physician practices today – business realities & opportunities
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Physician Practices Today – Business Realities & Opportunities. Rosemarie Nelson, MS Principal, MGMA Health Care Consulting Group October 2006. Best Business Practices. - PowerPoint PPT PresentationTRANSCRIPT
Physician Practices Today – Business Realities &
OpportunitiesRosemarie Nelson, MS
Principal, MGMA Health Care Consulting Group
October 2006
2
Best Business Practices
• Definition: a proven service, function, or process that has been shown to produce superior outcomes or results in benchmarks that meet or set a new standard.– Best: optimal for organization given its
patients, mission, community, culture and external environment
– Trends
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Dynamic relationship• More revenue
Higher operating costs
• Operating expense increases
Total profit rises
• How is it managed?
Productivity
Expenses Revenue
Profit
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Better Performer Findings:
• Overall effectiveness of physician/administrative team critical
• Commonality of expectations between physicians
• Motivation of physicians thru productivity based compensation
• BP administrators on incentive based compensation
• Regular physician/staff training to ensure coding compliance
5
Selection criteria by performance area:
Profitability and Cost Management
•Greater than median for total medical revenue after operating cost per FTE physician; and•Less than median for operating cost (not including NPP costs) per medical procedure (inside the practice).
Productivity, Capacity and Staffing (nonsurgical specialties)
•Greater than median for in-house professional procedures per sq.ft; and•Greater than median for total gross charges per FTE physician.
Productivity, Capacity and Staffing (surgical specialty aggregate)
•Greater than median for total procedures per FTE physician; and•Greater than median for total gross charges per FTE physician.•Anesthesia practices, greater than median for ASA units per FTE physician.
Accounts Receivable and Collections
•Less than median for percent of total A/R over 120 days; and•Greater than median for adjusted fee-for-service collection percentage; and•Less than median for months gross fee-for-service charges in A/R.
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Opportunity
Thesis – “There are no perfect solutions” “Nothing achieves 100%” “Many small changes add up” If others can improve, why not your
practice?
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Benchmarking- MGMA Hematology/Oncology
(where you stand vs. the rest of the world)
Per FTE physician (2005 Cost Survey Based on 2004 Data)
25th %tile Median 75th %tile 90th %tile
Gross charges $4,031,922 $4,995,615 $7,736,067 $10,182,290
Medical revenue $2,162,498 $3,288,839 $3,910,725 $4,926,461
Operating cost as % of medical revenue 65.32% 71.85% 79.76% 85.18%
Support staff 4.23 7.36 8.89 13.35
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Advantages of Benchmarking
Where is the opportunity? How much? Starting point for change?
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Profit Improvement Objectives (Are you voluntarily limiting profitability by not
optimizing return on overhead?)
Improve revenue Reduce, or realistically control cost Simple concepts, but we forget No single action, but combination of –
multiple actions
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Incremental Revenue Should you accept poor paying contract?
Obvious answer – No!Practical answer – project the numbers!
? Participate, or not?
Current practice
Proposed 50%
Payor B 70%
Payor A 80%
Medicare 58%
Health Plan Contracts
and % of fee
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Practice A – Full practice (limited access)
Answer – no
Practice B – needs patients, but cost would increase
Answer – maybe
Practice C – needs patients, minimal increased cost, physician willing to increase volume
Answer – YES!
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Volume Problems (inadequate patient base)
Access: Who controls the appointments? Convenience vs. productivity Convenience for:
Physicians Staff Patients
Hours/days
Marketing: Do you have a hook? Cost Patient network
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Staff Cost
Major cost (10% - 30% of revenue) Set the hours – avoid overtime Part-time/full-time Out source (billing service, MSO,
transcription) Midlevel – cost reality
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StaffingTelephones with messaging 300 – 400 calls/day
Appointment scheduling with no registration 75 – 125 calls/day
Appointment scheduling with full registration 50 – 75 calls/day
Pre- or site registration with insurance verification 60 – 80 patients/day
Check-in with registration verification only 100 – 130 patients/day
Site check-in with registration verification and cashiering only
75 – 100 patients/day
Check-out with follow-up scheduling, charge entry and cashiering
60 – 80 patients/day
Check-out with scheduling and charge entry 70 – 90 patients/day
Check-out with scheduling and cashiering 70 – 90 patients/day
Referral specialist (inbound or outbound referrals) 70 – 90 patients/day
*Reference: Elizabeth Woodcock 2004
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Billing performance benchmarks
• Billing FTE/provider • Cost of billing (% of net revenue)• Annual claims/FTE• Accounts worked/day• Encounters worked/day• Payments posted/day
.75 FTE
7-9%
6,700
60-70
130-140
500
Source: Collation of MGMA, Physicians Practice, Camden.Note: Billing includes charge entry.
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Communications: Your Patients Are Online
• 7.2 million consumers visited physician web sites over 3 months in 2002
• Compares to 2.5 million over same period for 2001
• Want more than “electronic business cards” on physician sites– Clinical info
– Automated appointments
– Electronic prescription refills
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www.patienteducationcenter.org
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Web service providers
• www.max.md
• www.medfusion.net
• www.nexsched.com
• www.practisinc.com
• www.relayhealth.com
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Billing structures
• Centralized– Encounter slips route to billing office for charge
posting and time of service payment posting– Follow up by billing office
• Decentralized– Charges posted at check out– Follow up scattered among departments
• Hybrid– Charges posted at check out– Payments and follow up centralized
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Details of success
• Collect co-pays in advance of service• Professional coders• Denial analysis• Longevity = experience• Combination of point of service and batch
method of data entry• Electronic submission and remittance• Monitor and communicate
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Cost management
• Costs identified – service lines• Reduce manual efforts and use
reporting tools – add-ons to practice management system
• ROI on collections calls to patients• Gap-itis costs – automate appointment
reminder calls and cancellation lists• Nursing time and paperwork
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Time/cost spent per FTE physician
Per FTE physician Hours/year Cost/FTE
Support staff time on phone with pharmacies - formulary 25.8 $375
Support staff time on phone with pharmacies – Rx substitutions (generic) 23.7 $344
Support staff time on phone with pharmacies – Rx refills 133.0 $1,929
Support staff time on phone with pharmacies – other issues 26.9 $390
Physician time on phone with pharmacies – formulary issues 15.7 $1,570
Physician time on phone with pharmacies – Rx substitutions (generic) 14.4 $1.442
Physician time on phone with pharmacies – Rx refills 80.8 $8,083
Physician time on phone with pharmacies – other 16.4 $1,636
Support staff time verifying patient coverage/copayment/deductibles 267.3 $3,876
Support staff time resubmitting denied claims 63.8 $925
Total cost per year $20,570
2004 MGMA – Analyzing cost of administrative complexity in group practice (www.mgma.com/gprn)
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Cost management example: Internal collectors effectiveness
Collector Jones$ in Agency $ Collected # of Accounts
Jan $590,707.45 $2,418.29 310Feb $47,072.88 $2,836.76 283Mar $83,680.98 $3,016.62 352Apr $95,254.40 $3,359.49 415May $65,019.46 $2,236.42 266Jun $72,017.49 $3,052.95 238Jul $73,765.04 $3,156.50 271Aug $83,459.86 $4,488.45 301Sept $84,144.32 $3,464.24 365Oct $108,220.41 $2,369.68 433Nov $78,737.07 $1,952.73 283Dec $84,343.22 $3,728.64 310
Total $1,466,422.58 $36,080.77 3827
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Internal controls
• Budget variance reporting
• Post-investment audit
• Bulletin board indicators
• Per cent of patient pre-registrations and verifications
• Per cent of copays collected at time of service
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Reports as management tools
• Monitor– Trends– Duty of curiosity
• Decision making
• Project impact
• Measure and monitor
• Decision making
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Metrics to Manage
Office servicesPrior Year
Totals
Prior Year Monthly Avg Sept Oct Nov
Running monthly avg
New Patient visits 372 31.0 36 27 37 33.3
Office consults 226 18.8 19 17 23 19.7
Est. patient visits 10982 915.2 991 892 987 956.7
Total encounters 12296 1024.7 1114 1006 1122 1080.7
You name the service 1235 102.9 108 92 111 103.7
Lab procedures 8241 686.8 692 670 675 679.0
Xray studies 1120 93.3 96 87 97 93.3
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Metrics to Manage
Financial DataPrior Year
Totals
Prior Year Monthly Avg Sept Oct Nov
Running monthly avg
Beginning A/R $213,983 n/a $234,026 $239,154 $230,985 $234,722
Gross charges $1,542,110 $128,509 $140,260 $131,410 $146,295 $139,322
Adjustments ($32,500) ($2,713) ($2,960) ($3,155) ($3,080) ($3,065)
Insurance write-offs ($187,344) ($15,612) ($18,420) ($20,050) ($20,100) ($19,523)
Adjusted charges $1,322,266 $110,184 $118,880 $108,205 $123,115 $116,733
Gross collections $1,324,638 $110,386 $115,672 $118,440 $118,406 $117,506
Receipt adjustments ($22,415) ($1,868) ($1,920) ($2,066) ($1,744) ($1,910)
Net collections $1,302,223 $108,518 $113,752 $116,374 $116,662 $115,596
Ending A/R $234,026 n/a $239,154 $230,985 $237,438 $235,859
Change in A/R $20,043 n/a $5,128 ($8,169) $6,453 $1,137
Net collection ratio 98.5% 98.5% 95.7% 107.5% 94.8% 99.0%
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Metrics to Manage
A/R AgingPrior Year
Totals
Percent of Total Sept Oct Nov
Running monthly avg
Mthly Avg Percent of Total
Current $91,036 38.91% $96,182 $93,355 $98,114 $95,884 40.87%
31-60 days $52,188 22.31% $51,260 $48,365 $54,104 $51,243 21.84%
61-90 days $35,104 15.00% $36,514 $35,598 $35,269 $35,794 15.26%
91-120 days $21,764 9.30% $15,358 $10,596 $10,596 $12,183 5.19%
>120 days $33,864 14.47% $39,842 $39,355 $39,355 $39,517 16.84%
Total $233,956 100.00% $239,156 $227,269 $237,438 $234,621 100.00%
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Performance areas measured
Productivity, capacity, and staffing Better Performers
Accounts receivable management Better Performers
Patient satisfaction Better Performers
All Better Performers
Others
Claim denial rates by payer
29.67% 31.82% 41.11% 32.24% 32.43%
Claims processed by billing staff
34.07% 31.82% 40.00% 33.55% 32.43%
Next available appointment time by physician
37.36% 38.64% 46.67% 37.50% 28.83%
No shows and cancellations
35.16% 47.73% 52.22% 39.47% 39.19%
Patient visits per physician
70.33% 77.27% 88.89% 72.37% 66.67%
Reimbursement to contract terms by payer
51.65% 63.64% 65.56% 55.26% 47.75%
Performance and Practices of Successful Medical Groups: 2005 Report Based on 2004 Data
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Operational and business discipline
• Critical concepts– Sound financial management to ensure profitability– Perfect operational methods
• Sample behaviors– Annual budget and business planning– Incorporate financial goals into strategic plan– Monitor against budget
• Essential metrics– Revenue/collections– Total operating expense and as percent of revenue– Staff per FTE physician– Accounts receivable aging– Denial rates– Payer mix– Revenue and expense per RVU
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Incremental change
• How do you become a better performing practice?– Where would you start?
• Focus, focus, focus– No more than 3 objectives
• Write goal and action steps– List areas for focus– Prioritize and develop rationale
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Successful groups assess strategy and evaluate implementation
• Identify specific goals and objectives– Identify methods to overcome anticipated barriers
• Identify concrete tactics and actions to achieve goals
• Commit to the physical and human resources needed to support the tactics
• Establish objective measurement criteria to monitor progress
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MGMA Cost Survey Says…• Physician comp method that rewards productivity• Good communication among physicians, administrators,
staff• Effective physician-administrator management team• Clearly defined roles and responsibilities for physicians,
administrators, staff• Budgeting and control systems to monitor performance
(group knows cost of doing business)• Decision-making delegated to executive committee, even
in smallest practices• Clinical staff, business office and physicians that focus on
customer service• Physicians and staff who place significant emphasis on
quality of care, reputation and patient satisfaction• Supervisors who are empowered to be decision-makers,
held accountable for productivity and cost-efficiency
Better Performing Practices:
That which gets measured gets managed.
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Thank You
We appreciate the opportunity of speaking with you today. If we can be of assistance to you in the future, please do not hesitate to contact the MGMA Health Care Consulting Group www.mgma.com.
Rosemarie Nelson, MS
Principal, MGMA Health Care Consulting Group
315-391-2695