’ve made access to care a lot easier. But the phone calls, telehealth, and these alternative ways of getting care – even before the pandemic there were a lot of urgent care visits and these other areas to get care. Some retail locations are opening up their own clinics as well.

What’s your point of view on what I call the other ways to receive care, and how they impact or benefit pediatricians and the customers that you serve?

Bethany Williams: Yeah, we have seen that well-run pediatric offices are not intimidated by urgent care. Our best performers are marketing their offices as the medical home and training their parents to call them first. And, honestly, our parents want the doctor that knows their child to care for them. We’re doing everything in our power as a software provider to make sure that the offices that don’t fall into that ‘best-run pediatric offices’ category are trained up to be, so that urgent care becomes a supplement and not a threat.

Jeff Lin: That’s interesting. I call it the old six sigma approach, right? The most well-known businesses, they’re doing something right. I’d love to understand from your perspective what really makes an amazing office that we can all learn from. Is it adoption of technology? How would you characterize the nirvana that creates that medical home, the trusted partner that I think a lot of these practices, even hospitals, are looking for?

Bethany Williams: Well, what really became the brand and awareness of Office Practicum was years and years before portals were even offered in the market, patients could go online and just for their visit, they could fill out advanced surveys. We had rolled out population health prior to the visit. That ability to move the offices into touchless care for 12 or 13 years is really what makes them well-performing practices. We have some automation and tools that allow them to pull in the list of patients who missed a well visit, who didn’t come in. It’s a very proactive approach to managing their population. That’s what has given them the time and the effort and the energy to be able to move their patients forward.

Jeff Lin: You mentioned you worked in San Diego and the non-pediatrician space. How would you compare your current experience working with pediatricians verses your prior experience in the regular healthcare space? What are the pros and cons and the differences that you see there?

Bethany Williams: What I missed is, for years, we were talking about how we should get to population health. We should get to caring for people before they get sick. We should survey them and know what their possible problems are. A lot of that was very difficult to do, because we were in adult care. We were disease-focused. We were disease reimbursed. We were episodic, from the payments perspective.

My big aha moment as I moved throughout healthcare was to see that if you think about it, pediatric care is already population-based. You probably took your child to the doctor way before they were sick. Because you wanted that well visit, you needed the immunizations. You’d sit all day long and fill out a survey if you thought your kids were going to be better at school and pay more attention. So, it is this opposite paradigm. It hit me all of a sudden when I was at work one day at Office Practicum. I said, do you realize that adult medicine needs to learn from pediatric care? Because we do the work, they will fill out a survey. They’ll actually fill out all their registration information, all their insurance information, correspond with the doctor and fill out surveys before they’ve ever even been to the office. That would be so unheard-of in adult care.

Jeff Lin: That’s great. It’s almost like it’s blazing the trail. I imagine the parents that are coming into your office are probably a lot younger than a person going into a hospital, right? It’s almost like telling a story of what healthcare could be in 30 years, 20 years or hopefully sooner. This is quite interesting, looking at the differences there.

One thing I’d love to get your point of view on is COVID’s impact. You referenced this before, how there are decreased patient visits. There’s a reluctance to reduce hours, all the things that you have to go change. How are the actual providers doing right now? They’re on the front lines. They’re dealing with sick patients who may or may not have COVID. What are you hearing from that population and how they’re dealing with this?

Bethany Williams: Yeah, that’s a great question. It has been really tough for some of our practices. We never thought we’d have to spin up, take efforts from our marketing department and our education department to do webinars on how to apply for a PPP loan and some of the things that we just didn’t see coming.

One area where we’ve seen a big, big impact is declining revenues. Because we have revenue cycle billing solutions and we do billing and follow up for hundreds of practices, we saw their revenues start tanking, and it was really fast. I mean, it happened in March, and many of them were trying to figure out, until the PPP loans came out, were they going to be able to keep the doors open? Our revenue was greatly impacted as well, as their volumes and visits dropped.

Another area is the mental health aspect. Right amidst revenues dropping, we had to step up and provide more than we were doing already in order to keep our offices open. From an internal aspect – the stress on our employees, moving everyone to work-at-home, they’re working around the clock, they’re getting some of the things you’ve heard about like zoom fatigue and they say they’re living at work. And they now have to care for children at the same time, while they’re trying to work.

What I’ve seen is this direct correlation between how well we take care of our employees and how well our employees take care of our physicians. One of the things I love most about Office Practicum is the heart of our leaders. One of our senior leaders was formerly an educator. She encouraged us to look at what we call the OP community and create for our staff what we call the OP village. We have created an OP village that has educators and staff that can help each other. What they’re doing is providing support for the caregivers. If you need a teacher, we will have a teacher there on certain days that can help with education and support. Or they can offer a class for the rest of the people in the OP community so that other person can take that conference call.

It is the coolest thing ever. At the same time, we’re offering Headspace to all of our employees. Do you know what Headspace is? It’s an app for mindfulness that can help you sleep; help you relax at work. Because what we’re hearing is the stress is really hard.

Couples that have not spent every waking hour together have spent the last six months staring at each other. So, we provided those two things for our staff and we see a direct correlation between having healthy, de-stressed staff and making phone calls that are more supportive to our pediatricians and really providing a better environment.

Jeff Lin: That’s great. If everyone is stressed, then mental health is sometimes forgotten. That’s amazing that this OP Village and Headspace are initiatives that your leadership has taken on.

As you alluded to before, you don’t think this is going to go backwards in terms of technology adoption, et cetera. It’s almost like we’ve been spurred on by this event that’s created change in mindset for a lot of people. Where do you see this going in the next one, two, three years? In a positive way, where it can it go?

Bethany Williams: I think it’s going to be nothing like we’ve seen up to this point. Innovation adoption is going to happen at a faster pace than we’ve seen. If you look at it from the entire workflow – front office, back office, before I get to the office – it’s going to be so much different than what we see today. I think that our practices are going to continue to move towards more automation and more innovation.

If you look at telemedicine, it’s been out for a long, long time. Those of us that were pushing it five, eight years ago were frustrated because no one wanted to use it, because the payers weren’t paying for it. Think about what happened – overnight, it literally quadrupled. There are very few practices, if you click online and look at an ENT doc or you look across specialties, very few aren’t using telemedicine, or haven’t figured out something that they rolled out very quickly. It’s on fire.

And if you think, even about online scheduling, where a lot of doctors used to say – I mean, I worked at IDX, I was meeting with Duke and Stanford and Montefiore and the major health systems in the US – they didn’t really want to open up their schedules to let patients or parents schedule their own visits. And that, as well, is turned completely upside down. Now, these pediatric offices, they might only have two doctors, but they want their patient, their parents, to schedule those encounters.

I’m predicting a total change in the functionality, the way we see it, into a world of touchless care that’s going to require us to look in a new way at every piece of that old picture we’ve been looking at for years.

Jeff Lin: That’s great to hear. There’s always some silver lining with these dark clouds that we’re seeing.

You see all aspects of healthcare – payer and reimbursements, billing, the contactless needs. If you had a wish, or a magic pill where you could snap your fingers and change anything, what would that be? The world’s your oyster. What would it look like if you had one thing, and one thing only, that you could change within healthcare in the US?

Bethany Williams: Oh, that’s an awesome question. I would remove all of the administrative burden. I would take away all those scrubbing rules that payers have, and all of the staff that hospitals and offices have to have to get it right.  I would move to automated adjudication. It would adjudicate instantly, like when you go to the pharmacy, you would either have the benefit or you wouldn’t. You get the drug and you leave. They’re not billing that three months later, and finding out that your doctor billed it first.

I don’t think the world in general understands how much money we spend on administration. We added all these EDIs. We added electronic data interchange to know that, oh, Jeff, your insurance is valid today; your son can see the doctor and he has insurance. But yet we still go through what I would call the molasses journey to getting that bill out and sent, and then you get billed. I would remove all that administration. I would put that 35% back into the hands of the doctors who need to be compensated for their care and into the hospitals to buy equipment. I would just restructure it.

We’re really billing and following up on a system that was created in the late sixties, early seventies. Electronic medical records have changed. All of this other stuff has changed. But that hasn’t changed.

Jeff Lin: That’s great. You know how much we spend on healthcare every year and it’s not a small number, maybe 20%. Some people think healthcare is only the care itself, but to your point, there’s a lot under that. It’s all the administration that happens here.

Bethany Williams: I worked in the United Kingdom for four years and it was such an incredible lesson to realize that when you just have a budget and you spend that budget, how much less things cost. So, I’ve seen the model where you don’t have to do all the billing and follow up.

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