Note: Susan Childs, FACMPE, is a popular national speaker and noted healthcare consultant. Her talk at a recent MGMA meeting in Memphis was highly praised. She has graciously allowed the Memphis Medical News to print her message. The following is the first segment of her message.
Ten million new patients have knocked on our doors in 2016! That is great access for people who would not otherwise be able to receive healthcare. In fact, 33 per cent of our Medicare patients are now on an advantage plan.
The most important thing to remember is the power of your practice and how that is conveyed to your staff, patients and communities. You can reflect that value by knowing your numbers. Who are your patients, who are you affiliated with and what are your outcomes? As your teacher said, “You will be judged by the company you keep.”
All future insurance fee schedules are based on outcomes and risk. Whether you are independent, clinic or system based, being familiar with your numbers will give you the power and allow you to realize the patterns and true value of your practice.
Although we pay a fortune for our systems, most of us tend to go only as deep as we need to get the job done. Call your vendor today and ask about any nuances or updates to the system that you may either be not utilizing or unaware of. This may save you tons of time with operations and workflow.
So where is our crystal ball? How may we best prepare for the next stage of our professional lives?
Think about your future as a business. What choices can you make that can actually help you earn more money? Think in both short and long term goals. Any consideration should include a quick pro forma to get a ballpark idea as to true financial value of the option.
When is the last time we reviewed missions and goals with staff members? We are so busy putting out fires over the little details of everyday life and getting a claim paid sometimes we forget why we are here.
Most practices introduce missions and goals with the personnel manual that are quietly filed away with not much future reference.
Personal investment turns into organizational investment that patients notice. As the practice leader, we have to live what we say and if you want staff to be a part of the change, invite them to help set the standards.
Consider a retreat for you and your staff. It’s not just touchy-feely stuff. It includes business goals as well.
Begin with your agenda. Invite staff to contribute. It is enlightening and cathartic. It helps you move onto the next step. It clarifies and confirms standards and values that you want in place. A retreat can also very quickly identify who will be there for the long run.
During this retreat, also share your business goals. You don’t have to give away the farm, just enough to let them know what your goals are and how they may contribute towards that success. Of course anything that can result in increased income can also equal increased pay by the end of the year, which is something all employees can appreciate.
A few tips? Mandatory attendance, including physicians. Have food, no recording and have an independent, and I mean independent, facilitator.
Provider Shortage
With physician training taking up to 10 years, this means we have a problem right now as the shortage is anticipated to begin in 2025, particularly due to the baby boomer generation.
This represents and includes changes in rapid growth of the non-physician clinicians widespread adoption of new payment delivery models such as patient centered medical home and accountable care organizations, greater use of alternate settings, retail clinics and delayed physician retirement.
Addressing the shortage will require a multi accessed approach including Innovation and delivery, greater use of technology, and improved and efficient use of health professionals on the care team, and an increase in federal support for residency training.
Concierge and Direct Pay
Are you tired of insurance companies dictating your care? Primary care, ophthalmology, gastroenterology, orthopedics and neurosurgery all have a presence with this updated approach to care.
There are approximately 12,000 concierge and direct pay physicians in the United States with more than 80 percent accepting insurance within their practice. Most membership practices require patients to pay a fee upon each visit. The typical age of a direct pay patient is between 40 and 59 years of age. These practices typically seat six to 10 patients per day with blended practices usually higher.
Female physicians fill concierge practices 30 percent faster than men and 58 percent of membership practices have 1 to 2 employees.
While this may not be a current choice for rheumatology, do not discount this network of providers that can actually complement your services. They can offer another venue and patient base to care for.
Know Your Numbers
If anyone has doubts about the delivery of care with this model, please remember they exist because they are needed. Consider this yet another resource to complement the services you provide. These practices now comprise a decent part of your medical community and nothing to scoff at. This is another network that you may tap into.
This is why it’s more than essential to know your numbers and your practice’s patterns of care and outcomes. Knowledge is power. Know your numbers!
Revenue Forecasting
There is an implied level of expectation of performance with any product that I purchase. I should be able to sit in a chair for a while before it breaks or the fabric tears. You know what you are purchasing.
As for practices and insurance companies, all we know is we have discounted our fees to be on a list of providers that a patient may choose according to his or her preferences. There are no guarantees.
Insurance carriers for years also required global agreements to any product they would be offering at any given moment and time.
Now there are narrow networks, usually associated with larger health systems not including independent physicians. Many long-time patients are told that their practice suddenly is out of network for their plan.
Now is the time to speak with payers and legislators regarding these concerns. As physicians, we should be able to care for our patients. As business people we have to watch out for ourselves. It is as simple as that. Consider the long-term implications and decisions we are making right now. Now that’s a business decision.
As managers – many of you are financial wizards. Let’s utilize that. And never forget the subscriber’s voice to their insurance marketing departments that hear it loud and clear when he or she calls in.
Telemedicine
When the average age of an individual can vary seven years just within one county or two due to access to care, think of how easily we can improve the lives of patients, compliance and maintained wellness.
The patient really could become engaged in this type care. On the other hand, how much can you really see in this venue when 49 percent of patients typically withhold information from their doctor?
You know your patients better than anyone and only you can answer this.
We also should consider the availability of broadband support as well as insurance plan coverage for these kinds of visits. This of course depends upon your geographic area as well as insurance carrier plans.
Be in touch with your insurance representatives to inquire about telemedicine and coverage for your area. It is growing rapidly in all specialties and only adds to access to care for patients.
This, of course, can result in better outcomes, one of our major goals. We also know that happy patients often remit their bills sooner.
Politics, Politics
Just as with insurance companies, meeting with your local and state representatives is always a good move. In my state, we have an advocacy group that works with the state medical society where many of us get together and meet with local legislators.
Let your local political representatives feel your pain. Ask them to spend time in your office observing. Attend a local medical managers group.
How Do We Stack Up?
These day patients view us as they view any other business. Our services are purchased contingent upon the patient’s preference. We are a commodity that can be selected and replaced with a newer model if need be.
I believe we are like car repair shop – when patients need us, they really need us, and when they don’t, they would prefer to just stay away.
Dealing with Insurance Plans
No no, no, we are not like other businesses. We are not car salesman and we don’t manufacture washing machines. People don’t often look for cars when they’re sick.
As we all know, healthcare is beyond personal. It goes to the core of our bodies. As a patient, what we expect can come from a very fearful space, especially when seeing a specialist. For example I may be your millionth patient but you are my first rheumatologist. Please respect both my invalid and valid concerns and fears.
Take that extra special need for our profession and provide the level of stellar care in the most efficient way possible.
Now take a moment and reflect upon each of your staff members. Is everyone really pulling his or her weight? Which employees do we need to speak with regarding their performance and potential for excellence? Are good employees leaving because we won’t get rid of bad employees? Every single staff member has value to the practices operations as well as the cost associated with that specific employee’s role.
Next Month: Staff Accountability