Navigating a Profit in Post-Reform Medicine
Navigating a Profit in Post-Reform Medicine
Over the month since the election I have heard many complaints about healthcare reform and where healthcare is headed in the very near future. If you haven’t gathered by reading my posts by now, no matter what my opinion or my vote is/was, I always try to spin things for the positive. Call me a politician or call me optimistic, I have made a career and a company off finding the silver lining.
One of the positives from the state of healthcare reform is the focus on prevention and early detection. This means for the roughly 100,000 U.S. family physicians, there are some great new ways to generate revenue.
Many companies are dedicating resources to bring new generations of early detection devices to the market that can bring physician offices significant income, and help their patients by detecting debilitating diseases long before the clinical symptoms appear to the even the most trained eyes.
One of the most important things you can do on the physicians/office manager side of the equation is recognize that your routine of waiting for patients to become ill and letting them fall in your lap won’t work anymore. Equally important, give the companies that are dedicated to helping make your clinic increase its profitability a chance to show you how it works.
There are devices out there that are inexpensive, portable, and range from completely non-invasive to a minor lab draw that test for sudden death, diabetic ulcers (prior to visual identification), silent heart attack, Cardiac autonomic neuropathy, diabetic autonomic neuropathy, peripheral artery disease, vestibular/balance issues, syncope, allergies, and a myriad of other diseases and health issues.
You have to change your marketing practice to ensure that you are capturing quality referrals from other physicians, business, and your highest quality clients.
And equally as important you have to keep the patients that you have. Amp up your customer service so that you are treating your patients like the important assets that they are. Providing a broader base of testing and treatment in your office can decrease the need to refer to a specialist and often times lose your patient.
Keep your head up, there are practical ways out there to survive and even thrive in the coming years of healthcare reform rollout.
Hi Richard, thank you for your comment. In the interest of full disclosure, some of these (not all) companies that we have a financially beneficial relationship with, but to name a few: ANS Testing, Vestibular Testing, Peripheral Artery Disease, Early Detection of Diabetic Ulcers, United Allergy Services, Health Diagnostic Resources.
I'm an optimist as well. However when you actually get the reimbursement on these extra devices let me know.
As some insurances have already not been paying for urine dips, pulse ox...even though patient had an urgent symptom.
I didn't get reimbursed on medicaid flu shots or any preventive vaccine if it was administered on the same day as an office visit. I am already dedicated to giving my patients individual quality time...and for that reason they are not admitted to the hospital for preventable non complex diagnoses.
I believe we should be reimbursed for preventive measures without having to attest to get the bonus, because the codes are submitted. Therefore the Insurance companies already know patient was asked certain questions OR they have asked for records in the past.
Some of the people being reimbursed haven't asked the patients questions, but clicked on the computer that they did.
Thanks for the comment @Atinuke I cannot speak for every rep and every device and every test, but before we advise anyone to take on new testing system/ preventative measure for their patients we ask them to do (or let us do typically at the expense of the company making the proposal) 2 bits of research, part A of course is the clinical aspect, checking to see if it will indeed help their patients and be a positive addition to their practice, and part B is a Reimbursement Analysis where we check do the research to ensure that your insurance payors will pay for the specific tests/preventive measures performed.
It is quite nice to think that we can get paid for early detection. Our system pays very little to a primary care practice to deal with a myriad for problems for a single patient for a period of 5 years, in my office for instance since we implemented our EHR in 2007 our per patient contribution average ranges between $1000 and $5000 over a period of 5 years but yet a single trip to an ER for a 6 hour stay runs easily the same. So the great news is that by adding 30-40 million people to the roster I am having a hard time thinking that we will see better reimbursement for prevention. In the Boston area for instance most of the ACO talk can me summarize in double talk about health care but not really adding new dollars to the pot nor refocusing the resources into more prevention.
@Alberto Thank you for your comment! We currently have many primary care offices nationwide receiving reimbursement for a myriad of early detection testing (via lab and/or noninvasive tests). They are receiving payment from commercial payors, Medicare, and Medicaid (although MCD has a wide variance by state). These primary care offices that have began adding new tests and in cases where appropriate managing the treatment are seeing their per patient contribution at the 1-5k range over a period of 12 months. I agree, adding 30-40 million more people to the roster is going to cause issues, many more issues than reimbursement alone, BUT we aren't there yet, right now is the time to be utilizing these options before (if they do) these reimbursements go down.
As both a physician and an owner of a medical billing company, I am well aware that many preventive measures are not reimbursable.
However, one bright spot is that CMS/Medicare will now reimburse for weight counseling and management is now a reimbursable service.
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?i...
http://www.aafp.org/online/en/home/publications/news/news-now/practice-p...
Thanks for sharing @Sally. You are right, as I mentioned in the first response, it is of utmost importance to perform the proper analysis of any test or procedure that you are considering billing for BEFORE implementation. Most of our preventative measures have gone up from 2011 to 2012 and are expected to continue to grow in 2013.
And the weight counseling and management is one of the ways we suggest to our clients to look for new revenue avenues. Another is diabetes prevention and early detection and treatment of the effects of diabetes.
Hi. I had made a comment before, but it came up as my colleague @atinuke by mistake.
From our coding V65.3 and 278.00, CMS/Medicare had already known that we were counseling on weight mgmt, now they want to reimburse after all these years? Also, according to my billing person, and the denials for which they won't reimburse underweight counseling nor overweight, only reimbursing G0447 for V85.30 and up, therefore BMIs 30 and above.
Astrid
how about some specifics ?