Coping Medicaid Expansion with Shrewd Medical Billing Practices

The U.S. Department of Health and Human Services (HHS) predicts that the proposed Medicaid expansion will bring an estimated 16 million more Americans into the health-care safety net. The prediction comes even as some twenty-six states are against such expansion.

Although the proposed Medicaid expansion would eventually weigh more on the respective states’ budgetary allocation for meeting Medicaid expenditure as soon as the Federal Government’s ceases to support Medicaid related expenditure, it is imperative that, in a Federal Setup, states follow certain measures as dictated by the Federal mandate. Moreover, Medicaid, expansion, being a pro-healthcare measure, is destined to elevate the quality of public healthcare across the country in tandem with Medicare reforms.

Coming to the composition of the Medicaid expansion, the proposed scheme opens up health insurance eligibility to all people with household incomes up to 133 percent of the Federal poverty level. Irrespective of whether you are unemployed or the so-called working poor – there can be no denial of Medicaid coverage from January 2014. This is going to be a significant shift from the current coverage which covers only low-income parents and children, and the frail elderly and the disabled. Therefore, when it comes to pro-societal issue, quality healthcare should take precedence over the rest. Quite encouragingly, some states – California, Connecticut, Minnesota, New Jersey and Washington have already started with the expansion of Medicaid programs.

While Medicare expansion is going to bring an unprecedented population under the ambit of Medicaid, physicians will have a hard time in coping up with sudden influx of patients. The situation is going to even more serious if the patients happen to be in need of specialty services as there is already a dearth of specialty-specific physicians across the state. And, with the situation requiring sometime to become ideal, the existing physicians will have to bear the additional brunt. Although the additional workload would also bring in additional revenues from Medicaid reimbursements, their medical billing practices would be put to test as Medicaid reimbursement environment has progressively become more stringent over the years. When you consider dealing with such stringent environment along with the mandatory EHR compliance that support ICD-10 and HIPAA 5010 practices, you might get apprehensive of physicians’ ability to devote quality time to patient care.

Therefore, it becomes inevitable that they seek medical billing and Revenue Cycle Management Services (RCM) that would not only ensure maximization of their revenues but also elevate their clinical efficiency. Care should also be taken to analyze your prospective service providers’ credibility and competence for Medicaid-related reimbursement practices.

While you embark on seeking a suitable medical billing and Revenue Cycle Management Services (RCM) provider, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of long-standing reputation as a credible and competent source for Medicaid-related billing and Revenue Cycle Management Services (RCM) comprising Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting – may well prove to be your preferential recourse.

Navigating Through a Multiple Payer Environment – Providers’ Perspective

Healthcare delivery in the United States of America has come a long way from cash-based to insurance-backed. Currently, over 85% of the nation’s residents have health care plans either through employers’ private pools, private companies, the veterans’ health administration, the children’s health insurance program and Medicare/Medicaid/TRICARE. While insurance payers (whether Federal or private) essentially cover health risks of the insured, they differentiate themselves with their respective restrictive operational requirements. The impact of this restrictive payment environment is such that health care providers are increasingly finding it difficult to procure their payments on time. And, with the Federal Government inclined to make health insurance mandatory, care providers’ only hope is to find a way to deal with multiple regulatory insurance payers.

Unlike United Kingdom and Canada, which have single-payer system, US is characterized by Federal and Private Payer systems. And Federal system is again sub-divided into Medicare/Medicaid/TRICARE.

The majority of insured Americans receive their health care (insurance) coverage via a private insurance company. Currently in the country, 59.3% of all insured Americans have coverage through private insurers. These private insurance holders can once again be classified under:

• Group insurance, which is availed through an employer with provision to cover spouses and children, based on the particular package
• Individual Insurance, which is purchased by the insured himself to cover his or his family health risks
• Managed-care plans: The two most popular types of managed-care plan providers in America are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). An HMO plan will have a predetermined facility and doctor for you and/or family. When you need treatment, you will have to visit the contracted facilities and see the contracted physicians in order for the insurance to pay the bill

With so many variants of private healthcare policies, healthcare providers usually have a hard time understanding and billing with private payers. The stress is so much that it is actually started to impede their clinical efficiency, which is their main concern. There is a whole lot of stressful restrictions that providers will come across, such as:

• dealing with deductibles and copayments,
• establishing medical necessity of a procedure
• dealing with preexisting conditions

Though dealing with Federal Payer system is relatively less difficult, providers have to deal with state-specific rules that govern Medicaid/Medicare:

• With the Federal Government hinting at extending Medicare base from the current 28%, providers will have more Medicaid/Medicare supported visitors
• Federal Government entertains Medicaid/Medicare beneficiaries’ bills from only a few designated providers. Therefore, care providers have an overriding duty to check insurance authorization prior to administering medical services
• Further, Medicare/Medicaid is also bound by restrictions on repetitive, pre-existing, and quantum of admissible medical expenditure to its beneficiaries

If understanding multiple payer system and their respective restriction constitutes half of the battle, billing and coding in ICD-10 and HIPAA 5010 Version will constitute the other half. But, providers, with their clinical efficiency at stake, would do well to assign these operational issues to external billing consultants.

Medicalbillersandcoders.com with credible history of helping physicians realize maximum claim realization amidst multiple payer environment – will help make the task a lot easier. Our medical billing professionals are highly trained and certified with experience in handling multiple payer environment and the latest coding practices. Their expertise combined with our technology edge is a sure way to turnaround your practices’ revenues.

Monitoring Potential for Up-Coding Errors in EHR with the Help of a Medical Billing Service

There has been considerable resolve and persuasion from the Federal Government to introduce Electronic Health Record System across the health care continuum. The Health Information Technology for Economic and Clinical Health (HITECH) Act has indeed given much impetus to pace of conversion from paper to electronic medium. The bait of financial incentives and penalties for complying with ‘Meaningful Use Criterion’ or otherwise has done wonders to the overall macro clinical efficiency as well physicians’ operational efficiency. In fact, no one would have foreseen the extent of transformation when the Federal Government first announced its major IT reform in 2009.

One of the significant advantages of EHR is that it has enormously simplified complex documenting during the billing process. As a result physician practices have been able manage higher level coding with far more degree of confidence than before. But, amidst all these catalytic effects of EHR, EHR is also known to have paved for errors that had not been possible with paper documentation. While EHR’s ‘cloning feature’ allows one to copy previous notes to current notes, it could also inherit errors in the previous notes or be filled with information that may not be pertinent to the current visit. 

The consequence of such cloning is that it may promote coding inconsistencies or up-coding. While physicians may benefit initially with inflated reimbursements, they may be susceptible to audit later. Therefore, with their credibility at stake, they should see that EHR is utilized for the purpose it is meant for: safe and efficient patient care. Whether EHR errors come from system inadequacies or personnel incompetence during billing, physicians should actively involve themselves in resolving them through:

Charting reviews while processing bills through electronic systems

Sourcing EHR systems from vendors who promise what is right for you

Generating baseline CPT frequency report of your E&M services for each provider before you adopt an EHR

Evaluating variations in coding patterns

Reviewing your practice records and looking for evidence of cloning or carrying forward notes on physical exams and patient histories

Shutting down “auto-coder” if your EHR has one

Practically, it may seem too much to ask of physicians who are primarily motivated by clinical focus. The best recourse is to engage competent EHR consultants or medical billers and coders who offer EHR consultancy as an extended service. Medicalbillersandcoders.com– with an extended capability for EHR sourcing, implementing and monitoring for physician practices of varying sizes and specialties – should practically solve all of your EHR related woes. Our strategic alliance with leading EHR vendors will help you find custom-made EHR systems that make it easy to find out cloning and up-coding even before the claim is submitted to the payers or Medicare/Medicaid.

Medical Billing Partner: A Strategic Avenue for Achieving Revenue Integrity?

Healthcare providers in the current environment are aware of the fact that every step counts, leaving no room for errors as far as securing the revenues and reimbursements are concerned for their services. However, as the procedure of patient billing information has been traditionally managed by different departments in isolation, showing little integration the deficiencies of one department might impact the other department adversely, and even damage the revenue cycle of the healthcare provider, hence providers are now in need of a strategic avenue to procure the right revenue for their clinic.

Processes like medical billing, collections and denials managements are some of the prime activities handled by the health care providers, which play a significant part in ensuring revenue optimisation. However payment accuracy, resolving cases of denials and managing the underpayments are specifically critical in order to maintain the healthy bottom line. Additionally healthcare reforms like – Electronic Health Recording (EMR) mandatory for securing incentives under ARRA, transition to HIPAA and ICD-9 to ICD- 10, though improving quality of care are also slowing down the Revenue cycle. All in all physicians have very little option but to re –organize their clinics entire billing process.

Medical billing partners being specialists in their field provide a practical and optimum choice for improving the revenue cycle, streamlining medical billing functions, ensuring optimal reimbursements, operational efficiency and compliance, thus helping the physicians and health care providers to achieve revenue integrity. Billing partners regularly check for any coding errors adding any modifiers if necessary thus negating any chance of discrepancy in the billing process. Problems like denials and underpayment can also be dealt with on the same platform, as billers assist in helping streamline changes to the clinic due to health care reforms providing experts who are well versed with ICD-10, HIPAA & knowledge about the EMR software suitable for your clinic.

RCM of a health care provider being quite complex, involves various processes and people, ranging from scheduling the patient to billing for the services and collection. MBC through it medical billing service has been helping physicians who are at a constant risk of losing considerable amount of revenue where lack of communication between various departments and inefficiency are common features. Medicalbillersandcoders.com has been involved in revenue maximization for healthcare organizations by billing and coding for over a decade now for physicians across the 50 US States and across varied specialties.

Our team is constantly training and updating themselves about industry requisites also providing consultancy right from the best EHR– to data analytics. At MBC our medical billing and coding experts are constantly striving to update themselves to achieve the right revenue for your organization.

Average Single Specialty practices cater to 42-49 percentage of Medicare Populace!

That means nearly half of your total patient population comprises of Medicare beneficiaries.  And, you could have remained indifferent as long as Medicare’s reimbursements continued to be as normal as private health insurance reimbursements.

While physicians’ have remained immune to its impending backlash thus far, they may not be so lucky henceforth; the Federal Government, unable to contain the exploding Medicare expenditure, has finally pressed the panic-button which physicians had been feared of –

 

Medicare reimbursements cut and their effects:

Approximately 4-5% cuts expected each year through 2012, – can result in a substantial erosion of practice revenues

Practice will find it hard to compete, sustain, and grow – on marginal revenues from private insurance reimbursements

Extreme possibility – the cumulative effect of such Medicare cuts may even bring practices on the brink of sell-out or closure

 

Ways to off-set the adverse impact of the imminent Medicare cuts:

Maximize your Medicare reimbursements – error-free billing, coding, and submission

Being eligible for Medicare bonuses and incentives – adopt ACO model of medical care dispensation and compliant EHR practice

Focusing on getting as many reimbursements as you can from – other sources (private health insurance reimbursements and fees)

Get credentialing services for your practices

 

Outsourcing your billing to dedicated specialists could be the key!

Specialization as their lone concern is to maximize their clients’ revenues from reimbursements

Voluminous operations – helps in reducing the cost of medical billing services

Market-orientation –  ensures that clients’ medical billing practices are compliant with the evolving industry standards

 

Tackling Medicare as well as other reimbursements with MBC …

Medicalbillersandcoders.com – by virtue of being the leading consortium of medical billers and coders across the U.S – is uniquely poised to play the defining role in this regard. Combining its unique legacy with a comprehensive process of medical billing RCM – Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, A/R Management, and Financial Management Reporting – Medicalbillersandcoders.com additionally offering value added services like consultancy and credentialing promises to guide physician practices through these testing times.

How much salary can Medical Coders expect in New Mexico?

• The New Mexico state government has introduced an incentive program where healthcare providers will be rewarded for moving their data operations to an electronic platform to be HIPPA complaint
• Chronic diseases and conditions prevalent in New Mexico have led to an increase in consumption of healthcare services like laboratory studies, radiologic imaging, oncology treatment and other specialties

These two seemingly disconnected developments, one relating to insurance compliance and another core care, have collectively made New Mexico a state highly in demand by medical billing and coding professional to be in for job and career opportunities.

This increase in demand of medical billers and coders in New Mexico is apparently a matter of concern for the state as despite being a fairly large state, New Mexico has only about 1290 medical billers and coders, reports a survey.

• The average billing and coding salary in New Mexico is about $32,070
• A professional with about 10 years of experience in billing and coding can command around $45,740

Moreover, a new billing and coding professional in New Mexico can expect his/her salary to span from $10.59 to $14.33 per hour.

Medical billers and coders in New Mexico and surrounding states are experiencing an increase in demand of billers and coders triggered by HIPPA and a climb in chronic diseases. Moreover fees of billers and coders in all states are souring with ICD-10 implementation on everyone’s mind, and states like New Mexico, Arizona, Tennessee, Michigan and Idaho experiencing minimum 20- 22 percent hike in their hourly rates.

Medical coders trained and certified in the methodologies of coding and familiar with the current software platforms required for compliance can make use of this industry trend in New Mexico, which many recruiters and industry insiders believe is an opportunity of the kind which comes once in long passage of time sometimes covering a lifespan of a career or two.

Present in all 50 US states and in New Mexico for over 10 years now, MBC can help meet this industry need with a team of highly trained in-house and outhouse billers and coders who have sound familiarity with New Mexico specific regulations.

MBC can further help meet this industry need by bringing care providers and billers and coders together through the MBC’s job board which is successfully catering to provider and biller needs across the US and in this way helping billers and coders to access job opportunities available in New Mexico and care providers to post their requirements.

Appealing a claim- Will a standard format work to improve your practice’s medical billing?

The procedure of appealing an insurance claim is intricate, although it can be successful if completed properly because there are many grounds for claims to be denied by an insurance company or a payer. The payer collects a lot of claims on a daily basis and the claim can be easily denied if there has been a mistake in analysis or medical billing and coding errors including many others. Furthermore, there is also a requirement to understand if the claim is of importance because a claim of a very small amount need not be appealed and can be written off but one which is worth a considerable sum needs to be scrutinized. However the physician’s office in this case may need to apply various measures considered the following challenges.

In Denial

The fact that a physician or practice receives the accurate amount of reimbursement even when the claim is not denied is a wrong assumption. Insurance companies may con a physician out of his or her fair share of reimbursements in many ways that are very difficult to detect and need a dedicated and keen professional to find the lacunae in the proper reimbursement of physicians since almost 19% of claims denied are due to errors of the insurance companies. This especially holds true in the case of private insurers due to errors made by the insurance companies in claims and detecting these errors requires skill and sustained effort. As a result some physicians and practices are reluctant to appeal denied or underpaid claims since this may increase the administrative work and expenses. However, nothing can be further from the truth when considering the long term repercussions of the monetary benefits that can be enjoyed even with 5-10% increase in revenue which can be a considerable amount.

The Impact of Reforms

In the face of reforms, revenues are set to increase dramatically along with administrative and billing process as 31 million uninsured Americans receive insurance. Appealing a denied claim is becoming voluminous but the new billing and coding procedures are aimed at making this process of reimbursement or appealing much smoother with the transition from ICD-9 codes to ICD-10 codes and adoption of the 5010 platform and emphasis on quality care and patient privacy through HIPAA compliance. The importance of time and money cannot be overemphasized and denied claims, especially for private insurance companies, have to be appealed within a stipulated period of time after the claim is denied. Therefore preventive steps to save time such as error reduction through analysis and a scientific approach in Revenue Cycle Management (RCM)  is required in order to sustain the low rate of denial over longer periods of time.

Vital Signs

Analyzing the pattern in which claims are denied by an insurance companies and finding out the most common false denials is a crucial part of the process of appealing denied claims. Denied claims can fall in various categories such as:

• Errors in documentation
• Services not covered
• Mistakes in medical billing and coding
• Technical difficulties involving Electronic Health Records (EHRs)
• Not considered “medically necessary” by the payer

Arguing your case becomes more difficult due to the huge amount of laws, rules, and regulations that seem to drown the actual cause of the denial. Thus customization of claims becomes much easier when they can be categorized and scientifically solved within a given period of time.

Scientific approach

In this scenario appealing a claim may require more than a standard format and physicians short of time can benefit by acquiring services of a medical billing service. Medical billing and coding experts at Medicalbillersandcoders.com not just perform basic coding and billing functions but are also backed by a team of research professionals who ensure efficient RCM, productive payer interaction, and a scientific approach towards collections with the “bucket” approach in Accounts Receivables (AR) and prompt reimbursements for physicians and practices all over the country with complete HIPAA compliance.

‘Pay-as-you-go’ as a value-based medical billing service model

While we are not alien to the term ‘pay-as-you-go’, it is something that is catching the imagination of physicians opting for outsourced medical billing services. Unlike in the past, when ‘pay-as-you-go’ was sporadically availed by a few physicians, it is now emerging as a viable alternative to long-term contractual medical billing services. Well… what is this ‘pay-as-you-go’ service model after all and what makes it so affable to physicians opting for outsourced medical billing services? Much true to its name, ‘pay-as-you-go’ service model’ is a niche medical billing service wherein physicians are obliged to pay their service provider (usually a percentage of the eventual reimbursement) only when they approach for getting their bills reimbursed. Usually, a percentage is worked out prior to soliciting ‘pay-as-you-go’ medical billing services from prospective medical billing companies. The reason why the present-day generation physicians deem ‘pay-as-you-go’ service model’ appropriate is primarily because of their restrictive financial ability as well as being able to transact on value-based system.

The surge in the demand for ‘pay-as-you-go’ service model’ has its roots in a combination of factors – spiraling cost of contractual billing services, continuous fall in reimbursement rates, rapid increase in stand-alone or small physician practices, and less incidence of insurance-backed medical services, popularly known as cash-based services. The thought of countering this adverse impact on physicians’ revenues through in-house medical billing seems to have lost its significance amidst the monumental cost associated with switch over to mandatory EHR, and the ensuing ICD-10 & HIPAA 5010 compliant clinical and operational mandate. While physicians are convinced of the efficacy of ‘pay-as-you-go’ service model’ in countering their sagging revenue fortunes, service providers need to be equally responsive to such demand from physicians. Notwithstanding it being an additional service portfolio in the medical billing companies’ service offering, many medical billing companies are apprehensive of the future of the contractual model. But, their reasoning may not be true.

The main reason why they may not be true in assuming ‘pay-as-you-go’ service model to be detrimental to the future of the contractual model is the fact that large hospitals, clinics, multispecialty groups, and more importantly the ACOs will continue to drive the demand for contractual model of medical billing services.  Therefore, ‘pay-as-you-go’ service model will not come in the way of their main service portfolio, but will only evolve to be an additional revenue source. In view of such scope for additional portfolio of service, medical billing services would do well to strategically expand their ‘pay-as-you-go’ service model to the areas where challenges faced in medical billing are rampant. On the whole, it puts both physicians as well as service provides in a win-win position.

While most of the medical billing companies are still analyzing the pros and cons of ‘pay-as-you-go’ service model, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – by virtue of being the largest consortium of medical billers and coders across the U.S – has already begun to reach to the physician practices in need of ‘pay-as-you-go’ service model. The strategic spread of its diverse medical billers and coders across the regions dominated by stand-alone practitioners makes it easily accessible and affordable.

HIPAA 5010 enforcement delayed to ensure doctors & entities complete transition

Enforcement of HIPAA 5010 transactions on March 15, 2012, was delayed for the second time for another 3 months by the government, with the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) pushing the date further to June 30, 2012, in order to not compromise physician cash flow. Physicians have previously communicated to AMA significant cash flow problems they encountered associated with the transition to HIPAA Version 5010. Essentially the rule called for compliance by January 1, 2012, however earlier on November 17, 2011 OESS announced its first enforcement delay of three months, referring to the move as “enforcement discretion”.

OESS states that there are still various outstanding issues and challenges hampering full implementation, hence the delay. To make sure that all entities complete the transition OESS considers that these remaining issues necessitate an extension of enforcement discretion, anticipating transition statistics to reach 98% industry wide by the end of the enforcement discretion period.

Progress on HIPAA 5010 enforcement by varied healthcare entities

According to OESS Health plans, clearinghouses, providers and software vendors have been making steady progress towards enforcement:

The Medicare Fee-for-Service (FFS) program is currently reporting successful receipt and processing of over 70 percent of all Part A claims and over 90 percent of all Part B claims in the Version 5010 format

Commercial plans are reporting similar numbers

State Medicaid agencies are showing progress as well, and some have made a full transition to Version 5010

What can Doctors do now to prepare for HIPAA 5010?

Reaching almost midway to the second enforcement delay date, along with the need to convert to ICD-10 soon after complying with 5010, it becomes imperative for doctors who haven’t as yet to begin their transition work as early as possible.

The major apprehension for practices is to complete implementation and full functionality at or before the deadline to avoid transaction rejections and subsequent payment delays. Practices will need to develop an implementation plan:

• Updating software to work under the new standards and contact software vendors, claims clearinghouses or billing service and health insurance payers to verify that they are operating as per 5010 standards
• Identify changes to data reporting requirements, changes to existing practice work flow, business processes and staff training needs
• Test with your trading partners- like payers/clearinghouses and budget for implementation costs – including expenses for system changes, resource materials, consultants and training

In this crucial time of healthcare reforms and increased stress on value for service, physicians short of time find it practical to partner with experts who can handle their entire revenue cycle, in order to concentrate more on streamlining their process and enhance patient care.

Medicalbillersandcoders.com expert consultancy providing medical billing and coding services is also offering software advice and support to US healthcare providers with their RCM and has been assisting physicians with HIPAA 5010 implementation. MBC offers professional support and assistance to healthcare providers to keep abreast to the changing industry norms, so that they can concentrate on their core service of patient care.

How are States retaining physicians in times of shortage?

Physician shortages is a growing concern and is pushing various states to keep doctors trained in medical schools and residency programs from crossing state lines to practice medicine. According to new statistics from the Assn. of American Medical Colleges- nationwide, there were 258.7 active physicians per 100,000 people and in individual states, ratios range from a high of 415.5 physicians per 100,000 people in Massachusetts to a low of 176.4 per 100,000 in Mississippi.

In this scenario medical school, hospitals, medical societies and state legislatures are increasingly taking a practical approach to retain the physicians and doctors-in-training in their state. According to a report by AAMC Center for Workforce Studies on average:

39% of U.S. physicians practice	State where they went to medical school
48% of U.S. physicians practice	State where they completed graduate medical education

Methods adopted by states to retain physicians

AAMC projections depict that physician shortages nationwide are projected to reach 62,900 doctors by 2015 and 91,500 by 2020 and several states to retain physicians have:

• Opened new medical schools or expanded existing ones
• Are offering incentives such as bonuses, scholarships or loan repayment programs to physicians
• Communities are developing new residency programs with the aim that physicians will develop long-term professional and personal relationships during GME training and keep them from moving out
• Certain schools’ mission is to train physicians from their states to practice in their states. However states need enough GME training positions else this efforts are wasted as then physicians will shift to another state

Iowa is below national average retaining 22% of its medical school graduates and 37% of physicians who complete GME training in the state and several efforts in Iowa have been designed to attract physicians to stay in the state. Several other states including Kansas, Mississippi and Alabama offer loan repayment programs for doctors to practice locally.

In Oklahoma, the state offers scholarships and loans to medical students and residents who agree to practice in rural Oklahoma for a set amount of time. Hence Oklahoma is above national averages, retaining 48% of its medical school graduates and 52% of physicians who complete residency training.

Physician adapting to this shortage

Higher revenues and incentives would attract more physicians to the profession and also keep doctors from moving out from states. Healthcare reforms are striving to improve quality of care and physician incentives, to entice more doctors to stay in the profession; but this leaves doctors with little time to balance both patient care and Revenue Cycle Management. As physicians move towards a value based system of healthcare delivery, they would be well-off by partnering with experienced Medical Billing Companies which can offer a balanced approach for both operational as well as revenue maximization.

Medicalbillersandcoders.com experienced in offering cost-optimizing and revenue-maximizing Medical Billing Revenue Cycle Management in tandem with their goal to assist healthcare should be able to play an essential role in making physicians’ transition towards a value based model easier and profitable, hence also helping towards eliminating physician shortage in the long term.