1. Focus on the revenue cycle. Keeping an eye on collections and payments is important for practices, especially in a struggling economy. Michael H. Cox, PhD, CEO of Central Maine Orthopedics in Auburn, Maine, says that many patients many are not aware of what plans they qualify for, such as Medicaid, so practices should take the time to work with patients to help them figure that out.
With rising copays and deductibles, many patients may find it difficult to make these payments. Don Love, administrator of an orthopedic practice in Roanoke, Va., advises practices to prescreen their patients and to speak with them prior to arriving at the office so that patients are aware of what cost their insurance will cover and what they will be expected to pay.
"It's important to provide a patient with a complete financial picture," Mr. Love says. By taking these steps, patients and physicians can work together to arrange a payment schedule, and the chances of patients paying their copays upfront increase.
Curt Mayse, a principal with LarsonAllen, suggests that practices should work better with their front-desk staff members to help them understand all aspects of the billing cycle and collections process. "Many practices are too focused on their payor reimbursement and Medicare to notice that the patient portion of healthcare payments is growing," he says.
Mr. Mayse says that practices should figure out how they can stay on top of this information and help patients gain a clear understanding of their payment responsibilities, as Mr. Love suggests. Mr. Mayse suggests gathering the following information for patients regarding their responsibilities:
- Co-payments
- Deductibles
- How many patient visits to the office or physical therapist will be covered
Mr. Love suggests that practices should closely watch their bad debts and other outstanding debt in A/R.
Mr. Mayse agrees and notes that practices should focus on getting their collections out of the door immediately following a patient visit. "These should be sent within minutes or hours, not days, of a visit," he says. "This way, the practice will get their reimbursements or denials back quicker from insurance companies."
When practices receive a denial, Mr. Mayse says that they should not sit on this information. "The business office should pass the reasons for the denial on to the front-end to communicate to them why the claim was denied." By improving the communication between these two parts of the practice, offices can cut down on repeat mistakes and improve their overall collections and billing.
One way to improve the revenue cycle is to focus on efficiency within a practice. Total quality management, or process improvement, can help a practice to develop more efficient processes. Mr. Love sees now as a good time to implement changes within a practice. "It's not something that you'll be able to do in three or six months," he says. "It really is a culture change within the practice."
Mr. Love suggests taking the time to teach process improvement techniques to the practice's management team and staff. In addition, he says that it is important to reinforce its use so that the new techniques become part of the operation of the practice.
From "Improving and Maintaining Profitability at Orthopedic and Spine Practices: 12 Areas of Focus."
2. Never underestimate staffing needs before and after the doors open. Human resources are a significant consideration in any successful ASC. The staff itself should represent the most appropriate mix of clinical and administrative talent to ensure safe, efficient and quality patient care, while at the same time ensuring that coding and billing are done in an expedient and accurate manner.
Staffing levels must be adequate to effectively manage both patient caseloads and administrative workloads with little or no "unproductive" time, but not so little downtime that staffers are overwhelmed. The right balance is critical, as too many employees are a financial drain while too few can impact safety and patient/physician satisfaction levels.
To that end, cross-training should be a consideration for all staff members. Pre-operative nurses should also be able to provide post-operative care, and all nurses should be able to serve in the OR when necessary. This enables greater flexibility in staffing skill mix and levels.
One aspect of staffing many planners fail to adequately address are needs during the licensing and accreditation period, which often occurs before an ASC is generating revenues at top levels. At minimum, a properly trained skeleton staff is required to work with auditors and accreditation teams to ensure that paperwork is in order and documentation processes and procedures are clearly defined.
It is also not sufficient to limit pre-licensure staff to those on the administrative side. In many cases, such as with Medicare certification, the ASC must be actively performing procedures as certification teams will typically make unannounced visits to observe care processes. Further, both Medicare and state licensing agencies expect to see, at any given point in time, patient records and other documentation such as inspection reports and facility policies and procedures are properly labeled and organized. (This information should be kept after the initial inspection because licensing boards can and will come back.)
From "Building a Successful ASC From the Outside In."
3. Improve workflow by focusing on specific procedures. Successful orthopedic and spine practices should consider focusing on specific types of procedures, rather than try to offer everything, to eliminate distractions and make sure the institution runs effectively, says John Grossmith, MD, a board certified neurosurgeon at The Bonati Spine Institute in Hudson, Fla. A focused facility has a specific workflow to keep the patients moving through the pre-, intra-, and postoperative process. At The Bonati Spine Institute, the spine surgeons only perform minimally invasive endoscopic laser spine surgery involving the thoracic, lumbar and cervical spine. The surgeons and medical staff have extensive experience treating patients undergoing these specific procedures, therefore the process is able to run smoothly, says Dr. Grossmith.
From "7 Key Elements for Achieving High Patient Satisfaction and Better Outcomes for Orthopedic and Spine Surgery."
4. Examine the impact of high transfer rates on multiple issues.David Kelly, administrator of Samaritan North Surgery Center in Dayton, Ohio, says that benchmarking is important because often one issue will uncover "10 more issues" to be addressed. For example, since Mr. Kelly's ASC keeps patients overnight, the center benchmarks the number of patients that stay overnight and the profitability of overnight cases every month. The center decided to address high transfer rates by keeping some of those patients overnight, which increased overnight stays and physician satisfaction.
The committee also discovered during data examination that the center was waiting too long to transfer cases once they knew the patient would need an additional level of care. "Things weren't necessarily going to get better, but we were keeping them in the PACU forever and then making the decision to transfer," Mr. Kelly says. "That kept our employees staying later into the evening." By understanding how delayed transfers affected overtime, the ASC could be vigilant about identifying patients needing a transfer and completing the transfer quickly.
From "6 Steps to Reduce Transfer Rates Through Benchmarking."
5. Elect staff members to monitor finances, particularly pre-collection and billing functions. There are approximately three staff members who work at Midlands Orthopaedics as financial account specialists. These specialists' primary role is to meet with patients before surgery to pre-collect copays, deductibles and co-insurance amounts and work out payment plans as needed, Ann Margaret McCraw, CEO, and Belinda Rutledge, administrator, of Midlands Orthopaedics Surgery Center in Columbia, S.C., says. Delegating specific responsibilities, such as pre-procedural collections, to staff members helps ASCs collect in a more efficient manner.
"Our financial account specialists collect both for our professional practice and ASC, so our patients don't have to make separates trips for different bills," she says. "These staff members are trained to have those sensitive conversations with our patients and know how to interpret statements, EOBs and explain deductibles. So it helps our ASC and practice because the payments from one patient are all funneled to a specialist, and it's nice for our patients because it alleviates confusion on their part as they navigates bills from both entities."
From "6 Ways to Increase Profitability at Your Orthopedic-Driven ASC."