Earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued a price transparency mandate to hospitals across the nation. This new regulation requires that hospitals make their charge masters publicly available. In theory, this information will allow patients to gain a better understanding of their costs – before care is consumed. It remains to be seen if the reality will match the intention.  

Price transparency has been in the healthcare headlines for years; however, one of the biggest hurdles to real transparency is the variance of managed care contracts – especially for independent medical practices.  Independent medical practices are at a disadvantage when it comes to negotiating with payers; they do not have the same leverage of practices associated with hospitals, health systems, or other large networks. And, payers have used this to their advantage.  

Before entering into payer negotiations, you must arm yourself with knowledge.  

Analyze your Current Contracts 

At least annually, you should analyze all of your managed care contracts. Create a checklist that includes the following points and then answer the questions as they apply to each of your contracts. 

  • Contract length  
  • Days to submit claims 
  • Days to pay claims 
  • Percentage of claims denied 
  • Reimbursement rates for specific services 

Find Areas of Opportunity 

After completing your analysis and getting an “apples-to-apples” comparison of each contract, look for areas that can be improved. Boosting reimbursement rates, while important, is not the only item to consider. For example, look at how long it takes a payer to reimburse your practice – it should be 30 days or less. Also, if a payer has an unreasonably high percentage of denied claims, find out why and what you can do to ensure claims are approved on the first submission.    

Understand the Market 

Know who the biggest players are in your market – both from a payer and a provider perspective. The larger the market share a payer has, the more power they have to squeeze rates and narrow networks. In terms of other providers, try to find out which payers they contract with, their volume, and their level of care quality. This information can help you better position your practice during contract negotiations and know which payers will be more likely to give you the most favorable terms.  

Unfortunately, there is no magic formula to ensure your practice is getting the best reimbursement rates possible. Regularly reviewing your contracts and analyzing the market conditions will allow you to have a better understanding of your position with each payer. This is the key to making sure you get the most favorable reimbursement rates and contract terms.   

Contact us to learn more about how Practice Partners can help you analyze your managed care contracts to improve your practice’s bottom line.  

 

 

Recently, MedPage Today published its 2018 Salary Survey. The report analyzed the salary information submitted by 7,753 healthcare providers. According to the survey results, on average, physicians made $8,039 less in 2018 than they did in the 2017.

To add insult to injury, many physicians are also reporting that their workload is increasing due to a variety of factors such as regulatory compliance requirements that bury them under a mountain of paperwork. In fact, in the same survey, recordkeeping and burnout were listed as the worst aspects of their jobs by more than half of the respondents.

Despite the push for value-based payments, most physicians’ salaries are tied to a fee-for-service model. Therefore, many physicians believe that the only way to increase their earnings is by increasing patient volume. While boosting volume is one way to grow revenue, there is a drawback to this method: the finite number of hours in a day.

Physician compensation is tied to the medical practice’s profitability – the more profitable the practice, the higher the physician’s compensation can be. Typically, there are ample opportunities to improve overall profitability within a medical practice. Patient volume is just one area to consider.

In fact, while working with medical practices across the country, Practice Partners identified 5 areas that, when optimized, can significantly improve a practice’s bottom line:

  • Reimbursement
  • Billing/Collections
  • A/R
  • Expenses
  • Access

Over the next few months, we’ll discuss each of these topics in a series of blogs titled, The 5 Levers of Practice Profitability. The goal of this series is to help independent physicians discover how they can enhance the business side of their practices to achieve their financial goals.

Contact us to learn more about how Practice Partners can help you ensure your medical practice is positioned for long-term success amidst an everchanging healthcare industry.

Organizations around the globe have been using Business Intelligence technology, data and support systems to guide their operational strategies and improve business efficiencies for years. With business intelligence, organizations can access historic, current and predictive data to enhance workflows, improve policies and procedures, and optimize finances.  

Business intelligence systems create data-based tools and analytics to facilitate informed operational decision making, while tracking progress against short- and long-term goals to effectively manage and anticipate change. Through interactive software programs and systems, an organization’s leaders can access this data through program-specific analyses, visualizations and statistics. Programs help decision-makers decide what metrics are most relevant to their business goals and objectives, and what information will be most helpful in informing broader operational approaches and strategies.   

While the healthcare industry has been slow to adopt these strategies and technologies, more and more medical practices are adapting existing business intelligence and data analytics tools to optimize their practice’s finances and operations. Appropriately leveraging relevant business intelligence allows practices to operationally manage at a peak performance level to increase operating margins and income.  

An effective approach to harnessing the power of business intelligence ensures crucial business metrics are tied to existing operational processes. Connecting the two and leveraging that relationship can help medical practices establish Key Performance Indicators (KPIs) around profit levers including: 

  • Access 
  • Revenue 
  • Billing 
  • Accounts Receivable 
  • Overhead 

Implementing easy-to-access dashboards and scorecards removes the ambiguity from planning and status reporting. With high-level, at-a-glance KPIs and status updates available to the broader operational team, administrators can quickly and effectively understand where they stand in relation to broader short- and long-term goals, and adjust their strategies accordingly. Leveraging business intelligence on a broader scale allows for the creation of action plans to address poor performance without losing time trying to establish where inefficiencies exist. The inefficiencies are identified and can be quickly mitigated thanks to the relevant data provided through the business intelligence systems. 

Practice managers and administrators who implement business intelligence systems and strategies will have the data readily available to develop and execute on actionable metrics and goals, while also accessing the flexibility needed to ensure those metrics and goals remain relevant. Managers and administrators can easily measure changes within their goals, and plan accordingly based on projected financial, operational and growth needs. Through reliable forecasting and predictions, operational teams can act proactively rather than reactively, empowering them to make the informed decisions needed to achieve their desired outcomes.

With healthcare increasingly becoming a consumer-driven market, many patients are more acutely aware of the process and costs behind their healthcare. High deductible health plans have added a new layer to the patient / physician relationship, and physicians now have the opportunity to meet – and help define – the emerging patient-as-a-customer standards.  

High Deductible Plans 

High deductible health plans are popular among both consumers and companies who offer employee health care benefits. While healthcare consumers do have significantly higher deductibles under these plans, and therefore, are responsible for more out-of-pocket medical costs, they pay a smaller monthly premium. Many people choose to set aside the money saved on premiums away for health-related expenses in tax-free health savings accounts (HSA). Consumers get more control over the health care decisions, and insurance companies foot less of the bills.  

Now, as more patients make the decision to utilize high deductible health plans, many physicians are finding that patients ask more questions about their health care and the additional costs that may arise. Additionally, because patients are spending more from their own pockets, their expectations are higher. 

Transparency and Patient Experience 

Physicians are responding to healthcare shifting to a consumer-driven market by not only providing price transparency, but also care transparency. Today’s healthcare consumers expect frictionless transactions in their physician’s office. Additionally, patients have elevated expectations around service standards and the quality of their healthcare. This shift means physicians must manage each patient’s expectations around appropriate care and outcomes. By educating patients in the beginning about realistic outcomes and appropriate care plans, physicians can mitigate the risk of a patient having an unpleasant experience in the medical office.  

Further, since many patients are taking on more financial responsibility for their medical care, physicians now have the opportunity to explain the necessary care in terms of dollars and cents. These conversations can help deter patients from demanding tests that are either not required at the time or are completely unnecessary. This allows the physician and patient to work together to determine an optimal, cost-effective care plan. Patients gain a feeling of control over their own care, which improves their level of patient satisfaction.  

The idea of healthcare becoming  more consumer driven may seem challenging.  However, it gives physicians an opportunity to align their workflows and practice management policies to create a better patient experience. This creates an environment for building long-term, loyal patient relationships. 

Contact us to learn more about how Practice Partners can help your medical practice better meet the needs of today’s healthcare consumers.

When you are setting up a new medical office, there are a multitude of details that require attention to ensure that the practice is ready to open when expected and that the office operates efficiently from day one. Practice Partners will help you simplify and expedite this complicated process.With success in launching numerous practices, we are well equipped to advise you on personnel issues and staffing; operational systems; vendor selection; and marketing your practice to potential patients. Read more