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Ancillary Services: Making the Most of Your Medical Practice


Adding ancillary services takes time and planning, but doing it correctly can also provide a small boost to your bottom line.

If anyone has felt the crunch of the current economic slowdown, it would definitely be small private medical practices. For many of us in private practice, we witness on a daily basis the number of patients that are delaying treatments, calling for refills without office visits, and consolidating office visits to handle several problems during one visit.

As a husband and father myself, I can certainly understand why patients are exhibiting such behaviors toward office visits. However, for those patients that do present for treatment, there are several items that we can offer our patients in our practice that would encourage them to use our facility when possible.

I have a phlebotomist in the office to do venipunctures and we submit these specimens to Labcorp. Many of the larger commercial payers such as Medicare, Medicaid, Anthem, and UnitedHealthcare contract directly with Labcorp for testing. However, the smaller insurers do not have these restrictions in place and we are able to submit the specimens to the reference laboratory and bill the insurance companies for the testing. Certainly there is some risk involved with this as we must make every effort to ensure that the codes used for billing are correct. Once the proper codes are used, the medical practice can realize a small addition to their bottom line by billing for a service that would normally be out of our hands.

It is also important to take advantage of the Clinical Laboratory Improvement Amendments (CLIA) waived testing available to us. We do urine dipsticks, rapid strep screens, rapid influenza screens, fingerstick glucose monitoring, hemoglobin a1c, fingerstick lead (for the children), and urine drug screens. Patients that are taking narcotic pain medication all sign a medication use agreement and are randomly called for pill counts and urine drug screens. The full implementation of in-office CLIA lab testing can certainly add to the vitality of your medical practice.

I just purchased a new EKG/spirometer unit from Welch Allyn that has a bi-directional interface with my EHR. Previously we were sending our patients with COPD down to the hospital for spirometry testing and now we are able to take advantage of the testing capacity in the office. The EKGs obtained are inserted as a digital image directly into the patient chart, as are the spirometry results, and this work flow adjustment adds improved efficiency for rapid results delivery and gives me the ability to add my interpretation and successfully bill for the services provided.

It is also important to remember that patients are also willing to pay for aesthetic services as well. Due to demand from my patients, I began to offer Botox and Juvederm treatments over a year ago. While the initial return on my investment for the medications and the training did not materialize for several months, it is now an added service that I can easily offer my patients that would normally drive over an hour from our rural location to get the same service.

As physicians, we have been given the honor and privilege of properly caring for our patients. However, the process of doing so requires that we successfully run the medical practice and ensure that it remains viable so that we can continue to provide the care our patients need. Adding these services takes a great deal of time and planning, however the successful implementation will allow you to realize a small additional supplement to your bottom line.

Find out more about J. Scott Litton and our other Practice Notes bloggers.

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