Are you looking for a secure way to access your patients from anywhere as well as save time and costs? Do you need a reliable EMR platform to enhance efficiencies and keep your practice compliant? AttendingDR can help you maximize your practice revenue stream while improving patient outcomes.
Summer barbecues, boats and beaches should not distract you from the business of your taxes. Throughout the year, you take your car in to the mechanic for maintenance – so too should you chat periodically with your financial professionals to be sure you are not missing any individual or business opportunities to minimize your taxes by December 31st. The end of Summer is a perfect time for a mid-year review of your tax return which can reveal money saving ideas and leave you plenty of time to implement new financial plans.
Here are some events that can significantly impact your tax liability:
- Change in employment, ie., from private practice to clinical, educational, research or hospital based career;
- Marriage or divorce;
- Death of a spouse;
- Spouse starts to work;
- Birth of a child or adoption;
- Substantial increases or decreases in income;
- Large gains from the sale of assets, stocks or bonds;
- Buying or selling of property or rental property;
- Starting a practice, acquisition or sale of a practice;
- Purchases of medical equipment or other property;
- Buying, selling, or re-financing a domicile or vacation home;
- Receiving an inheritance;
- Substantial investment income or gains from the sale of investment assets;
- Imminent retirement or reaching age 70 ½; and
- Unplanned withdrawals from an IRA or pension plan.
On your checklist of things to consider should be:
- Are you able to take advantage of the 20% of qualified business income (QBI) deduction? Physicians can benefit from the 199A Deduction if their taxable income is below $157,500 for single filers and $315,000 for joint filers. Proper tax planning and restructuring alternatives can help your eligibility.
- What does your balance sheet look like? Is your practice’s financial plan on budget, are you managing cash flow, are you feeling the impact of income gains or projecting losses?
- Starting a 401(k) or similar retirement plan like a SEP for your practice.
- Review withholding and estimated tax payments to avoid paying too much or too little. Two-income families may be more vulnerable to being under-withheld or over-withheld.
- If your income is approaching the net investment income tax (NIIT) threshold consider strategies to defer earned income or shift some of your income-generating investments to tax-advantaged retirement accounts.
- Have you considered bunching charitable contributions?
CONTACT US: Don’t procrastinate! Life altering events and changes in both your practice and personal circumstances can impact your taxes, don’t wait until tax time 2019 to see the results. With mid-year tax planning, you may be able to mitigate the tax impact of certain events and avoid unpleasant surprises before it is too late, as well as decrease your prepayments and obtain more cash flow. Call toll free to set up a consultation with one of our tax and financial professionals: 855-534-2727.
Did you know that building a better budget can boost your practice’s performance? Your medical or dental practice’s budget is a tool that tracks your revenue and expenditures, but also helps you plan for the future. When it comes time to make decisions about adding or reducing staff, moving to new space or purchasing/leasing new equipment, your budget will be invaluable in helping identify which options will work best and when. Your budget can also provide warning signs of financial trouble or suspected fraud, and make big changes less disruptive to cash flow.
The budget for your medical or dental practice is just as important as your personal budget. A well-constructed budget acts as a guide on where to focus cost-cutting efforts and can also be used to forecast returns on larger investments. Changes in revenue will affect your expenses, and vice versa, so you can’t just look at one side of the coin. Don’t get worried just yet, to be effective a budget does not have to be overly complicated.
Start with planning the revenue side of your practice budget. Look at the number and flow of patients and what services you provide to them. Evaluate the services you currently offer, as well as those you could offer that might be more profitable, or might attract additional patients. Look at the expenses associated with those services when determining whether changes are merited. Incurring expenses to support revenue-generating activities is okay. When considering revenue, also look at dropping some unfavorable contracts if the administrative work is too great to collect your money.
Try to organize and divide expenses into categories like supporting staff compensation and benefits, occupancy expense, furniture and equipment expense, medical expenses, miscellaneous expense, mid-level provider expense and physicians’ or dentists’ expense. These broad categories make a budget easier to understand, and see if and when variances occur. For example, medical or dental supplies could be one broad category, or broken down into specific subcategories for greater detail. When considering expenses don’t forget any changes in practice contributions to profit sharing.
Be sure to compare last year’s numbers to the current financial snapshot, and then compare that to what is projected toward the end of the year. If a particular category is much higher or lower than it was previously, start asking questions. Are we overstaffed? Why are supplies costing more this year than last? It may be time to look at vendors or procedures.
At Fuoco Group we feel it best that larger practice budgets should use separate revenue lines for each physician in your practice. When you create the budget, take a look at the payors mix as well. It’s not practical to say you’ll increase revenue by 10% next year, because when your patients are 50% Medicare your revenue may be flat.
Some larger medical and dental practices break it down even further, using separate revenue lines for different types of services provided. This can help clearly identify if too much, or too little, of the budget is allocated to a certain service or area.
However you choose to organize your practice budget, review it at least monthly and adjust periodically as needed. And, make sure it makes sense for your practice. Creating a pie-in-the-sky budget you’re unable to stick to won’t add value or revenue to your practice.
CONTACT US: Pulling together a budget shouldn’t be painful, even for a smaller solo practitioner. Our healthcare CPAs and medical accounting professionals have the perfect prescription for you and your practice. Let’s have an honest conversation about your budget so we can help to minimize the surprises and maximize your cash flow – then help you keep more of the profit in your pocket. Contact us toll free at 855-534-2727.
Advance the health of your practice. Did you know that studies show that 60% – 70% of your patients who are convinced of the quality of care they receive from your practice would try more services, or even products, if you offered them?
Hiring a licensed technician with a specialty that complements your practice can allow you to expand your menu of services to existing patients and broaden your brand as well as your bottom line. Aesthetic or cosmetic services might be right ancillary offering for your practice, or maybe it is weight loss services, diagnostic allergy testing, nutrition counseling, acupuncture or massage. If chosen properly and strategically marketed, any of these can help increase your bottom line and strengthen your practice brand.
Adding new service lines is not the only way to increase the revenue of your medical or healthcare practice – look into introducing new products as well! If there is an ancillary product line that you are passionate about, consider carrying it, or better yet, private labeling it to promote YOUR brand and YOUR practice.
For a positive experience, a patient-centric approach must be followed. The most important thing when deciding what services to offer is to understand the costs involved and who your ideal patient is. Overweight patients who want to improve their health? Those who want natural remedies? Mature women might be the right fit for cosmetic services, diabetic patients might focus on counseling, etc. Costs come into play because cosmetic lasers can generate a lot of income, but are expensive. Diabetes and weight-loss counseling are less lucrative, but expenses are quite low. The same holds true for product offerings. Private labeling a product for your practice can be very lucrative, but you must be sure to tailor your product offering to a specific niche within your patient base. The options are not just limited to skin care or derma products, vitamins and supplements, or even medical equipment or healthcare tech accessories.
No matter what the category of product, is important to do your research on price when seeking out a manufacturer to partner with, but also be sure to address these points:
• Minimum order requirements
• Lead time – how long between order and delivery
• Labeling requirements and artwork – does it cost anything extra
• What product testing has been done, and when
• Is there required licensing
In summary: One of the most effective ways to increase revenue is to start offering add-on services that are outside of your standard billable insurance to your existing patients. Look at the testing, services and therapies you are referring out to others and consider bringing that in-house. In addition to offering quarterly wellness checkups, biannual lab tests, and consultative services think about ancillary product lines that would contribute to the health and wellbeing of your patients, as well as to your bottom line.
Contact Us: We think physicians, doctors, and most healthcare providers should rethink their revenue streams. Ancillary services and products provide an opportunity to boost practice revenue, provide well-being and convenience for patients while increasing their satisfaction and the visibility of your brand. We can help you develop a business plan and run the numbers, develop a fee structure, and factor in the costs and labor associated with “add-ons.” We are more than healthcare accountants and CPAs, we are business advisors. Our experts in New York or Florida can be reached toll free at 855-534-2727.
Administrative demands coupled with growing physician dissatisfaction about poor work-life balance are causing some doctors to consider moving to a “direct” primary care payment practice. Hiring extra staffers may not be the right prescription to reduce the paperwork and compliance burden for every practice, but the direct payment model may just be the medicine needed.
A direct payment model allows healthcare providers to deal with patients directly for payment, cutting out the insurance payors along with the red tape. This model, an alternative to fee-for-service insurance billing, typically charges patients a monthly, quarterly, or annual fee that covers all or most primary care services including clinical, laboratory, consultative services, along with care coordination and comprehensive care management. Patients worried about major health issues, or services that are not covered by direct payment, could acquire a high-deductible wraparound policy to cover emergencies.
Advantages to physicians are the ability to care for the whole patient, providing more personalized care. It reduces documentation requirements, prior authorization, and electronic health record and burdensome desk duties known to contribute to doctor burnout. Advantages to patients include substantial savings, and a greater degree of access to and time with their physicians.
Don’t be fooled – direct primary care and concierge care are not synonymous. In practices offering concierge care, the patient typically pays a high retainer fee in addition to insurance premiums and copays, and the practice continues to bill the patient’s insurance carrier. Direct primary care physicians often offer house calls or email access, adding to the confusion. However, the distinction is important because direct primary care is explicitly mentioned in the Affordable Care Act, while concierge medicine is not. Several state laws have also recognized direct primary care as medical practice models, and non-insurance entities, exempting direct-payment arrangements from any regulations under the state insurance code.
The American Academy of Family Physicians supports the direct-payment concept, citing the following advantages:
• Decreased practice overhead
• Fewer medical errors
• Improved practice collections rates
• More time with patients
• Zero insurance filing
Medicare is the platform through which almost 80 Million Baby Boomers will receive medical attention. It may be a life-saving solution to patients, but unfortunately is a headache for providers. How can physicians, doctors, PAs and office staff suffocating under the paperwork and billing nightmares that plague practices both small and large?
In May of 2018, America’s Physician Groups, an association of medical groups, submitted a proposal to the Centers Medicare & Medicaid Services whereby a provider network could receive Medicare funds up front to manage patient care. CMS announced recently it would develop a potential direct payment model enabling providers to contract directly with CMS and share accountability for costs and quality of care, eliminating administrative burden for clinicians and providing increased flexibility to provide the high-quality care while reducing expenditures.
It remains to be seen how CMS would set capitation rates. Would they use methods and benchmarks similar to those used to establish rates for Medicare Advantage plans? Payments must be risk adjusted and updated annually. The CMS would pre-pay this amount to provider networks each month for enrolled beneficiaries, and encourage Medicare beneficiaries to participate through differential co-payments and co-insurance.
In conclusion, if you are considering transitioning from a fee-for-service to value-based care, please keep in mind that implementing a direct-payment model will take time, and it is not without risk. Consider:
1. A business plan and implementation timeline must be put in place;
2. Create an appropriate fee structure for you and your patients;
3. Address the financial aspects and impact on cash flow;
4. Develop a marketing plan to attract patients;
5. Consider regulations and legal implications that apply;
6. Research technology or service providers to help with the conversion.
Contact Us: Want to learn more about alternative reimbursement structures? Contact your Fuoco Group healthcare consultant for insight into industry changes and how those trends may impact the finances of your practice. Dial toll free to reach our Florida or New York CPAs at: 855-534-2727.
Non-Physician Providers would seem like the perfect prescription for a busy practice to cure patient overflow and long wait times while increasing practice income, however it can take time to integrate the NPP into your practice and add to your documentation worries as well as billing and coding headaches.
Mid-Level providers like Physician Assistants and Nurse Practitioners can increase patient satisfaction and the quality of care at a lower cost, but be aware that it takes time, training, and effort to guarantee your medical practice sees an increase in productivity, cash flow and the revenue stream.
Medical Group Management Association’s (MGMA) recent survey found that physician practices with more support staff per FTE physician report a 34% to 55% increase in productivity in addition to higher revenues. NPPs are likely to take on administrative as well as quality aspects of health care delivery. They can free up doctors to see more patients, and seek efficiencies which drive increases in revenue. NPPs preform patient outreach and improve their experience. Delegating to NPPs is key for high-growth medical practices and seems like a win-win, but you need to do your homework first for a successful outcome.
The first steps in your decision to move forward with hiring a NPP should be to consider:
• Instances when services can be provided by NPP with or without Physician’s direct supervision,
• Can the NPP themselves supervise ancillary staff,
• Gauge how quickly complete integration can be achieved – by physicians, by patients,
• Can NPPs handle follow-up appointments with patients,
• Will NPPs handle quick, urgent patient requests and conditions so patients can get in for same-day treatment,
• If you will be able to build a better appointment schedule to keep your patient flow up without bottlenecks and long wait times,
• Who will address training the NPP, introducing the NPP to patients, and evaluating their performance,
• Will your office be able to handle the additional documentation necessary regarding treatment, who rendered the services, were they necessary, plan of treatment, and supervisory requirements, etc?
Also take into consideration that there is stigma often associated with non-physicians on both sides of the examining table; so providers must be upfront with patients, informing them that an advanced practice practitioner will be seeing them, and upfront with other doctors that they need to embrace the NPP as part of the team. The profile of the medical practice team of providers is changing – the point is that to better your bottom line, he NPP should be operating at the top of their skill-set as much as possible. When your schedule is packed, the more tasks they are performing at the top of their pay-level, the more revenue will be streaming in and the happier everyone will be, including your partners! Optimizing an appointment schedule is one of those tasks which is balance of art and science. An NPP 9or two) can help you keep appointment wait times down and allow same-day walk-ins.
It’s the perfect storm – Just as the population ages, there will be an increased need for medical practitioners, but the number of practicing physicians is expected to fall through the next 15 years due to retirements and slow growing medical school enrollment/graduation. Fortunately, the numbers of NPPs like nurse practitioners and physician assistants are increasing throughout the entire health care enterprise.
CONTACT US: Total expenses have risen much faster for physician-owned practices as compared to other healthcare delivery options. An NPP may be the prescription needed so physicians can stop migrating to health systems. Medicare billing policies, has evolved to address the growing involvement of NPPs and their new prominence in the healthcare industry. Please take the time to review the sister article in our newsletter addressing this exact topic written by guest contributor Jean Acevedo of Acevedo Consulting. Fuoco Group and its strategic partners are all about helping you to boost your bottom line while providing excellent medical care to your patients. Call toll free 855-534-2727 to find out more about how we can help YOU!
It’s easy to figure out what’s driving digital healthcare: physician shortages, graying population, lack of mobility in rural areas, frustration with health organization wait time and high costs, and of course, thanks to Google and Apple, the love of self-diagnosis! Patients now use their computers, tablets or smart-phones to teleconference with a doctor which is often less stressful and lower cost for treatment of chronic conditions. The fastest growing line of medical services is: one-time, on-demand visits with physicians 24-hours day, seven days a week via phone, video or email. No question healthcare is changing – physicians need to change with it. For the purposes of this article, we will be looking at telehealth and telemedicine.
The telemedicine industry has been abuzz recently upon learning that “provider-friendly” legislation was included in the new federal Bipartisan Budget Act of 2018**, signed into law February 9, 2018. The bill introduces many significant changes to Medicare law to accommodate telehealth use. Key elements of the bill include: (1) expanding stroke telemedicine coverage; (2) improving access to telehealth-enabled home dialysis oversight; (3) enabling patients to be provided with free at-home telehealth dialysis technology; (4) allowing Medicare Advantage plans to include delivery of telehealth services in a plan’s basic benefits; and (5) giving Accountable Care Organizations (ACOs) the ability to expand the use of telehealth services.
The 2018 Bipartisan Budget Act translates into increasing support for expanding Medicare telehealth reimbursement. Telehealth providers should embrace the Act and use it as an opportunity to contribute to and develop meaningful telehealth reimbursement policies. Some changes take place immediately and others in 2019. Starting January 1, 2020, the patient’s home qualifies as an eligible originating site for telehealth services provided by a physician or practitioner participating in certain ACOs!
Lobbyists are now turning their sights to getting Medicare to pay for treating opioid abusers and to allow the remote prescription of controlled substances to treat addiction, Also on the horizon, Medicare payment for remote care of patients in nursing homes. Legislation is being discussed to waive restrictions on the originating site of care if telemedicine is found to improve quality without reducing cost – or – reduce cost without impairing quality.
Although easily interchangeable, don’t confuse telehealth with telemedicine. Telehealth may or may not include clinical services. Understand that Telemedicine is not a separate medical specialty and does not change what constitutes proper medical treatment and services, it is a delivery component. For both our New York and Florida physician clients and patients, “telehealth” means the use of electronic information and communication technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient. Be aware that telehealth does not include audio-only telephone communication, fax machines, or electronic messaging (email/text) alone.
Telemedicine raises many legal and regulatory issues beyond the scope of this article. Health-care providers and regulators still face significant hurdles in adapting to new remote treatment. Some are regarding cross-state licensure, confidentiality and security, malpractice and liability, credentialing, prescribing rules, FDA as well as state regulations, electronic health records, and fraud prevention. Below is some helpful information to help you navigate within Fuoco Group practice areas in New York and Florida.
New York Definition and Details: “Telemedicine means the delivery of clinical health care services by means of real time two-way electronic audio-visual communications which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care, while such patient is at the originating site and the health care provider is at a distant site.”
New York has parity laws in place that allow coverage of telemedicine under private insurance and Medicaid. All specialties are covered by both Medicaid and private insurance. Eligible healthcare providers include: physician specialists, psychiatrists, psychologists, dentists, nurse practitioners, genetic counselors, licensed clinical social workers, and certified diabetes/asthma educators. Under the current Reimbursement Policy, Medicaid and private providers both provide live video. Private care plans may cover telemedicine at their own option and establish payment guidelines. Reimbursement Rate covers live video. Cross-state telemedicine licensing is allowed, however New York extends licensure reciprocity only to bordering tri-states New Jersey, Pennsylvania, and Connecticut.
Florida Definition and Details: “Telemedicine” means the practice of medicine by a licensed Florida physician or physician assistant where patient care, treatment, or services are provided through the use of medical information exchanged from one site to another via electronic communications. Telemedicine shall not include the provision of health care services through an audio only telephone, email messages, text messages, facsimile transmission, U.S. Mail or other parcel service, or any combination thereof.”
The standard of care shall remain the same regardless of whether a Florida licensed physician or physician assistant provides health care services in person or by telemedicine. Controlled substances shall not be prescribed through the use of telemedicine except for the treatment of psychiatric disorders. Prescribing medications based solely on an electronic medical questionnaire constitutes the failure to practice medicine with that level of care, skill, and treatment which is acceptable. Physicians and physician assistants shall not provide treatment recommendations, including issuing a prescription, via electronic or other means, unless certain elements have been met, including a documented patient evaluation, patient is inflormed regarding treatment options and the risks and benefits of treatment. Telemedicine does not alter any obligation regarding patient confidentiality or recordkeeping. Separate rulings have been issued regarding emergency medical services.
On a more financial note, implementation of private payer parity laws for telehealth has been spotty across the states. There is one in New York, but not Florida. A bill in Florida that would have created tax credit for health insurers and health maintenance organizations that cover telehealth services also failed. There are different tax implications for taxable vs tax-exempt providers regarding unrelated business income and definitions of what is a “patient.” Documentation of telehealth and telemedicine encounters are extremely important and must follow individual state rules regarding what is a recognized “originating site” and who approved practitioners are that may furnish and receive payment for telehealth services. Of course billing and coding for telehealth is a tangled web, but thankfully the GT modifier on professional claims for telehealth was just eliminated by the CMS (Centers for Medicare & Medicaid Services) on January 1, 2018. There are special rules for billing and payment for originating site facility fees, and as part of their expansion in telehealth reimbursement for 2018, the CMS is finalizing codes and payments for remote monitoring in both non-facility and facility settings.
Things are still a bit more complicated if telemedicine is being practiced by a Florida physician to a patient outside the state because that creates an interstate practice. Another challenge is that the treating physician needs to be licensed both in Florida and the state in which the patient is receiving care. New York rules are a bit more relaxed for the tri-state area as noted earlier.
The American Telemedicine Association and other organizations have started accreditation programs to identify top-quality telemedicine sites; the association also tells consumers to be wary of sites that sell products.
The American Medical Association approved new ethical guidelines for telemedicine, calling for participating doctors to recognize the limitations of such services and ensure that they have sufficient information to make clinical recommendations. 2018 legislative priorities include: modernizing state medical practice acts to lay the groundwork for adoption of telemedicine; promoting model legislation to ensure physicians are paid for the care they provide via telemedicine; and (very important) facilitating license portability through support of the Interstate Medical Licensure Compact.
In conclusion: This has just been a glimpse of the future – According to the Tampa Bay Times, BayCare Health System and Publix Super Markets are pairing up in telemedicine. Their product: convenience, as in going to the doctor while you shop for groceries! What started as an experiment will be expanding. There will be many opportunities within the changing landscape of digital healthcare no matter what you area of medical practice might be. Digital health apps, telehealth or telemedicine will NEVER replace the relationship with a primary care physician. Your professional accountants and advisors at Fuoco Group / TFG don’t want our physicians to be left behind or miss any financial opportunities while you do what you love: practice medicine, and make life better for your patients.
Have questions? Want to speak to your Fuoco Group advisor – contact us today! We are here to help you.
Gone are the good old days of the revenue cycle healthcare providers remember. They have been replaced by today’s reimbursement challenges and the problem of collecting final payments from patients after insurance has been billed. The new reality is that the final patient balance may take months to collect, unless the physician provider is pro-active, and that can wreak havoc on your revenue cycle.
Statistics on patient collections are compelling:
• Collect “pre”-service = 80% to 90% capture
• Collect “point-of-service” = 50% to 70% capture
• Collect “post”-service = 40% capture
The cost of collections on patient receivables can be expensive, so here is what the professionals at Fuoco Group recommend as best practices to help physicians maximize collections:
• Financial policies and collection procedures should be clear and well documented.
• Staff must be trained regularly regarding prior authorizations and patient collections pre-, post-, and point-of-service.
• Communicate expectations for payment to patients up front, either on registration forms, or practice website, etc.
• Emphasize the importance of benefits verification and eligibility to staff.
• Estimate costs and patient financial obligations at the first point of contact if possible, or as soon as possible.
• Directly engage patients early in the process after deductibles and co-pays have been identified, be sure they are aware of their obligation for payment.
• Be sure the “front desk” has a handle on the approach needed, and is incentivize to collect or follow up on balances.
Fortunately this is the new millennium and technology is available that can enhance collections. Enabling electronic transactions will lower operating costs and increase collections. Of course telephone calls help, but be sure to implement the following to increase your chances of payment:
• Send timely statements and balance reminders by email as well as text, in addition to “snail-mail.”
• Use secure click to pay links in those email and text reminders.
• Accept multiple forms of payment, but also allow more than one way to securely pay: web portal, mobile phone “app,” credit card on file, debit cards, payment plans, even Care Credit!
• If you have a high volume practice, an investment in medical collections software might make sense to help you mange both your patient and insurance collections process and follow up on accounts receivables quickly.
We’ve shared just one prescription that is part of our total care Rx for your financial health. Medicine is changing and so are your financial goals. Be a part of our New Financial Dialogue and see how our 360 degree approach can cut your risk, help you master the management of your practice, and bring you financial peace of mind for the future. Got questions? We have answers! Contact your New York or Florida Fuoco Group healthcare advisor at 855-534-2727.
No matter what type of healthcare business or medical practice you have, you will be able to benefit from most of these revenue enhancers and cost cutting ideas.
Strategize Patient Collections
There is an increasing number of patients on high deductible insurance plans. One quarter of most medical practice revenue comes from patient co-pays, but only 60% of what’s due gets collected. Studies show when patients are informed of their responsibilities and asked to pay at the time of service, collection rates rise substantially. Make changes to your billing practices if you are invoicing small amounts by snail mail. Consider a payment portal on your website, and read our prior article on maximizing collections here: Physician Secrets For Maximizing Patient Collections
Most of you already have a practice website, but if you don’t have a social media presence, you’re falling behind your competition. 72% of patients now check out the internet for healthcare information and 62% are using online reviews to find new doctors, including facebook. An online presence is crucial to new patients finding you and your practice. Don’t forget to create or claim your profile on the major review sites like Vitals or Healthgrades. This will help your practice pop up in search results.
Virtual Visits Have Value
Every medical or healthcare office experiences those seasonal scheduling nightmares! To replace lost revenue, consider telehealth which may or may not include clinical services. It covers the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient and is reimbursable. Patients frozen out of the waiting room can now be accommodated, as well as the homebound who cannot get in to see you. Replace those after-hours urgent patient phone calls with reimbursable skype virtual visits! Read our prior article on increasing revenue with digital healthcare here: Telemedicine – What’s Driving Digital Healthcare?
Use Your Mid-Level Providers
Even small practices generally have a physician assistant or nurse practitioner on staff. Let them use and build their skill-set as much as possible – it is a great motivator. Having them handle quick patient requests and less complex conditions can get more patients in the door when your schedule is full. The more they’re doing at their pay grade – the more revenue you’ll be bringing in at less cost. Don’t have a PA or NP? You may want to consider hiring one after reading this article: What To Consider If You Are Considering Mid-Level Non-Physician Providers
Cut Down on No-Shows and Missed Appointments
No-shows and last minute cancellations can cost your practice thousands of dollars. Invest in an app that sends reminders out to cell phones about appointments. Installing a plug-in for your website with a patient scheduler may be helpful. Add a cancellation policy and charge a fee to let patients know you will not tolerate less than 24 hour notice.
Annually Renegotiate Your Payor Contracts
Every year you should renegotiate your payor contracts to increase fee schedules. Track the data that shows your practice is getting great care outcomes in a cost-effective way, and you have the leverage to tell payors you deserve a raise. Hiring a qualified healthcare business advisor to assist with this initiative is well worth the cost.
Consider a Direct Payment Model
A direct payment model allows healthcare providers to deal with patients directly for payment, cutting out the insurance payors along with the red tape. This model, an alternative to fee-for-service insurance billing, typically charges patients a monthly, quarterly, or annual fee that covers all or most primary care services including clinical, laboratory, consultative services, along with care coordination and comprehensive care management. Advantages to physicians are the reduction of documentation requirements, prior authorization, electronic health records and burdensome desk duties known to contribute to doctor burnout. Advantages to patients include substantial savings, and a greater degree of access to and time with their physicians. This is not the same as “concierge care!” Find out more here: Direct Primary Care Payment Model Has Distinct Advantages
Work environment has a big impact on a provider’s empathy, focus, stress levels and overall performance. Keeping up with technology changes is important to your success. For healthcare, advances like electronic health records, cloud hosting and security software are critical pieces of the ability to care for patients. Does your system need a tune up? A change of carrier? Is your staff is always complaining about slow systems, hardware that’s down, and frequent stoppage and interruptions to workflow? It may be time to outsource your IT and tech support for more efficiency, especially if your staff is always waiting for it to work. After all – “time is money!”
Examine Expenses Quarterly
Taking a regular look at your financial statements will allow you to spot overhead items that appear to be out of line or a drag on the bottom line. Look at what you are paying for copiers, postage machines, paper and office supplies. Don’t be afraid to shop around when your lease is up or move to sharing a single networked printer for everyone at your office rather than maintaining — and buying ink — for multiple printers. Ask vendors for discounts on shredding services, cleaning services, disposal services, and even basic medical supplies like gowns, gloves, etc. Look at kitchen items like water and coffee and snacks for staff, often there are savings to be had buying in bulk or from warehouse clubs. Very often the local Chamber of Commerce or Medical Society offers discounts for members on things like insurance, supplies, business services, etc.
Search for someone to share or lease that extra office space, it will generate income but could also initiate a synergistic relationship that yields new clients. Think of an esthetician if you are a dermatologist or plastic surgeon, massage if you are a chiropractor. Adding services may make a lot of sense if you have a loyal patient base. Depending on your practice, you could offer weight management and nutrition counseling for example. If you have the space and staff, consider adding a complementary line of facial products, nutritional supplements, medical tech accessories, etc. We have some more great ideas here: If You are Looking for More Profitability Look into Adding Product Lines
Join the Local Medical Society
Not only will you get discounts on insurance and office supplies, but you get FREE advertising in the form of a directory with public access, and a chance to network at events with peers who might refer you a patient. Just like folks check out the local Bar Association when looking for a lawyer, many tend to go to the local Medical Society to find a doctor practicing locally in a certain specialty.
Know the Numbers
Do you have an idea of what your revenue per patient is? What your revenue per employee is? Do you have a monthly, quarterly, or annual budget? Might be time to call in a healthcare accountant who is also a business and financial advisor. Did you know that building a better budget can boost your practice’s performance? Your practice’s budget is a tool that tracks your revenue and expenditures, but also helps you plan for the future. When it comes time to make decisions about adding or reducing staff, moving to new space or purchasing/leasing new equipment, your budget will be invaluable in helping identify which options will work best and when. Your budget can also provide warning signs of financial trouble or suspected fraud, and make big changes less disruptive to cash flow. See why else it is important here: Budgeting For The Health Of Your Medical Practice
Spending money on energy efficient office and medical equipment and using “green” technology often comes with a rebate as well as lower electric bills. Motion-sensor interior light switches are not expensive, yet save plenty $$$. Having staff turn computers to energy saving settings at night save lots $$$ over time.
Hire an Intern
Need an extra set of hands? Hire a college student or senior-soon-to-be-grad who wants to discover the healthcare industry, examine a practice niche up close before picking a major, or learn the ropes of running a practice. They can start with basic administrative tasks that are overwhelming your staff. Lower your labor costs and make your staff smile, while you inspire and mentor a future healthcare practitioner!
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Those physicians with a large percentage of Medicare patients need to find ways to increase revenue and quality scores while improving the health of their patients. All too often with the Medicare patient, prevention takes a back seat to chronic illness and acute conditions. But an Annual Wellness Visit (AWV) creates an opportunity to make preventative care a priority for the patient while providing revenue for the doctor. It is also an opportunity to introduce Chronic Care Management Services for those who would benefit, which are now reimbursable under CPT Code 99490!
There is a recent study from the American Medical Group Association which shows that less than 20% of eligible Medicare patients received an AWV. It also notes that practices within an ACO are more likely to offer AWVs because they “…benefit financially from assessing health risks and filling care gaps.” Make no mistake, an AWV program requires time and money, but the physician group that is able to enlist eligible patients in an effective manner would most likely see a substantial return on investment. Why are AWVs not the status quo?
Some confusion often exists on the part of both patients and providers as to what exactly a “wellness visit” should entail. The scope of services to be provided should be well defined. Patient education about the process is also paramount. If issues arise from chronic illness or multiple conditions, or medication refills are needed, patients would schedule a future visit. This would be a good time to educate and enlist eligible Medicare patients in Chronic Care Management Services.
Operational challenges include: applying the appropriate process, proper coding, sufficient staffing, exam room availability, and the software/technology necessary for calendaring, notifications, scheduling, and email reminders. Protocols for data capture and retrieval must also be taken into account. An advantage is that turnkey solutions are available for administration of Chronic Care Management Services, which satisfy all CMS requirements for reimbursement.
Keep in mind, a well administered AWV program can generate follow-up visits for preventive services that patients might not otherwise inquire about. In addition, the screening tests and other preventive services arising from wellness visits can help raise quality scores.
Also on the positive side, as a preventative care visit the AWV does not always have to entail a physical exam by the provider, rather a highly structured screening and series of specific pre-determined questions can be administered by an RN or PA.
A best practice is to use EHR-interoperable software that is specifically designed to process the AWV smoothly and ensure compliance with all of the CMS requirements, including the automatic creation of an eligibility-based personal prevention plan.
Preventative care improves quality of life at a very reasonable price and AWVs can be used to even out income fluctuations during slow periods throughout the year. Some physicians find it financially beneficial to schedule the bulk of patient wellness visits in the slower Summer months because Winter flu season creates more sick visits. The added bonus is that the AWV is a perfect time to introduce CCMS and sign up eligible, interested patients.
Contact Us: There are many revenue drivers within the changing landscape of healthcare that TFG Health can help you identify. Make no mistake about it, wellness visits and Chronic Care Management Services drive dollars to doctors but also help patients to be healthier. Whatever your area of medical expertise might be, your professional accountants and healthcare advisors at TFG Health don’t want our doctors to miss any financial opportunities while they do what they love: practice medicine, and make life better for patients. Call Brian Gaynor at 904-655-4749, or Lou Fuoco at 561-209-1101, to see how your bottom line can get healthy!