What to do to make your practice recession-proof in 2009

March 1, 2009

The nation is in the midst of a recession, and confidence in the economy continues to deteriorate. Many experts consider the health care industry to be more resilient than most, but how well a practice does depends on the decisions you make.

Surviving is simply a matter of carrying on and enduring unpleasant events that affect the practice. That's giving away a lot of power. Thriving, on the other hand, requires taking positive actions to help the practice prosper.

First, you must develop a plan of action. Consider these questions:

Manage costs

A urology practice's highest expenses are staffing and employee benefits. The typical staff has about 4.82 full-time employees for each full-time equivalent physician, with staffing costs equal to no more than 20.4% of annual revenue, according to the Medical Group Management Association. If you are not within these parameters, it might be due to such inefficiencies as too many manual processes, errors that need correcting, or a staff that is not as productive as it needs to be. Consider freezing wages, reducing staff hours, or replacing a departing full-time employee with a part-timer.

Analyze overtime costs. Regular overtime is often due to poor work habits or a poorly managed schedule. These problems can be fixed by examining the practice's inner workings, looking for flaws that compromise efficiency and quality, and establishing a means to take corrective actions with built-in accountability for both staff and physicians. Most businesses tie wages to productivity and outcomes measures, and physicians must do the same.

Other top expenses are insurance and office space. Shop your insurance benefits and determine whether more economical coverage should obtained or if employees need to share a bigger portion of this expense.

Office space is at a premium, so use it wisely. If you have underutilized space, consider adding ancillary services or subletting. On the other hand, if you are bulging at the seams, extend the hours the space is being used and alter physicians' schedules accordingly. The bonus is improved service to patients.

Medical and office supplies can be managed through better inventory control and online shopping with price comparison. Shopping at retail office supply web sites can save you time and money.

Plug revenue leaks

Conduct a coding audit that compares evaluation and management coding patterns and documentation. Examine 10 medical records for each physician and select a date of service for each patient record that dates back at least 3 months. Compare the code that was billed to the documentation requirements for evaluation and management code selection in the Current Procedural Technology book to see whether physicians are under-coding or dropping charges.

Take a look at the explanation of benefits for the particular date of service selected and verify that the insurance plan paid it correctly and that your staff made the appropriate adjustment. Too often, staff assumes the carrier is processing claims correctly with too little attention paid to how much of the charge they adjust when posting the payment. Timely billing and collection activity can improve revenue for 2009.

Set goals to get charges documented in real time and insurance billed within 24 hours of service. Establish goals to have balances collected within 60 days of service. Electronic claims remittance, improved collections when patients are in the office, and an online portal for patients to pay bills will make such a goal realistic.

Train staff to work harder at collecting from patients at the time of service. This is not just a matter of collecting co-pays; it's important to examine the patient's financial record and collect previous balances when the patient is in the office. If this is not a practice in your office, it's time to train staff on how to do it. Communicate the new policy to patients through the practice web site, new patient information packets, and the patient statement. Schedulers should also inform patients of their previous balance when scheduling an appointment.