Jared Vishney:

When you look at a firm and you talk about efficiencies, one question we ask folks always is, do you know how many of your cases and demand letters are being held up by missing medical records?

Chris Dreyer:

How could your firm grow if every medical record request came back in less than 30 days?

Jared Vishney:

So for every hundred, it’s roughly 40 hours of labor. With our Arctrieval methodology, it’s now eight or nine hours, so you’re saving almost 30 labor hours per hundred requests. It’s an 80% improvement in time spent working on things, you can do other stuff.

Chris Dreyer:

Welcome to Personal Injury Mastermind. I’m your host, Chris Dreyer, founder and CEO of Rankings.io, the preeminent personal injury marketing agency. Before we get started, if you like what you hear, head on over to Apple or Spotify and pound that five star review button. And if you don’t like what you hear, tell me about it in a one star review, I got a big hug for all my haters too. Each week we talk to the best in the legal industry, ready to dominate your market. Let’s go.
Missing or delayed medical records, it’s a frustrating, expensive, and time-consuming process and it hurts cash flow. You can’t move a case forward without access to protected health information. I think every personal injury attorney or case manager can relate to this bottleneck. So how do we improve access and increase velocity? Jared Vishney has a solution to close more cases in less time. Arctrieval is a software service that uses individual right of access request to decrease the time it takes to get medical records. He breaks down how to get medical records in-house quickly, increases the throughput of cases and reduces time wasted on chasing down medical providers. Let’s jump right in. Here’s Jared Vishney, CEO and founder at Arctrieval.

Jared Vishney:

Arctrieval started as a software platform for healthcare providers to really optimize their release of information process. It was horribly inefficient and we had a family business that worked in that space and I brought in software to fix that. And during our time there running the business for 10 years, we kept having attorneys come to us and saying, “Hey, you guys are fast, friendly, efficient, can you help me get records from other healthcare providers and doctor’s offices?” And for the longest time we said, “No, that’s really not our space.” We were really focused on fixing this problem for healthcare providers and anybody that knows anything about the healthcare industry and by extension, because you got to get records from it, knows that it operates at three speeds, slow, stop and reverse. So what we were trying to do wasn’t always very well received by the senior management at the healthcare provider.
So really in 2019, we had enough attorneys come to us and saying, “Hey Jared, can you help me get records from other places?” So in that timeframe, I sat down, really looked at it and said, “Well, what we’re doing is just the other side of the coin. So let’s flip sides.” So we retooled our software app platform, really geared it towards attorneys using the experience we had from working as release of information for 10 plus years. We were really able to leverage that experience and knowledge and build a software tool to help attorneys get medical records. We realized we couldn’t be like other retrieval services, we had to do something different. We had to bring in a different process. We released our software platform and for attorneys, really a request management software and it’s designed for the in-house staff as a tool to really cut the time, effort and expense. It takes them to get records and it’s just been going really well since then.

Chris Dreyer:

Yeah, and that’s that money, that profit, that leverage, right? So we’re going to dig into that. So Arctrieval, I’m going to read this is directly from your site. It’s you’re not a retrieval service. “We’re an in-house tool for legal professional to request their medical and billing records.” So break down for those listening, what that means.

Jared Vishney:

Well, it’s attorneys and the clients that they’re serving, especially in the plaintiff’s litigation PI space wait way too long to get the medical records. It takes the staff way too much effort. They’re wasting so much time on it. The records themselves are really, really expensive and all that does is it delays the firm’s ability to resolve cases, obtain justice for the injured party and put that person’s life back in order just because somebody in medical records doesn’t want to do what they’re supposed to. So what does it mean that we’re doing differently? Well, first we don’t use HIPAA authorizations. Everybody talks about these third party HIPAA authorizations that are a permission slip. It’s like, “I, Jared can give you Chris permission to get my records.” And you will then write a nice cover letter and you’ll send it off to Good Samaritan Hospital says, “Dear Good Samaritan Hospital, I would please like a copy of Jared’s records. Here’s his authorization and permission to do that.”
And the hospital will respond and go, “Big rasp barrier, no, we’re not going to give it to you, or we can’t find the request, or you got to call and follow up. Or on the third Tuesday and next month when all the moons align with Jupiter and the astrophysicists are in sync, we’ll get you the records.” It’s a huge problem and pain. The problem is that process is fundamentally broken. We use as a foundation what’s called an individual right of access request. It’s directive based. It is, I Jared will tell Good Samaritan Hospital, I want a copy of my records. That’s option one. They have to send it to me, either electronic or paper format. I, Jared can also command Good Samaritan Hospital to send Chris an electronic copy of my records in an electronic format and they have to do that under the current rules and regulations which are being modified in summer.
The current rules and regulation says that hospital or doctor’s office, Good Samaritan Hospital must do that within 30 days, which is a big decrease from what firms are dealing with today. And if they don’t do it within the prescribed timeframe, they open themselves up to investigations, fines, penalties, and corrective action plans from the Office of Civil Rights. And this is not a paper tiger government entity, it has real teeth. The Office of Civil Rights, for example, fined Banner Health here in Arizona, $200,000 for not responding to two individual right of access requests within the prescribed 30-day timeframe. That’s only part of it. The other part is they were put on a two-year corrective action plan and who knows how much money they had to spend to hire staff to monitor internal processes and to report back to the government on a quarterly basis their progress of meeting that plan. So it’s really a different way of doing things and it gets much better results

Chris Dreyer:

When you’re talking about that 30-day turnaround without using the individual right of access. How long would it take if you weren’t using your software to get that information versus your software?

Jared Vishney:

We’ve surveyed, and this is primary research, over 900 firms, and when we talk to them, we ask them, “What’s the longest you’ve had to wait for medical records?” Over 72% of their firms have said we’ve had to wait more than three months. Over 50% have said we’ve had to wait over more than four months. And what a lot of people get trapped into is this question of what is the average turnaround time? What’s your average? And I will say averages don’t matter. You want to deal with absolute. So it doesn’t matter that if you have a client, let’s say a motor vehicle accident single event, they’ve seen five providers. You need records and bills from those five providers. So that’s 10 requests. You send out all 10 requests and eight of the 10 come back in five days or two weeks or a week, but it takes six months to get those other two requests.
And let’s say they come from the hospital itself, your case is stalled out for that six months. So what we’re seeing is by using the individual right of access request, hospitals and doctor’s offices and covered entities are required to respond within 30 days. Folks that are using this methodology and you can’t implement it outside of Arctrieval, we think that the automation component that we bring to it, just simplifies it. That folks are getting 90% of their records back in 30 days without having to make the follow-up phone calls. It’s not a perfect situation, but it’s a vast improvement over having to chase 70% of the requests that are issued under a third party HIPAA authorization.

Chris Dreyer:

I’m hearing leverage, leverage, leverage. I’m hearing velocity and cash flow improvements and I’m hearing additional utilization by my case managers. How does the tool impact the case manager’s job in terms of utilization and capacity?

Jared Vishney:

When you look at a firm and you talk about efficiencies, one question we ask folks always is, do you know how many of your cases and demand letters are being held up by missing medical records? Every time we’ve asked an attorney this question, it stops them dead in the tracks at a trade show and they’ll say either, “I don’t know.” Or all of them are, “Wow, nobody’s asked me that question before.” Because they’re no performance indicators around this metric because it’s so nebulous. If you say you want demand letters to go out six weeks after a patient’s completed treatment, you start working backwards from that. So you need to make sure you have the medical records.
So let’s say the demand letter doesn’t go out in six weeks after treatment. So you go back, “Well, did we get the medical records?” Well, somebody was on vacation, okay, or were overloaded in that department. So you can start to see those demand letters, that throughput’s not there. “Well, are the medical records there?” “Well, we didn’t get the medical records boss.” Okay, well we back it up. “Well the medical records were due at 30 days. Why don’t you have the medical records at 30 days?” Was it somebody didn’t issue the request? There was a complaint, there was an issue, there was a defect. Somebody didn’t follow up with the provider. With the individual right of access, you now have leverage over that provider to get them to get the records.
For a case manager or somebody that does medical records, it gives them the leverage to compel the providers to provide the information so they don’t waste the time on their phones chasing stuff down. It also exposes KPIs in the organization overall to see who’s doing a good job of getting the information in and out and who’s doing a job that maybe needs improvement. Or who’s deficient or high performing and able to mimic and take those best practices from that high performing individual and replicate it through the rest of the organization, without a KPI in the ground you can’t do that. So that’s step one is let’s give you a key performance indicator that you can put in the ground and maybe it’s eight weeks after treatment, but it’s a definitive timeframe that you can work on and reduce. That’s part one.

Chris Dreyer:

Tracking KPIs is a great way to evaluate performance. But what does the system look like for a case manager’s workflow and capacity?

Jared Vishney:

What we see is if you issue a hundred requests for records, and that would be roughly 10 cases of single event new in a month. In that month you have to send a hundred record requests out for 10 clients, 10 requests per client, and you’re going to have to follow up on 70% of them as a case manager because the process is defective. Even if it takes you a half an hour or 35 minutes on hold. So for every a hundred requests you’re following up on 70, it’s roughly 40 hours of labor per a hundred requests. With Arctrievals methodology, there’s still some follow up, but it’s more like five or six requests. So it’s 10%, it’s now eight or nine hours. So you’re saving almost 30 labor hours per hundred requests. It’s an 80% improvement in time spent working on things, you can do other stuff, client facing activities, getting the demand letters out, reviewing the documents. Time is spent much more effectively than sitting on the phone talking to providers.
And a case point is we have a personal injury firm in Texas that we started working with almost two and a half years ago. At the very beginning they were using third party HIPAA authorizations. They brought on Arctrieval to do the individual right of access request and the automation we offered, they had two and a half people or two and a half FTEs, full-time equivalents, requesting about 450 to 500 records per month. After three months of using Arctrieval, they were able to cut that down to just a half a person working on the request cycle. The other two FTEs were redeployed at other parts of the organization to work with clients. So it was a huge time savings for them and that one person that was left doing the records had more time to do other things, like make sure the records were accurate, make sure they got all the records and they weren’t spending their time on the phone calling providers to say, “Hey, when am I going to get my records?” So it’s a game changer in the methodology and the automation just helps accelerate the process.

Chris Dreyer:

Hey guys, the attorneys listening. Are you farming without tractors? You got a tractor here, right? You got leverage. What I was hearing is ding, ding, ding, profit not to be too cheesy because of the added utilization and time savings and those revenue per employee. You know your greatest expense walks on two feet. And so it’s tremendous advantage here. You got over 300 firms already using your services. Tell me about during the time when your company was really growing during COVID, you really focused on conversations with your customers and alleviating pain points. What were some of those conversations? What were some of the things that you learned that you applied to your tool or maybe even have in the kind of future plans as well?

Jared Vishney:

During COVID, we could have multiple conversations in a day, and for us it was really about what is a really meaty critical problem that we can solve. And we honed in on this one from our own experience. So the conversations were with the customers, the initial ones were, “Hey, if we did this, would you be interested?” And they were like, “Yeah, if you can pull this off, we’re all over it.” And we did a lot of primary research. We’ve surveyed at this point also over 2200 firms and we asked them, quite frankly, what frustrates you when obtaining medical and billing records? And the top three reasons were following up with the providers. Over 80% of them said, “Hey, this is a problem and it irritates me,” waiting for the reply so the records aren’t coming back over 75% and the copy and retrieval costs. So when we set out with Arctrieval, we were going to solve three key problems. One, the long pole in the tent is getting the records in-house.
So not only they’re expensive, but you got really bad service, so at least let’s make sure the records get there so you have your case velocity, your volume, and you’re not wasting time and you can get the throughput on the cases going. Two is, this waiting for a reply following up with the provider? Well, let’s stop the staff having to waste their time calling these providers just to get answers from, and I’ll call them dumb dumbs, and medical records that are poorly trained, don’t know what they’re doing. That are paid minimum wage in some cases poorly that are holding up hundreds of thousands of dollars in settlements in money that a client needs to put their life back in order and they don’t care. And then the final one is the copy and retrieval costs. That is partially legislative. We couldn’t affect the regulations, but there’s some good news coming in March about the individual right of access request. It’s going to get strengthened and there’s key components that’s going to really change the landscape in the summer timeframe of how every attorney should be requesting records from that client.

Chris Dreyer:

A lot of the old school or it’s a little slower to adapt to implement this and how long is it to implement this and then also let’s talk costs.

Jared Vishney:

From the technical standpoint, we’ve built the platform really easy to get up and running, so if somebody decides, “Hey Jared, we want to get this thing going. There’s an onboarding session that’s 15, 20 minutes really to set up the account and make sure that all the switches and dials are set correctly to map as best as possible onto their firm’s existing processes.” So that’s 20 minutes. Then they get a homework assignment because we have a specific form that needs to be signed by their clients, so we can ingest their signature into our system and build the templated request that we send out, however long it takes them, it could take them a few days a week maybe to get some of those back. And then we do a follow on training session 45 minutes to an hour depending upon how many questions they have.
Maybe then there’s a follow-up session a week or two later for a half an hour and people are off to the races. The hangups or any problems in the adoption of the technology is not, “Can I use the platform?” It’s more educational about, well wait a second, we’re turning upside down an entire process we’ve used for 30 years. It’s an understanding, “Well, what do I do in this case the provider said X, how do I respond?” Well, we just happened to build that into the system. For example, the provider only sent part of the records or they said, “We have to use their request form.” No, there’s a button in Arctrieval you push it, it’s an easy button, regenerates correspondence, sends it out to them and goes back at the provider saying, “No, you haven’t complied with the original request.” We are very compliant driven.
That onboarding process quick and easy. Also cost, for a single user to issue and manage an unlimited number of requests in our system is $139 a month, all in. Does not include the cost of the records, but if you look at and if you have one person doing requests and they can save 30 hours of labor a month times say $25 an hour to pay a paralegal. You’re $750 of labor saved just in that month against $139 spend, which doesn’t capture the opportunity cost of getting your cases settled faster. If you move to multiple users, five users is 239 a month, 10 users is 449 a month. So it starts dropping down to 40, $45, 38, 33. Eventually, if you have a large department that’s doing it goes to $33 per user per month for unlimited usage.

Chris Dreyer:

Big changes are on the horizon for the HIPAA privacy rule. Individual right of access requests will help your firm close cases faster than ever before. Jared explains how, but first he hits us with a history lesson.

Jared Vishney:

What this centers around is the cost for the record and what we had is everybody refers to this thing called HITECH and they say, “Oh, this is a HITECH request.” And first and foremost, anybody that’s using the HITECH request, stop using that nomenclature. It’s incorrect. It’s going to cause you problems in the future going forward. It’s technically called an individual right of access or a patient access request. HITECH was an implementation specification passed as part of the recovery act in 2009. And what it says is it says, “If records exist electronically and I want them electronically, you got to send them to me that way, to the patient.” If the records exist electronically and you send them to me electronically, you can’t charge me per page rates as the patient because what you would have is you’d have people issuing requests for records, Ciox, MRO, Sharecare, Verisma, IOD, all these release of information vendors would say, “Oh, that’s nice. Here’s a big pile of paper, I’m going to charge you a buck of page.”
And it was ridiculous. So it fixed part of the bad behaviors and predatory practices of these release of information companies. And even smaller doctors’ offices that viewed record retrieval as a secondary source of income and we know some chiropractors quite literally that built vacation homes on what they charged for access to medical records. So it’s just not right. So that happened in 2009 and the other thing it said, “If the records exist electronically, I can direct that to Chris.” Like I gave the example in the beginning that I can send electronic records electronically to Chris. I believe it was 2014, the Department of Health and Human Service issued guidance and said, “Oh, by the way, we think if it’s an individual right of access request by the individual sent to a third party that should really be subject to this cost based rate as well.” Okay, great. Well we think it should be. Nothing really happened. Then in 2016 they came and they said, “You know what? You’re not doing what you’re supposed to healthcare providers, you’re charging too much for the record.
We’re going to issue an omnibus rule that says the cost based rate for electronic records now applies to request going to third parties. We’re going to edict this. We have the rule making authority to do this.” 2018 Ciox sued the federal government, specifically Alex Azar, the then Secretary of Health and Human Services and said, you can’t do this. In 2018 they brought the suit, 2020 January, Judge Mehta in federal court said, “You know what, Ciox, unfortunately, as much as I don’t like it, you’re right. The letter of the law says they can’t do this. We’re vacating that application of the cost base rule the electronic records.” Overnight, all these electronic caps on fees went away. It all went back to per page fees. So that kind of brings us up to the current state, Department of Health and Human Services rather than fighting that decision in January of 2021 issued a notification to modify the HIPAA privacy rule. That came out in 2021 due to COVID and some other things going on.

Chris Dreyer:

We can expect to see this final action this month and Jared expects their implementation to roll out this summer. There are four big changes we’re going to see.

Jared Vishney:

One, if you issue and it does not apply to the HIPAA authorizations, it applies only to the individual right of access request. So regardless of how you do it, what you do it, whether or not Arctrieval is the right fit for your firm, don’t know, stop using HIPAA authorizations and you will absolutely want to issue individual right of access request. Because it’s going to do four things. One, it’s going to cut the delivery time from the 30-day timeframe to 15 days, calendar days. Two, it’s closing some loopholes in what’s considered an electronic health record. In Judge Mehta’s decision, he defined electronic health records and a little tighter than what’s considered the broader electronic protected health information and there’s various definitions floating around.
So what they’re doing is they’re unpacking that and they’re basically saying, “This type of request will now apply to any and all electronic protected health information no matter where it’s stored and no matter what covered entity has it. If it’s related to the past, present, or future care of that individual or the financial transactions and it’s held by a covered entity, it will be subject to an individual right of access request.”So that’s really cool that it cuts out the loopholes. Third thing it’s going to do, remove roadblocks, and I’m sure every personal injury attorney staff will know this one, you have a nice HIPAA authorization, you fax it to a hospital, they fax it back and say, “We don’t accept attorney requests via fax. You have to mail it to us, or you have to jump through these fiery hoops to get it in.” It removes and codifies what’s considered an unreasonable measure that impedes access to the protected health information.
The bottom line is it means the providers will not be able to dictate the submission process. They cannot tell you how to deliver this thing. They can still tell you how to deliver a HIPAA authorization, but they cannot tell you how to deliver the individual right of access. If you submit it via fax and they’ve got it, they have to process it, know if, ands or butts, they can’t make you submit it through their online portal, submit it through a third party, all of that blows up, so it’s going to force them to become more efficient in how they operate their businesses and be more customer service driven. The final piece, and this is probably the most exciting is Alex Azar said that people or entities should not be profiteering by being gatekeepers to protected health information.
Just because you sit between the person that needs it and the data source you have people just predatory business practices and profiteering. There’s no reason, for example, in the state of Florida that a 500-page document from a hospital costs $500 as a PDF file delivered electronically. That’s insane, there’s no reason for it. Or $9500 for 15,000 pages of medical records in Massachusetts, that’s insane, delivered as a PDF file. The cost is not commensurate with the effort to produce that material and it should be cost based. So all these per page fees are going to get wiped out. What we expect will happen is you will see record requests for costs for an entire record set, whether it’s five pages or 5,000 pages, expect say 20 $25 fee caps on everything instead of the thousand dollars. It’s a huge change. It’s very important.

Chris Dreyer:

Wow, amazing. Thank you for highlighting those benefits. Number four certainly is the big whammy, right? Where can people go to learn more and how can they connect with you?

Jared Vishney:

Well, they can connect with me by going to our website. It’s just arctrieval.com and filling out a request to see a demonstration. We have resources on our website if you want to learn more about the HIPAA privacy rule changes. We are going to be conducting a series of webinars, purely educational on the topic as soon as the rule changes. We have some recordings of those on our website as well that we did last June when we thought it was changing in October. It’s still relevant, the material, just the date shifted a little bit and we welcome everybody to come chat with us. We really are trying to do right for the injured party and in the process really remove friction from the overall workflow and process to get the records. Even if Arctrieval not the right solution, we’re always happy to answer questions to the best of our ability on the regulations.

Chris Dreyer:

Thanks so much to Jared for everything you shared with us. Time for the takeaways. Let’s hit the PIMM Points. PIMM Point number one, increase velocity. Guys, we do not talk about this enough. We hear a lot about increasing fees that are eliminating ways to get better cash flow, but remember, velocity equals profitability. Use technology to streamline your processes and ramp up that throughput.

Jared Vishney:

The automation component that we bring to it just simplifies it that folks are getting 90% of their records back in 30 days without having to make the follow-up phone calls. It’s not a perfect situation, but it’s a vast improvement over having to chase 70% of the requests that are issued under a third party HIPAA authorization.

Chris Dreyer:

And PIMM Point number two, know who are your A players. How do your A players stack up against the rest of the team, set up and track those key performance indicators or KPIs based on an outcome? Sure, you could track ours, but that only tells half the story. Looked at leading indicators for a better picture. Let’s say you had a content publisher, how many could that individual publish per month? Track that as a leading indicator. If you have multiple people publishing articles, you can determine who’s your lagger, who needs help, who needs more training, and where you need to improve your processes. There are many ways to do this, but whatever you decide, pay attention these KPIs impact profitability.

Jared Vishney:

See who’s doing a good job of getting the information in and out and take those best practices from that high performing individual and replicate it through the rest of the organization without a KPI in the ground, you can’t do that.

Chris Dreyer:

Let’s dig a bit deeper into PIMM Point number three, know your revenue per employee. This is such an important metric to track to determine the health of the business. As a rule of thumb, you want to be above $200,000 per employee. If you’re in the US and dip below that, it hurts your ability to drive profit. Remember, your greatest expense walks on two legs. To help reduce that overhead, consider international arbitrage a.k.a. hiring overseas or subcontract your strategic partners.

Jared Vishney:

They had two and a half FTEs, full-time equivalents, requesting about 450 to 500 records per month. After three months of using Arctrieval, they were able to cut that down to just a half a person working on the request cycle. The other two FTEs were redeployed at other parts of the organization to work with clients.

Chris Dreyer:

I’m your host, Chris Dreyer. Thanks for listening to Personal Injury Mastermind. If you made it this far, it’s time to pay the tax. No, I’m not talking about taking your cash like Big G. I’m asking you for a five star review on Apple or Spotify. Leave me a review and I’ll forever be grateful. If this is your first episode, welcome and thanks for hanging out. Come back for fresh interviews where you can hear from those making it rain. Catch you next time. I’m out.