Posts Tagged ‘interim practice management’

Physicians are feeling the pain and frustration of lowering Medicare reimbursements, increased malpractice insurance costs, new patient influx on the decrease, and rising overhead. In the meantime, physician compensation is lower. And by the way, the staff would like annual raises. It’s enough to drive physicians and their medical practices nuts!

But, there is a method to relieve those frustrations, as the case study synopsis below shows.

Medical Practice Efficiency: Case Study
We recently completed a long-term engagement with a multi-specialty medical practice. Their situation will probably sound familiar to many of you:

• Multiple service delivery locations – some doing well, some not so much
• Flat revenue vs. climbing expenses (rent, staff, lab, inventory)

Their goals (ambitious, but do-able) were to:

1. Reduce Costs
2. Increase Revenues
3. Increase Efficiency
4. Improve Patient Satisfaction
5. Improve Staff Satisfaction

We began with a medical practice operational and financial assessment, to measure cost structures, service lines, governance and related operations. From there, we were able to implement process improvements that led to millions – yes, millions of dollars in savings.

Waste can kill a medical practice – just look at our overall healthcare system inefficiencies:

• Paper-based systems accounts for 6% of annual overspending
• Administrative inefficiency and redundant paperwork accounts for 18% of healthcare waste
• Billing and administration take up one-quarter of the average US hospital budget
• US doctors spend nearly 8 hours per week on paperwork and employ 1.66 clerical workers per doctor*

Approach and Results
Our approach with the multi-specialty practice was to eliminate non-value added work to achieve better patient, provider and staff satisfaction while increasing revenue opportunities. In other words, implement our mantra: “have the right people doing the right work in the right amount of time for the right pay.”

Using Lean principles (and MGMA cost data benchmarks), we benchmarked costs, redesigned processes, helped with organizational restructure (including executive leadership changes) and implemented new policies. You can find details in the presentation on our website’s media section, but the final results were:

• $3.8 million saved in expenses!
• Increased physician compensation
• Increased lab and imaging profitability
• Improved morale

We’re proud to report that the organization has sustained the improvement gains. Plus, they continue to benchmark and raise the bar with ongoing waste reduction efforts!

Snippet:
“Efficiency is integral to a more cost effective, productive medical practice.” — Barbara Derry & Crystal Nolan

Download the presentation that inspired this blog.

*healthcare inefficiency statistics taken from a report by Robert Kelley, vice president of healthcare analytics at Thomson Reuters.

Things are changing in 2010 and our Oncology coding expert, Derry, Nolan & Associates’ medical practice consultant Gwen Davis, CPC, put together a few tips for our Oncology medical practice clients. It’s a good Evaluation and Management coding guidelines hotlist, so read on. Then, see today’s DNA Snippet for resources regarding Medicare Consults in 2010.

Manage Your Documentation (think EMR, Fee Tickets, MAR, Flowsheets & Coding)

• Keep updated tools and databases current
• Provide ongoing education to billing as well as clinical staff
• Hire certified coders and ensure regular interactions with physicians

Time-Based Billing Accuracy
Routinely, Oncologists have intense, sensitive “Life and Death” counseling sessions with patients and family members. For correct time-based billing, remember the following:

• More than 50% of the time you’re with a patient must be spent on counseling or coordination of care
• Face to face time counts, ancillary service provider time doesn’t – such as when a nurse is drawing blood. Also, should you leave Patient A to go check on Patient B and then return to Patient A, the time out-of-room does not count as Patient A time.
• Document clearly the time you spent and what was discussed, ensuring it is plausible and accounts for time claimed. No “cloning” from a previous patient or simple pasting of a generic statement about drugs and side effects, or using a blanket “spent 30 minutes counseling patient” statement.
  Suitable Documentation Example: Patient was here for 50 minutes; 30 minutes consisted of face-to-face counseling on end of life issues regarding his current diagnosis X, treatment options X, and side effects. Additional counseling discussing lifestyle changes (hospice, long term care) also took place.

Oncology Reimbursement Recommendations
Gwen mentions the importance of documentation as related to Oncology reimbursement and its associated regulations, “I routinely navigate complex regulations regarding expensive chemotherapy treatments. Right now, I’m developing tools that will help Oncology offices with the 2010 RAC and OIG regulations.” (Thanks, Gwen!) Her five quick recommendations are:

1. Know current FDA Indications (use the compendia!)
2. Document when you are going Off Label
3. Know current billing requirements
4. Watch those HCPCS Units
5. And finally, let your computer work for you. Flag your system to catch medically unlikely charges and work these audits prior to submitting claims. It will save time, money and headaches!

Understanding and Following Incident-to Requirements
This “last but not least” recommendation regarding documentation is about Incident-to criteria. Be sure to identify who rendered the service and that the direct supervision requirement was met. Show the physician’s initiation and continued involvement in the treatment, as well as showing that the services are reasonable and necessary. And be sure to show that the services are within the scope of practice for the non-physician practitioner.

Remember, correct documentation is the key to successful reimbursement!

DNA Snippet
Visit the Practice Resource Center at www.wsma.org for helpful guidelines to navigating Medicare Consults in 2010. Plus, the WSMA’s Coding Hotline gives great guidance on CPT, ICD-9 and HCPCS coding. Just call Michelle Lott, CPC at 1-800-552-0612.