So You Became A Partner In A Medical Practice – Now What?

Becoming a partner in a physician practice or dental group is a dream come true and comes as the result of goals setting, sacrifice and an investment of time and self. It can also be a cauldron of financial complexity.

Be prepared. Although partnership can give you a voice in how the medical group is run, job security, and additional income, it comes with complications. Partners assume the risk in the practice, but those who are entrepreneurial and productive can realize success, even in a smaller partnership. There is no silver bullet or one size fits all approach, but here are the major landmines to be mindful of:

1.    The Buy In: Some groups have you buy in with dollars, other have you buy in with time served. The difference between what you earn and what you’re paid goes toward your equity share in the group. That might include part of a building, some medical equipment, goodwill, and a share of the accounts receivable. Negotiate your partnership contract. Have built in compensation increases for reaching revenue goals or cost-saving benchmarks, as well as increases to keep pace with inflation, etc.

2.    The Additional Expenses: A step up the ladder comes at a price – now you will be responsible for the personal expenses that the practice paid on your behalf prior to partnership including health insurance, malpractice insurance, Social Security and Medicare taxes. Set up an HSA to pay medical bills and contribute to it as a retirement vehicle, it is triple tax free. You won’t have withholding, so consider making quarterly estimated tax payments. You may get paid on a K-1.

3.    Shared Business Costs: Be aware that as a partner, you will now share in costs of running the practice whether administrative, operational, or related to insurance, taxes and financial fees, etc. Some of the practice expenses will be variable and some fixed, some will fluctuate based on how many patients you see and how much revenue is generated. This also means your income will variable.

4.    Financial Complexity: The more you make, the more you pay in taxes. Tax minimization strategies still exist and there are business structuring options available – tax reform legislation now provides a deduction of up to 20% for pass-through entities on qualified business income.

5.    Retirement options: Often there are additional retirement savings options and investment plans available to partners, now is the time to consider contributing up to the annual limit. Whether early retirement is on your mind or not, you need to plan now to exit the practice later. Estate planning alone will not protect your family, but Business Exit Planning will protect your financial future.

Contact Us: Making partner is a significant life event! It is a great time to review your financial situation. Make a budget, look at your insurance, plan your investments, and put together an asset protection plan as well as an estate plan. As mentioned in the article It is also a good time to have a review of business structure and tax situation with your Fuoco Group CPA. Congratulations! Becoming a partner can bring financial complexity, but your TFG professionals are here to help you reap the rewards.


Physician Wellness – The TFG Fast Five To Thrive

Dealing with physician burnout – why is it so prevalent for so many practitioners in medicine in this new millennium?

Being a physician is a demanding job with serious responsibilities. Add to that the fact that patients are often chronically ill, sometimes treatment doesn’t work, and occasionally patients die — that is a heavy burden to bear in addition to a daily workload, rounds, running your practice. But what exactly is burnout, how prevalent is it, and why should the medical community be concerned?

Studies define burnout as “a syndrome consisting of emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, which is primarily driven by workplace stressors.” Recent research shows nearly half of practicing physicians in the U.S. experience burnout at some point, with those at the front line of care reporting the highest rates.

Leading drivers of burnout include excessive workload, imbalance between job demands and skills, a lack of job control, and prolonged work stress. Not all of the reasons for burnout are work-related. A physician may have significant issues regarding his or her own health or their personal life. Generally, the three symptoms of physician burnout are exhaustion, cynicism and doubt. Exhaustion isn’t just physical, but can be mental, emotional, even spiritual. Cynicism, or depersonalization, is sometimes dubbed “compassion fatigue.” And doubt, of course, is wondering why you bother.

Burnout in physicians has been linked with lower work satisfaction, disrupted personal relationships, substance misuse, depression, and suicide.  Burnout can result in an increase in medical errors, reduced quality of patient care, and lower patient satisfaction. Burnout is responsible for reduced productivity, high job turnover, and early retirement.

Kevin MD reports that more than 51% of physicians attribute burnout to excessive administrative burdens and bureaucratic duties, among other things like long hours, a constantly shifting health care system, and dealing with a built-in level of failure.

A recent article in Medical Economics suggests that simple tweaks in day-to-day tasks, workflow shortcuts, and running your practice more efficiently can ease stress and create a more positive experience for both physicians and patients. There’s a bit more to it than that.

First, as a physician you have to admit that you have normal human needs, will occasionally display vulnerability, are not a machine, and have the right to say “NO” when workload becomes impossible. There should be no shame or stigma about needing help, never wait till you are overwhelmed, exhausted, and stressed, before reaching out for assistance. Don’t blame yourself or let cultural norms, chaotic office conditions and a broken hospital system lead to your burnout!

Second, remember depression and burnout aren’t necessarily the same thing — but they often overlap. Take steps to avoid burnout and, if you feel yourself slipping over into depression, get help.

Third, the solution entails more than getting some sleep, meditating, exercising regularly, learning to say no, and better time management skills. The ultimate answer might be fixing the broken health care system. Studies show that burnout is a problem of the whole health care organization, rather than individuals. It requires structural changes and an organizational approach like changes in schedule and reductions in the intensity of workload, improved teamwork and leadership, communication skills training, changes in work evaluation, enhanced job control, and increasing the physician level of participation in decision making.

With all of that in mind, here are Fuoco’s five to thrive, self-healing strategies to stave off burnout:

1.    Sometimes you just have to say “no.” It’s impossible to say yes to everything. Before answering, always ask yourself: Will it lead to more balance in my life or create unwanted imbalance? Will it take away from time with my family and friends? Will it enhance my career? What aspect of being a physician do you enjoy the most and feel you’re best at? Try to focus on that and say yes to more of what you enjoy doing.

2.    Accept that you have limitations just like everyone else. Physicians can’t always help or save every patient. It’s impossible to predict or anticipate every possible medical outcome. Sometimes you won’t get to finish every item on your to-do list because you are juggling so many balls (or patients) at once. Develop coping techniques that work for you so you can accept it, and move on.

3.    Develop a strong support system. Whether it’s a spouse, friend, colleague, or trusted business advisor, everybody needs someone who will listen. Work on building a team, and better communication and collaboration whether at the office, or in the hospital (even at home).

4.    Slow it down. The business plan might call for spending 15 minutes with a patient and moving on, but don’t stress about being so efficient. Slowing down, and taking a few extra minutes out of your schedule when needed to listen, will benefit not only the patient, but you too.

5.    Learn to be flexible. Adapting to change is tough and it seems the practice of medicine is changing dramatically every day. Balance is hard to achieve, and stress as well as busy schedules are part of any career. Maybe “survival of the fittest” means most able to adapt to change. Being open and receptive to new ideas and ways of doing things is a positive way to work and live.

Some helpful resources for our physician clients in New York and Florida include:

American Association Physician Wellness Program: https://www.ama-assn.org/physician-wellness-program

Florida Medical Association Resources: https://www.flmedical.org/florida/Florida_Public/Resources/Physician_Wellness/Physician_Wellness.aspx

Florida Resources for Physician Wellness from the Palm Beach County Medical Society: https://pbcms.memberclicks.net/physician-wellness-program

New York Resources from the Medical Society of the State of New York Committee for Physician Health:

As you work for the health of your patients, the professionals at Fuoco Group work for our physicians’ financial health. If you are worrying about cash flow, internal controls, staff and equipment issues, perhaps the prescription is customized accounting and financial services from a CPA firm well versed in physician medical practices. Our “New Financial Dialogue” includes a 360 degree business advisory program designed to take the burden off you and your physician partners because worrying about costs, reimbursement, margins, operations and finances shouldn’t be keeping you awake at night!

Contact us today – offices in New York, Long Island, and South Florida.


Is It Time For Your Medical Practice To Have A Check-Up?

Here’s our Rx to protect and enhance your bottom line so you can spend more time practicing medicine and taking care of patients:

1)    Hire Better – This will save you money in the long run as having to replace staff is expensive in many ways and bad employees can cost you patients. You wear a lot of hats in your practice, but remember that patients spend a great deal of time in front of your employees so make sure they are technically skilled, but also compassionate and personable. The more your staff can do, the less time you have to devote to tedious tasks, and you might just help your stress level as well as your financial statement.

2)    Don’t Be Afraid of Change – When your practice stagnates so does your bottom line. Embrace technology that streamlines daily tasks, billing, processes, patient intake and records, etc. In the end it saves time, and makes compliance and collections easier. On another note, be aware of tech trends that are changing the status quo such as telehealth and telemedicine – there may be financial opportunities there as well as a way to better serve patients!

3)    Look Beyond Reimbursement – What insurers and other payors, including the government, are willing to reimburse is not controlled by physicians, and we have already seen how $$$ for quality vs procedure has shifted the financial landscape. Focus instead on internal costs which you can control. Focus instead on proper coding and compliance to avoid penalties.

4)    Better Billing – Train staff to increase time for revenue producing activities, code and bill accordingly, and reward staff for opportunities seized to streamline activities and avoid waste/duplication.

5)    Toot Your Own Horn – You can easily grow your practice by figuring out what is special about your brand or medical niche and then marketing that. If you are not ready for a facebook page, at the very least make sure all your online profiles are accurate, and your website is visible and accessible. Join a local medical society or professional organization and network with other doctors or large employers in your area who can refer patients to you.

6)    Avoid Burnout – You are the practice leader as well as the healer. You can’t do either well when you are seriously fatigued. Remember exhaustion is mental, physical and emotional. Know your limits, when to slow down and when to ask for help. Communicate, build a team, re-evaluate scheduling and workload, delegate where possible, and accept your limitations.

CONTACT US: Perhaps it’s time to consider an accounting ally in the healthcare industry with single or multiple physician practice expertise whether internist, specialist, surgeon, chiropractor, podiatrist, dentist, etc. In addition to tax and accounting services, our new financial dialogue includes a 360 degree business advisory program. All designed to take the burden off you and your physician partners because worrying about costs, reimbursement, margins, operations and finances shouldn’t be keeping you awake at night!


Physicians Have Their Part To Play In Preventing Healthcare Fraud

Doctors face a variety of legal risks every day: malpractice, fraud, waste and abuse. These actually surpass the risk of malpractice and tax liability. But physicians participating in federal health care programs can and must minimize those risks, because failure to do so exposes them to severe criminal, civil and administrative penalties, as well as tarnishes their reputation and impact reimbursement. Here are some simple steps that can help you take control:

1)    Review the red flags for fraud:

•    Billing for services not rendered.
•    Billing for a non-covered service as a covered service.
•    Misrepresenting dates of service.
•    Misrepresenting locations of service.
•    Misrepresenting provider of service.
•    Waiving of deductibles and/or co-payments.
•    Incorrect reporting of diagnoses or procedures (includes unbundling).
•    Over-utilization of services.
•    Corruption (kickbacks and bribery).
•    False or unnecessary issuance of prescription drugs.

Disputes often occur due to concerns about the adequacy of a provider’s documentation or the level of supervision over a service. Generally the provider is a repeat offender! Unfortunately it is assumed that physicians and their staff know all the statutes, regulations, and CPT codes, memorize the manuals, national and local coverage determinations, bulletins and fee schedules applicable to their claims. When participating in federal health care programs and government money is at stake, ignorance is not a defense. So what else can you do?

 2)    Create a culture of compliance. Be committed to compliance with education and training, random auditing, and detailed documentation. Let violators in the office know they will be held accountable and let “whistle-blowers” know there won’t be retaliation. Getting compliance right is a competitive advantage for your bottom line.

3)    Pay attention to the OIG guidance. The U.S. Department of Health & Human Services, Office of Inspector General, publishes voluntary compliance guidance documents for physician group practices, find it here: http://oig.hhs.gov/compliance/compliance-guidance/index.asp

4)    Attend to problems quickly.  Compliance problems not detected or those ignored for a lengthy period of time will attract government attention and lead to large penalties.

5)    Budget for compliance. Providers should ensure that adequate resources and time are devoted to compliance activities. Legal or consulting advice may be beneficial in developing a compliance plan and procedures, doing an audit or investigating non-compliance issues.

6)    Use benchmarking. Do not be in denial, big data is being mined by interested parties to find offenders. Be proactive and compare your billing data to similar providers in your area to be sure you are not under- or over-charging or incorrectly coding and providing the proper level of care. Abuse involves substandard, negligent or medically unnecessary practices that increase the cost of health care. Abusive practices often indicate fraud.

Keep in mind that health care fraud and abuse control programs are designed to prevent, identify and prosecute unlawful billings by health care providers and insurers. Health care fraud is a misrepresentation or failure to disclose pertinent information. A false claim involves an intentional false representation that causes the government to pay more than is allowable and might land you with more than a slap on the wrist!

Contact our healthcare team for assistance with this or any other accounting and operational needs. We have a depth and breadth of experience in the healthcare industry whether servicing hospitals, physicians, MSOs, dentists and DSOs, concierge medicine providers, chiropractors and podiatrists, etc. Whether in New York or Florida, call toll free 855-534-2727.


Revenue Cycle Management

Staying on budget and managing cash flow can be difficult when juggling expenses, collections and reimbursements. A lack an understanding of revenue cycle management can cause internal billing and coding errors, a failure to prioritize patient collections, not properly educating patients about payment policies or not verifying insurance for every patient.

Revenue cycle management is a complex interaction of services, billing codes, benefit analysis, and successful invoicing. Now that high-deductible health plans are more common, reimbursement patterns started shifting and doctors must develop good ways of interacting with patients to encourage payment of their bills. TFG Health Professionals can help you put a financial policy in place. We can design an audit process to help you track delinquent accounts prior to patient visit, and have our accountants analyze financial reports at month end to identify problems. Help and a more profitable practice is just a phone call away.

Is it time for your healthcare practice to have a check-up?

We have solutions to help you protect and enhance your bottom line so you can spend more time practicing medicine and taking care of patients.

Look to TFG Health for advice on: new payment models and care paradigms, revenue builders, cutting expenses, insurance planning, buy/sell agreements, new hiring physicians and mid-level providers properly, maximizing patient collections, preventing fraud in your practice, adding new products and services like telemedicine to increase profitability, Stark Law updates, and more.


Mid Year Tax And Financial Checklist for Medical Practitioners

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.


Budgeting For The Health Of Your Medical Practice

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.


If You are Looking for More Profitability Look into Adding Product Lines

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.


Direct Primary Care Payment Model Has Distinct Advantages

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.


What To Consider If You Are Considering Mid-Level Non-Physician Providers

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. 

: 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!