7 Steps to Enhance Spine Practice Revenue FeaturedWritten by Laura Miller | September 11, 2012
Spine surgeons discuss seven ways surgeons can enhance revenue at their practices.
1. Manage a lean team and promote multitasking. Each employee at the practice should be constantly busy and able to multitask to keep costs low. Hiring additional employees consumes much-needed resources, so hiring high-energy people who are able to function on several different levels is absolutely crucial to the success of any spine practice.
"The best way to maximize revenue is to keep costs at a minimal and go with the essentials, especially when it comes to staffing," says Terrence Crowder, MD, a spine surgeon with Sonoran Spine Center in Mesa, Ariz. "Be as lean as possible and run as strong of a practice as possible. This means not having several extra people working for you, but one or two people who can multitask and do three jobs at once. That's how our practices stays very efficient."
Efficiency is incredibly important in any practice, and Dr. Crowder says if an employee isn't able to perform, he hires another person.
2. Reward staff members for efficiency. Since efficiency is absolutely key for spine practices to maintain a healthy revenue cycle, reward members of your staff who are the most efficient. This can include employees who are taking care of patients well and making sure all of their responsibilities are completed each day.
"We try to reward the people who are most efficient," says Dr. Crowder. "We perform routine audits of patient charts and survey patient satisfaction, which is a factor in whether people receive a raise or bonus. We are constantly evaluating our staff to make sure they are doing a good job of taking care of patients and keeping them happy."
3. Invest in ancillary services. Few practices are able to maintain positive revenue streams without enhancing professional fees with ancillary services. Investing in imaging equipment, durable medical equipment, physical therapy and ambulatory surgery centers requires a hefty upfront cost, but will quickly pay for itself in a busy practice.
"These things provide ancillary income and are a big part of what it takes to stay competitive as far as revenue," says Dr. Crowder. "It takes time to make sure you are doing your due diligence and adhering to state and federal laws, but these things are definitely doable."
Khawar Siddique, MD, a spine surgeon with Beverly Hills (Calif.) Spine Surgery, and his partners have invested in a surgery center and within two years of opening they realized a profit. "Surgeons are dependent on how many cases they do," says Dr. Siddique. "In a one-man operation, if the surgeon isn't operating there isn't any revenue. Surgeons must break that thought and think about ancillary income."
However, do your research and make sure the ancillaries have a good chance of bringing success to your practice. Dr. Siddique considered adding durable medical equipment to his practice, but ultimately decided the cost wouldn't equate to the potential gain from the service. "There are many regulations and restrictions from Medicare and the federal government as to whether surgeons can own their own DME," he says. "We looked into it and decided it wasn't worth it. The revenue wasn't enough for us to get into that business."
4. Expand the size of the medical staff. Smaller practices having a difficult time staying afloat can expand the number of specialists, enhancing the case volume and potential revenue flow at the practice, by recruiting new physicians or merging with other groups in the area. Bringing additional physicians onboard will increase revenue and consolidate overhead costs.
"A major source of trying to be efficient and increase revenue is by creating larger practices," says Dr. Crowder. "Instead of being in a solo practice, people are getting together and using the same billing system for five people instead of just one. You can consolidate resources and cut overhead because you are sharing costs and overhead prices."
Spine practices looking to add an ambulatory surgery center don't necessarily need 10 or 15 spine surgeons committing their cases; Dr. Siddique and his partners have done so with only four spine and pain physicians.
"You don't need more than 10 surgeons to be profitable, but the practice must be run well," says Dr. Siddique. "Find a like-minded group of spine, pain and orthopedic surgeons who want to go into business together."
5. Perform a cash-flow analysis and fill any gaps. Dr. Crowder meets with his practice administrator every eight weeks to look over the books and make sure the practice has brought in the right amount of revenue each month. If he finds a month lagging behind expectations, he investigates the problem and corrects it as soon as possible.
One of the most common issues he finds is denied payments from insurance companies because policies changed without his knowledge.
"Routinely, insurance companies will change the way they do things without telling the doctors," says Dr. Crowder. "In one instance, an insurance company put a big change on their website but didn't notify doctors. Our practice was submitting claims the old way and they weren't paying them. Under the new rules, we were required to call the insurance company before submitting the claim and we weren't doing that so I saw a dip in my practice. That dip was related to the fact that the policy changed, but once we figured that out we fixed the problem and I didn't allow it to occur again."
6. Aggressively negotiate out-of-network contracts. There is still an opportunity for spine surgeons to negotiate out-of-network contracts. Instead of undercutting their prices to become the "lowest cost" provider in the area, surgeons should tout their outcomes, surgical skill and other aspects of their practice that improve the quality of care in exchange for a higher price.
"Increasing price is something doctors aren't very good at doing," says Dr. Siddique. "They don't recognize their worth or valuation, and they don't recognize they can charge more because they are worth it. Being out-of-network allows surgeons to set their own price."
If surgeons avoid becoming a commodity — charging the same low price for varying quality work — they will be able to negotiate better contracts.
7. Engage in direct-to-patient marketing locally and beyond. With more primary care physicians becoming employed by the hospital — and referring their patients within the hospital's care network — private practices can suddenly find their hearty referral streams petering out. Instead of relying on the old referral network, some practices are engaging in a more direct-to-patient marketing campaign bringing in patients from miles around to maintain case volume.
"There are some practices that have collapsed and become subsumed by the local hospital systems because the referrals went away when the primary care physicians became employees," says Don Johnson, MD, medical director at Southeastern Spine Institute in Mt. Pleasant, S.C. "You have to increase the catch net for patients. We are involved in advertising and marketing across the state, over the internet and television."
The practice released six 30-minute infomercials over the past few years and hired a media specialist to lead the marketing campaigns. "You can't stay local anymore," says Dr. Johnson. "I don't think specialty medicine is a local phenomenon. Patients are willing to travel, especially if the care is efficient."
More Articles on Spine Practices:
7 Spine Surgeons on Biggest Opportunities for Growth in Spinal Surgery
8 Benefits for Spine Practices of Adding Pain Management
7 Spine Surgeons on Cash-Pay Options
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