By Tom Freeman, VP, Paragon Health
As more and more hospitals and healthcare systems decide to employ Cardiologists and acquire Cardiology practices, it soon becomes apparent that the financial ramifications are not always as expected. In most cases the bottom line for the Hospital’s Cardiovascular Enterprise increases, due in part to the increased ancillary revenue that the hospital obtains. However the practice itself has become just another “cost center” in the hospital and the bottom line is rarely positive and, in certain situations, can be a very large negative.
The question is what can be done to minimize the losses of the cost center. Here are some suggestions.
- Monitor CPT coding of E&M services by physicians each month. Look at changes in volume as well as mix. Understand why changes are occurring. Ask questions as to why the mix between physicians is so great. Why does one physician have 25% level 5 established office patients while another physician has 2%?
- Educate the physicians on coding rules to assure under coding is not occurring. Each level under coded reduces pay by about 50%. Show a report of mix by physician to encourage discussion as to why it happens. This can add on the average about $45K per year per physician. This is increased revenue for the work already being done by the physicians.
- Develop a tracking system for denials by payer, physician, and type. Work the denials, don’t just book them. Fix the reasons. Don’t assume that if a payer denies a claim that they are correct. Make sure you have someone knowledgeable of the rules and they fight for claims that were correct.
- Monitor physician office scheduling as to number of patients/ day, number of days to schedule a new patient and number of days to see a post hospital procedure follow up. There are times that patients need to be worked into the schedule even if there are no openings.
- Are you using mid level providers in a way that enhances productivity or do they just improve “quality of life “ for the physicians. MLPs should more than pay their costs.
- Benchmark staffing and other expenses on a regular basis with MGMA norms and know why variances are there.
- Monitor volumes in the hospital versus the number of physicians there. Adjust as often as needed. Try not to have interventionists performing duties that take them away from potential procedures.
- Encourage the active participation in Research by all physicians. Many of the trials provide excellent revenue for the amount of work required.
- Monitor who is referring patients to each of your physicians. Understand why increases or decrease are occurring. Continually ask your referring physicians what you can do better.
- Monitor the ordering of tests by physician. Work for protocols as to when tests should be ordered and then monitor closely who abides and who does not.
- Ensure practice is participating in all available incentive programs, such as the EHR and E-Prescribing Incentive Programs. Also maintain an effective use of critical care, care plan oversight (CPO), and smoking cessation codes.
- Compare services portfolio to market demographics to assess underserved needs of the community. In many cases, developing a vascular program can identify undiagnosed disease and drive incremental revenue.
- Build a strong provider relations program to insure that the practice retains its referring physicians and aggressively pursues new referral sources.
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