Author Archives: support Team

Minimizing Technology Burden in a Pediatric Practice Using the new IPAD

March 30, 2012 in Blog by support Team  |  Comments Off on Minimizing Technology Burden in a Pediatric Practice Using the new IPAD

Most Pediatricians want to focus on treating their patients and not all the technology burden associated with Electronic Health Records. A Pediatric Health Record system should align with the technology in today’s market. The ‘old’ days of Television sets were large furniture or appliance size devices with low quality screens. Today every person seems to own multiple flat screen TVs in the House. The computer field evolved from a difficult to use device that had a mono chrome (usually green) screen to a wireless tablet that you can check your e-mail and banking while sitting on the couch. Less weight, less technology burden for the owner, less space with more features. The new IPAD (“IPAD 3”) has some features that a small Pediatric Practice could use to reduce their technology burden.

If you purchase the 4G model of the IPAD (about $640 with a $15-$30 4G cost), you can use the IPAD as a 4G Hot Spot. This means that the IPAD appears like a “WIFI” to the other lap tops/tablets in the practice. A small Pediatric practice could have a Desktop, the IPAD with 4G and a previous IPAD or another tablet computer to see patients all day (assuming all your systems are on the cloud). The practice could either use the existing internet connection or the 4G connection provided by the IPAD. Additionally, the physician on call can review charts on the IPAD (vs. using a smart phone) no matter where they are located. What would be the cost of this set-up? Two new IPADs, Desk Top computer and wireless router….less than $1500 brand new. Let’s say you also purchase a ‘good’ copier/scanner/fax machine…another $500. What is the maintenance? No back-ups, no IT people needed, no hassles…..this technology is now here today so that you can reduce the cost and hassle to your practice using the latest technology. Think of the freedom that you will achieve by moving to this model as well as improved operation by using a Pediatric Specific Cloud E.H.R. system.

There is plenty of supply of IPADs available at stores like Best Buy. Speaking of Best Buy, their leaders understand the importance of reducing overhead and space. They understand that due to the changes in technology, cloud systems and the high utilization of smart phones that there is not a need for a large store (the management of Best Buy announced recently that they will reduce the number of large stores and lay off 400+ individuals). Using the ‘right’ technology should lead many Pediatric Offices to evaluate the appropriate space for their practice. No need for the practice to have a file room, a server room (think of a server similar to that old box TV), extra break rooms, large storage. With the right system and devices, Pediatric Practices can be optimized to eliminate the burden of these extra spaces. Additionally, the practice can improve the scheduling so that the focus of the practice is the Exam rooms, Front Desk and small lab/nurse prep area. I recommend you consider leveraging the IPAD in your Pediatric Practice to see if you can remove the administrative and IT burden.

Potential Impact of Consumer Directed Health Plans (CDHP) on Your Pediatric Practice

March 24, 2012 in Blog by support Team  |  Comments Off on Potential Impact of Consumer Directed Health Plans (CDHP) on Your Pediatric Practice

Both cost and quality are important in the Healthcare system. Patients want to be treated and maintain their health with minimal costs to them. Employers want to reduce expenses like Healthcare costs. Health Plans want to provide a product that meets the needs of their employers and patients. The Consumer Directed Health Plan option provides deductible for all services (except well visits) in the range of $1000-$2000 per year. Services include: sick visits, hospital, specialists, as well as medications. A consumer that rarely engages with the healthcare system, could place $2000 in an account and just use the funds as needed (might even last for years). With the change in Healthcare laws, well visits are usually covered with no cost. The value proposition is that the employer and employee save on the monthly premium (or maintain the premium cost), planned/well visits to the physician are usually no cost and the employee can save the money to use for items not covered via the deductiable for the times they access their physician. Sounds like a win! Not so fast…..individuals with chronic conditions, medium and high users of the healthcare system are burden with the $1000-$3000 deductible every year so their total cost might increase (or they ‘avoid care’).

Let’s look at this for a Pediatric Practice. A parent would usually experience $0 co-pay/cost on all well checks and need to pay out of pocket (at the contract rate) for sick visits until their healthcare deductible is established. For patients that do not have chronic conditions whom are not on routine branded medications, this option can save total costs. The issues that this plan design can cause with appropriate Medical Care and/or operational issues to the Pediatric Practice include:
• Patients in the practice that have asthma will need to pay for sick/treatment patients out of their budget (not the plan). This might cause many to not seek routine asthma treatment at the Pediatric Office and instead wait until ‘crisis’ mode. Does this lead to higher ER costs? Does the ‘disincentive’ to gain treatment endanger patients?
• Patients in the practice with ADHD whom also have a CDHP will either spend the $1000-$3000 per year to hit the deductible or will forgo treatment due to the high cost of the treatments.
• In a well-managed Pediatric Practice, the practice should maintain >99% collection rate to contract amount. There will be an extra cost burden with the billing team sending statements to patients as well as follow-up calls. Patients have a much higher default/no-pay rate than insurance companies.

Employers seem to be leaning more toward options like CDHP to control the rate increase in premiums. What are some steps that your Pediatric Practice can take to monitor and manage this trend?
• Benchmark the number of patients with either H.S.A. or CDHP plans.
• Identify if these patients come to the office for both well and sick visits
• Confirm the current collection rate for this subset of insurances. Is the rate the same as the overall practice?
• What is the billing team handling time for managing H.S.A. and/or CDHP plans?

Some employers share in the Health Plan decision making with employees. Most employees do not want any cost increase (similar to employer). When the decision is shared between staying with the traditional plan with a co-pay (no in-network deductiable) and the employee paying an extra $100/month or moving to a CDHP, most employees would pay the extra money per month out of their paycheck. Although this might be the best financial move from them if they rarely use their insurance except for well checks, individuals are usually not comfortable with the change in payment system. As the Health System moves forward, the CDHP is a growing option.

Debt crisis…how could this impact your pediatric practice?

March 15, 2012 in Blog by support Team  |  Comments Off on Debt crisis…how could this impact your pediatric practice?

The United States has over $15 trillion dollars in debt with an annual budget deficit over $1 trillion dollars
for 2012. Let’s look at this if this was 30 year mortgage: at a low interest rate, the US would need to
repay $500 billion a year and not incur any debt moving forward to pay off the debt in 30 years. This
would mean that the US would need to double the current taxes on businesses and individuals as well as
cut the budget so we do not continue to spend $1 trillion a year more than the country receives in taxes.

Let’s link the size of the government debt to a Pediatric practice. Imagine if your Pediatric practice had a
debt load of 6-7x the revenue…..this is the level of debt the country has compared to tax revenue
received. If your two provider practice averages $800k in revenue a year, 6-7x would be $4.8M to $5.6 M
in debt. This level of debt would bankrupt the Pediatric group. This level of debt would cause a practice
prior to going bankrupt to make difficult cost cutting choices to avoid going bankrupt.

These numbers show that, more than likely, the US will increase taxes and cut spending. When you look
at the major expenditures on health care (potentially approaching 20% of gross domestic product), the
government leaders are likely to cut costs and will need to identify cost cuts in healthcare.

Where does the country cut costs in healthcare? This is a difficult question. From the pure perspective of
long term tax revenues, it makes sense for the government to invest in healthcare for children and
encourage more children in the country to replace all the aging baby boomers. These children grow up,
obtain jobs and pay taxes. There will likely be much discussion on difficult topics including how much
medical care the government should cover for an aging adult. Since the majority of healthcare is spent in
the last six months of life, is spending on procedures and treatments that initially extend life a good
decision for our future as country since we cannot afford our healthcare bills? About 5% of the country spend 60%
of the healthcare cost while most of the economic burden is placed on the other 95% of the country….will this continue in the future or will changes in policy/structure of our healthcare system bend this curve?

The healthcare system financially rewards physicians for choosing other fields of medicine other than
Pediatrics. Medical students, in many cases need a strong income to repay the student loans. Physicians
have families with financial needs and if the income is not sufficient, physicians might remove themselves
at a higher rate from clinical medicine and move into industry or other areas. How do health plans, the
government and employers align incentives to patients whom take accountability for their health via diet
and exercise? The responsibility of good health is dependent on the patient being compliant to a treatment
and being proactive in their health. A patient, whom smokes, is obese and does not exercise increases the
burden on the healthcare system. A patient whom does not smoke, exercises and controls their weight
provides on average, less of a strain on the Healthcare System. Should patients whom optimize their health see lower co-pays or lower monthly health premiums? Currently, most employer plans charge
the same per employee, some would argue that the system does not optimally align the behavior of patients with incentives. Incentives as well as costs are being evaluated in the Healthcare system. The recent change in Healthcare law decreased the co-pay for well checks for many pediatric patients to $0. This aligns the incentive with preventive care which, in my opinion, is a good change.

So how could this debt crises impact your pediatric practice? The Independent Payment Advisory Board (IPAB) is a new federal entity comprised of 15 unelected individuals with the authority to cut Medicare Spending if the program’s costs exceed specified targets. Although Pediatricians do not receive payment from Medicare, many of the insurance carriers based their reimbursements on Medicare Policies. We are overspending and there will be some difficult choices. Some recommendations to IPAB and other providers of healthcare include they should continue
the no co-pay policy for well visits (this lowers barriers to parents) and look to decrease costs via higher burden on patients for ER visits and hospitalizations. Policy makers might see the need to increase drug co-pays for non-preferred medications to help improve the adherence to a selected formulary.

Using electronic health records that provide the formulary advice will help providers prescribe the best cost
medication option to the patient. Pediatric offices will need to further train and monitor their internal staff
as well as leverage companies that specialize in pediatric medical billing to insure they optimize the
revenue cycle. I believe general Pediatrics to be the best investment in our healthcare dollar. Hopefully
our leaders that shape healthcare policy and determine healthcare cost cuts will come to the same
conclusion.

The Impact of Proper Coding to a Pediatric Practice

March 9, 2012 in Billing and Collections by support Team  |  Comments Off on The Impact of Proper Coding to a Pediatric Practice

The revenue cycle depends on teamwork between the front desk, providers, Medical Assistants, Nurses as well as the back-end billing team. Coding of the visit is dependent on the reason for the visit, complexity and time. Each provider should invest at least 2-3 minutes per visit to insure they are capturing the proper codes. A well-designed Pediatric Electronic Health Record and Practice Management system should help link the front end to the providers to the back-end office team. The providers are busy managing patients each day and usually do not have much free time and in many cases do not choose to invest in taking quarterly courses related to the Pediatric Revenue Cycle.

The practice could consider hiring a Practice Manager that completes at least quarterly training on the revenue cycle and have this person educate the providers and office as needed. The challenge with this is that the providers/partners need to achieve a certain level of understanding of the revenue cycle to insure they have an “A” rated Office Manager. An average office manager on the revenue cycle cost the practice twice – once in their salary/benefits while a second time with inappropriate/under coding. I call this the “hidden” lost revenue – a physician partner does not know what is missing until they work with a high caliber team that corrects their issue. Leveraging a company that spends all day only on Medical Billing for Pediatrics can increase the overall profitability of the practice while reducing the workload. Additionally, the office manager can focus efforts on the front end of the revenue cycle as well as Marketing to optimize the growth of the practice.
We have some clients that were missing up to 18% of revenue prior to us optimizing their revenue cycle – imagine an 18% change in your income with less administrative work. Usually, from the perspective of a Pediatrician, managing the revenue cycle for a Pediatric Practice does not excite them. There are a few Pediatricians that are on top of every claim and patient statement. This level of detail is usually redundant work and not needed (why spend all your free time looking at every claim if the audit report as well as your own audit functions shows above a 99.5% collection rate?).

We have competitions each month to see which biller can achieve the highest collection rate, who can improve patient collections the most as well as achieve the best AR days. What concerns me is that the Medical Group association benchmark data shows that the average office collects 95% of their contract amount and 70% of offices have theft at the front desk. This is easy found money with the right systems and billing team that know how to optimize the Pediatric Revenue Cycle.

What have you done this year to simplify your Pediatric Practice?

March 2, 2012 in Billing and Collections by support Team  |  Comments Off on What have you done this year to simplify your Pediatric Practice?

If you are spending more than 5 hours a week managing your Pediatric Practice as a physician owner/partner, then you should evaluate simplification techniques. How do processes move from simple to complicated? Usually it is a function of a process that has added features and needs with minimal looks at re-design. Redesign changes to a process shift a practice toward simplification and do not happen with a one-time change (there needs to be multiple small changes). An owner and/or operations lead of a Pediatric practice need to make incremental changes each week. Some suggestions on how to move your Pediatric Practice to optimal simplification include:
• Once a year, make a list of all the items that you spend time managing outside of Patient interactions (recommend spend 30-40 minutes to gain some depth without moving too granular). Identify how much time per month you spend on each item.
• Place each of the items in the list into different categories (Employee, physicians, marketing, Managed Care, finance, supplies, facilities, etc.).
• Rank the categories and the priorities that ‘matter’ most to the practice (e.g. which items increase revenue and reduce work load).
• Highlight the items that consume more than two hours per month and do not significantly increase revenue (a good question: would I pay someone $100/hour to manage this activity? If the answer is no, look to move off or eliminate from your work stream).
• Allow a week to pass then spend an hour (uninterrupted), to ask some basic questions: Do I need to service my processes (e.g. do you need to use your time to manage billers, IT personnel, back-ups)? What is the level of training and expertise of my practice personal? How do they benchmark in skills and performance versus the industry standards as billers and practice admin personnel? Do I have the skills/training to educate and assess them in the admin areas?
• Wait another week and evaluate 2-3 Pediatric Specialty Billing Companies – ask what is there collection rate? What is the range in increase revenue for Pediatric Practices that switch to their system? What support personnel will you as a Pediatric Office need if you leverage their resources?

A word of caution, this is a task that cannot be delegated to another staff member due to conflict of interest (e.g. billing team concern that the new process will show more productive to the practice – this was not ‘their issue’ probably just a system/process and/or training issue). Simplification, if done correctly, will provide the Pediatric partners with more income, less work and less stress.