Posts Tagged ‘specialty groups’

2012 was a busy year for us here at Derry, Nolan & Associates, LLC. As Barbara and I begin our 10^th year of business, medical practices nationwide have seen their bottom lines erode due to rising costs and declining reimbursement–oncology and cardiology, in particular.

Over the past year, Barbara has right-sized a local oncology clinic by ensuring that staffing ratios are commensurate with the number of providers and their productivity levels, ensured waste-free administration of high-priced oncology drugs (as well as negotiating better prices), plus she formulated a robust marketing plan that generated many new patients.

I answered a call in mid-September that took me to Texas, where I’ve been the interim manager for a large cardiology practice.  I’ve assisted them through a computer conversion, implemented many process improvements and helped the cardiology providers and staff “adjust” to hospital ownership and the loss of their thirty-year independence.

Once again, we’re proud to say we’ve met the goal of leaving our medical practice clients better off than we found them. And we very much appreciate the trust placed in us to implement the recommendations made. Now both of us have begun a new project where we’ll be assisting a large integrated healthcare system in Seattle. For this new multi-specialty project, we’ll use the Derry, Nolan proven business principles that have always served our clients well.

As we swing into 2013, the general state of the healthcare industry hasn’t changed. Healthcare organizations are challenged to eliminate waste, to ensure that people work smarter and to provide quality services that will now be measured—pay for performance!  To achieve those ends, we suggest that you follow our lead by:

1. Looking at year-end financials for the previous year; it’s a great time to consider how to improve the bottom line in 2013!
2. Scheduling ICD-10 Coding training to assure optimum reimbursement & coding compliance.
3. Reviewing staff functions to assure the right person is doing the right work – and is cross trained!
4. Scheduling privacy & security training – both new workforce and a refresher for current staff.
5. Spot-checking or “secret shopping” customer service – how happy are your patients?
6. Querying referring physicians, too—how happy are they with your services and communications?

Wishing you and yours health and happiness in 2013!

As we mentioned, Cardiology groups face up to 27% in revenue cuts from CMS and Congress in 2013. But have hope! Your cardiology group can counteract those cuts with internal process improvement strategies that help your specialty practice work smarter, not harder!

Six Survival Tips for Cardiology Groups

1. Eliminate manual processes. Achieve maximum Meaningful Use dollars; be sure your staff performs value-added work and optimizes your EMR.*
2. Build interfaces that transfer demographic data post-admission verification at the primary admitting hospital (not from the ER visit). That ensures your system gets correct data.
3. Authorize only appropriate tests (not every single one). Rather than medical office staff becoming bogged down in unnecessary authorization processes instead of revenue-enhancing work like researching denied claims and educating providers on non-covered diagnoses.
4. Cross-train staff. Beside obvious redundancy benefits, respect for your counterpart’s workload increases when you realize the scope of their responsibilities. Teamwork improves.
5. Streamline workflows – starting with the phone! A patient-friendly phone menu that allows the caller to bypass lengthy menus with a “0” or to enter a known extension improves satisfaction. Lines that “hunt” for available staff assure better customer service. Front-desk and clinical huddles each morning and at midday helps anticipate patients who may take more resources, and assures you stay on time.
6. Implement a service recovery plan that acknowledges lengthy patient wait times (>30 minutes) and empowers staff to give coupons to the local coffee shop or eatery along with a sincere apology.

With these simple strategies you not only help defuse effects of the 2013 CMS coding and bundling cuts but also improve patient satisfaction – making them happy marketers on your behalf!

*Resource(s) CMS eHR Tip Sheet

As revenue is squeezed and expenses expand, specialty groups such as cardiology or oncology practices seek financial “security” through hospital employment. Twenty – or even ten – years ago, such a trend would have been scoffed at. Unfortunately, what initially seems a reasonable solution eventually reveals many challenges. Physician groups who give up years of independent practice to become a hospital-owned entity, an “arm” of a hospital’s cardiology or oncology department, can kiss a straightforward salary good-bye. Hospitals pay on productivity models (most commonly RVUs and MGMA benchmarks), rather than a salary and the sharing of year-end profits. Then there’s the loss of autonomy, that hardest of all adjustments.

Diving deeper, other subtle yet insidious challenges come to light. When signing the employment contract, physicians may not have considered the loss of being able to make decisions that affect their schedules—remember, there’s accountability to hospital administration for strict productivity measures. Mundane tasks, like proof of insurance for mileage reimbursement, or adhering to per diem rates for Continuing Medical Education courses (which could make the difference between first and business class seating) are SOP. Specialists, long accustomed to informal yet collegial respect, might face arbitrary “higher” behavioral standards that if “not met” will find them facing a hospital disciplinary board.

Specialty practice staff face different sets of challenges. Rather than cost of living raises or performance bonuses, now their pay is tied to elaborate formulas. Myriad in-services not necessarily applicable to their specialty are suddenly required attendance. Manageable email traffic becomes a daily deluge to delve through.

If healthcare reform is sustained after this election, the trend for employment over independence will probably continue. Specialty physicians, such as cardiologists or oncologists, held to particular standards and paid on measures of quality outcomes, hospital readmissions and patient satisfaction will likely run to hospitals as their salvation, looking to them to provide the infrastructure needed to meet the standards.

An era of medicine is coming to an end, one where physicians held hospitals at arm’s length rather than asking to be embraced. Of course, the honeymoon will end, too, when the hospitals that promised high salaries and excellent benefits have to adjust compensation formulas to accommodate their own loss of state and federal funding.

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Derry, Nolan & Associates works with medical practices and specialty groups to create revenue gains through expense reductions and efficiency improvements. The firm provides interim executive practice management, compliance assessments and program development, revenue cycle analysis, coding and billing audits, and customer service training, among other medical practice consulting services.

Margins for healthcare organizations are slim at best, particularly when it comes to Medicaid and Medicare reimbursements. Rather than compromising care quality, many healthcare systems, hospitals, specialty clinics and physician practices are looking at a common denominator – facilities overhead.

Operational efficiency audits often examine workflow, resource allocation and general costs, yet the most thorough ones don’t ignore facilities, which can include an array of possibilities. In one engagement, we uncovered a number of cost-saving logistical and facilities measures that were fairly simple to implement, yet contributed to significant bottom line savings.

Consider supplies. From paper to needles and syringes, what’s your outlay? Do you keep too much of one item on hand? Do you have multiple locations that could benefit from volume purchasing? Or are you a single location with space limitations that should look at just-in-time ordering?

What about energy output? For instance, larger healthcare organizations might consider new air handling systems that use considerably less energy yet improve patient and staff safety with fresh, clean air supply. Smaller clinics or physician practices in leased space may want to look at everything from thermostat settings and light bulbs to air flow in underused spaces, air filtration systems, or water usage (toilets, automatic faucets).

The savings opportunities aren’t always immediately obvious. Work closely with your healthcare facilities engineer to discover sensible changes or simple adjustments that will not only help the bottom line, but also improve your healthcare facility.

Derry, Nolan & Associates helps specialty clinics and groups, physician practices and healthcare systems discover new efficiencies and more effective use of resources. Email us to schedule your free, one-hour consult with our medical practice specialists.

Get Social!

Medical practice websites are a given but the old, brochure style site is going the way of the dodo. In the social media age, patients expect interaction from their doctor’s website. An eye clinic, for instance, may have special prices for contacts or glasses available to vision patients promoted not only on their website, but also on their Facebook and Twitter accounts. An oncology clinic may have an informative blog series on “What to Expect” to help chemotherapy patients and caregivers prepare for treatment sessions and aftermath. And nearly all practices and clinics have blank patient information and medical history forms available for download – it’s a simple yet helpful time saving tool.

If you’ve not updated your medical practice’s website lately, consider having an “audit” of your site and your medical group’s online presence. Seek out a web expert who has a solid book of medical and healthcare related websites in their client list. Visit physician practice or hospital websites that appeal to you (and check out the competition!) and share those with the web developer or your marketing project manager. Many times, they can point out why those sites work or why they don’t. Often, the snazziest medical practice sites aren’t search engine friendly, and if Google can’t find them, neither can patients!

Improve Your Medical Practice’s Profitability & Reach

In our interim practice management or clinic executive roles, we look at practice profitability holistically, from efficient processes to best practices in all aspects of operations and marketing. This includes being called upon to help physician groups and specialty clinics update their online presence or develop more effective, efficient medical and patient marketing practices. We help assure online and traditional marketing procedures follow healthcare privacy and marketing regulations, while also helping bring your medical practice’s online marketing methods up-to-date.

Barb and I are both filling interim management positions within specialty practices right now. There’s simply so much to do that for many physicians, finding the time to fill a much-needed leadership role becomes yet another burden for their practice.

In my particular engagement, I’m not only recruiting for a new manager as a function of my interim management position, I’m also performing an operational assessment. It’s not really unusual to combine the two services. When key personnel leave, often the physician practice finds itself not only needing the role filled, but realizing how much more there is to be done – and sometimes wondering how that one person managed!

In this situation, my goal is to provide a thorough assessment of where the practice is operationally, providing a new manager:

1. The knowledge of where the medical practice stands, and
2. The basis on which to make appropriately prioritized recommendations for change.

Times of transition can be the perfect time to discover what needs improvement, what’s redundant, and even what’s potentially placing a practice at risk. From coding to reimbursement practices and systems, self-auditing for OSHA compliance and consistent HIPAA training, to patient safety and satisfaction, or looking at how the front desk can better support clinical staff – it’s all fair game.

Remember, even uncovering small issues can save physician practices significant time and money, improve quality and satisfaction, and perhaps reduce risk (non-compliance, coding or reimbursement errors). It all comes down to early discovery, corrective action and a can-do attitude toward multi-tasking!

With the NYSE resembling a roller coaster ride, 2011 was another tumultuous year for the global economy. It put us much in mind of Derry, Nolan’s own beginnings in 2003. The economy was less than ideal and President Bush had declared war on Iraq. Despite those challenges, we remained focused on our goal to help medical practices.

In the first six years of business, we did a lot of medical practice assessments. We were busy helping physician practices eliminate wasteful processes, streamline staff and improve their bottom line through clean-claim submissions–on the first attempt! Many times we recommended consolidation of resources, right-sized the staff to productivity and restructured practice billing departments.

Over the past couple of years, however, we’ve witnessed a disconcerting trend of physician specialty groups running for cover and entering into employment agreements with hospital systems. We’ve also seen several hospital systems merge—the recent purchase of Swedish Medical Center by Providence, for example. Is the entrepreneurial, independent physician spirit being squashed by such threats as 27% Medicare cuts? (Particularly in light of thirty-three million baby-boomers readying to apply for Medicare benefits!)

Never before has it been more important for physician practices and hospital systems to work as efficiently as possible. If recent trends lead to that, it will be a good thing.

We wonder, though, if hospital leadership can keep promises made, as their institutions face continued dwindling reimbursement. We well remember how in the mid-90s, the trend of HMOs and hospitals purchasing primary care practices resulted in an average loss of $90,000 per physician. Then, many physicians went back into private practice; whether this will happen with specialty services remains to be seen. One thing is certain, whatever form healthcare reform takes, all healthcare providers will need to meet the challenge to deliver quality-driven services, because their reimbursement will be based on outcome measurements.

As for Derry, Nolan, for the past eight years, our initial business goals have not wavered. We hope that medical practices choosing to remain independent will continue to assess how they perform daily work to ensure it is meaningful and value-added.

We end 2011 with fondest wishes to you and your families for a wonderful holiday season. We hope that 2012 will be a better year economically for all of us and that you achieve any New Year’s resolutions you set for yourselves!

Barbara and Crystal

P.S. As you plan 2012 business activities, check to see the last time you had a practice assessment. We’re scheduling operational “check ups” for our physician clients now!