Stop the Drop in Revenue

Question: I am part of a two-physician internal medicine group. Revenue has been progressively declining. What are three options we can explore to increase revenue?

Answer: There are a number of factors that might go into falling revenue. The first step here should be to staunch any possible bleeding before you go looking for an infusion of more revenue.

For example, have an audit done of your charts and corresponding coding. You may be able to code higher levels than you are, or you may be missing some things.

Your collections may also be at fault (that is, not the money you are charging but how much of it you actually collect). Patient accounts are causing declines in many practices these days since providers aren’t accustomed to collecting from patients, and patients are carrying more of the economic burden.

Take a look at your net collections ratio. Also run a report showing days in accounts receivable by payer. Include patient accounts as one payer. Ask your front desk to track what percent of copays they are collecting over the course of a week, and have them note what the problem is if they can’t collect it.

Also look at your overhead in relation to revenue over time. Revenue will seem lower if overhead is creeping up. Look for inefficiencies there, too.

Then, to find more revenue, payer mix is certainly one place to look. In many markets, Medicare is a pretty good payer, and they do pay quickly and with less fuss than many others (all their rules are public). So I wouldn’t worry about that. But I would analyze whether your worst two commercial payers are worth keeping.

Also consider ways to market your practice to communities where your better-insured patients hail from.

Many internists are also looking at adding ancillary services, from lab to X-ray to pharmacies to cosmetic services to mammography, etc., to add more revenue. What you add depends on your interests, what the market needs, and what you can make work financially. Services such as pharmacy and lab are really nice for older adults so they don't have to run someplace else.

You can also look to streamline your work flow and improve scheduling to fit more patients in each day without adding more chaos.