"In this article, we attempt to provide a way for a practice to consider the question, 'Does this new technology make sense for my practice?' " write Ray Painter, MD, and Mark Painter.
Ray Painter, MD
We are commonly asked our opinion on new technology. Questions range from “How do we get paid or code for a new technology” to “Does this new technology make sense for my practice?” The answers with regard to payment and coding vary from technology to technology and are an important part of the equation, and we will address these issues in future articles. In this article, we attempt to provide a way for a practice to consider the question, “Does this new technology make sense for my practice?”
As you consider new technology in the practice, we encourage you to remember that a urology practice is a complex ecosystem with many moving parts. Introducing a new service line may initially appear easy; others may not be so straightforward. As you consider new technology and procedures for your practice, we encourage a broad look at the practice impact.
First and foremost, as a urology caregiver, you need to consider the clinical aspects of the technology. Will the new technology improve patient care or your efficiency? Will the new technology drive utilization? If it does not make sense to the practice clinically, you should move on for now and revisit the technology only when the data support the service clinically.
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Once you are able to determine clinical relevance and there is support among at least a few of the providers in the practice for the new technology, you will need to consider the financial and practical requirements to support the introduction of new technology to your practice. The length of this article will not allow us to include every aspect you must consider, so we will focus on those items that are deemed the most relevant.
The following action plan will provide a guide to the evaluation and adoption of new technology.
Step 1. Define where the practice is today and where you need to be downstream. Is the technology directed toward a population that you currently serve, or is the service targeted to a new group of patients? New patient groups can be defined in many ways: self-pay patients, gender- or age-specific patients, or disease group-related patients-in short, any way to identify patients who are currently not served or are underserved by your practice.
Knowing your long-term planning is a must as you look at new technology. You should be able to articulate your goals for any new technology as it relates to your existing service lines. Make no mistake: New technology requires an investment. Time and capital will be committed.
Step 2. Align core practice data with robust analytics. If the new technology is directed toward your existing patient population, you will need to consider both the new revenue generated and the cost to your practice from the services that will no longer be provided. Being able to review your data to project the impact on your existing practice will help build a realistic pro forma (a spreadsheet with 24-month projected income and expenses for the new product based on your practice assumptions), develop marketing plans, and implement measurable goals to analyze the results of your decisions.
Next: Define actionable data and plans (business pro forma)Step 3: Define actionable data and plans (business pro forma). Ideally, new technology will be of immediate financial benefit to the practice, adding revenue to the bottom line as a profit center. However, some lines of business may not provide a true bottom-line bump in the short term but will become profitable over time, return benefits to the practice by attracting new patients that will generate revenue beyond the new technology, improve overall outcomes and performance on value-based care, or free up the practice to see other patients that provide revenue through other services. All of these may result in the decision to adopt a new technology that others may not adopt. Again, this requires data from the practice that can be used for projections.
You will also need to make realistic revenue projections for the new technology. New technology with codes, payment, and coverage for a majority of your major payers will make this easier. New technology with uncertain reimbursement pathways is more difficult to project. We recommend that projections on income be based on realistic and conservative outlooks, which is often difficult for the optimistic practice. For most of our groups, we also produce a “low-use” scenario, discounting our realistic projections by 25%.
Finally, it is important to look at the market pressure and influence surrounding the technology. If profits are high and uptake in the market is swift, payers are likely to attempt to decrease reimbursements for the service. The market tends to shift slowly, but projecting decreased income per service after a 2- to 3-year window is appropriate in some cases.
Step 4. Develop effective top-down communications to support practice team buy-in. This is arguably the most difficult step. Successful communication is often more art than science. Identifying the people in your practice who will work with the technology and setting up strong feedback pathways will help to ensure success. Providers, clinical support staff, administration, and billing will need to communicate routinely to provide the practice with real data once the technology is added to the practice. From patient coverage to time in the room and patient experience, the staff and physicians will need to make sure that any projections are accurate once implemented.
Based on feedback adjustments, modifications should be incorporated into the business plan. Do not forget outcomes; patient communication after the experience will serve both internal and external marketing for the practice.
Step 5. Align practice assets for future profitability. If all goes as planned, you can follow the business plan. If your business plan is well developed, you have incorporated the use of profits for some investment in the future. The market is changing and new opportunities will continue to arise. Good planning will not only invest in the present but will also save for future investment.
If the financial benefit of the new technology is not going as planned, your projections and planning should also include an exit strategy for the technology. These exit plans should have clear milestones and time lines. Making sure that you provide enough time to allow your practice to incorporate and market the new technology is important. It is also important that you look at all aspects of the implementation. In the end, however, some technology may not work as a line of business; if your milestones are not met and the problems identified are not rectified, walk away.
Next: Reengineer the practice to meet targeted goals and supporting objectivesStep 6. Reengineer the practice to meet targeted goals and supporting objectives. Some new technology introduces a new approach to practicing medicine. For example, some of the new BPH technologies will move patients from a pattern of repeat visits and follow-up once or twice per year to several years. The practice will then need to change its marketing and service focus to new patient services with the now-empty time slots that established patients once occupied. Marketing and interaction with outside referral sources will need to be increased or other service lines pursued. The practice must change with the times.
This may require only small changes or it may require the addition of new support for the practice that will require reallocation of personnel and time. Keep looking forward.
Step 7. Implementation. Planning for success must be followed by execution. Communication, as noted, is key to all aspects of the practice and is vital to any new service line. We have found that in order to execute any plan, the practice must identify a leader who will act to implement a successful new service line. Assign a person to communicate and review the processes and procedures that were identified in the plan.
Lack of leadership can come in the form of a true leadership void (ie, no one is monitoring the plan), or it can come from too many leaders who are focusing on different parts of the plan without coordination. The implementation plan must include both processes and procedures for all staff and a designated leadership structure to monitor the implementation.
Step 8. Review, monitor, and adjust as needed. This not a static business. Autopilot is not a setting that can be used with organizations made of human beings. Plans, procedures, and protocols must be monitored routinely. Even the well-oiled machine should be reviewed to avoid the pitfalls of complacency. New lines of business are no exception. Build review points and milestones into the business plan that continue beyond the implementation phase of the new service line. Ask the question, “Is this aligned with our practice goals?” at least once per year.
Finally, do not ignore data, your personnel, or your patients. If the information points to needed change, then plan to change.
Evaluating and implementing new lines of business is not easy (figure). In today’s environment, new practice business services must offer quality, value, and profitability. Doing the math and extensive homework really does matter. Effective due diligence is required to define value and overall impact on the practice. Also, remember that you are asking people to leave their comfort zone and that you are committing operating capital.
Building an effective practice infrastructure and implementing new services requires leadership and a skilled team. Focus on the core financials and clinical issues. When considering new business services and committing practice capital, in-depth due diligence is required. Understand that while the numbers may appear positive, it only works if the procedure can be efficiently provided and accurate payment collected. In closing, we understand the challenges and critical pressure points confronting today’s successful practice, as well as the stress and time constraints of evaluating and onboarding successful new business services. For a few examples of high-level financial business case studies, please visit bit.ly/PRScasestudies.
The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.