We all know the scenario - a really terrific doctor who is very skilled clinically and who cares deeply about their patients and their well being. They are good at being doctors. But their practice is struggling - struggling financially even though their schedules are full. Or they are struggling with frequent and disruptive staff turnover. Or they are struggling under mounds of denied claims and high accounts receivable - having done the work for the patients but not received payment from the insurance company. Unfortunately these scenarios are not uncommon.
The fact that they are struggling is not lost on these physicians. In a 2012 study by Accenture on Physician Alignment, physicians reported the following:
-61% of physicians surveyed identified help with "business operations" as one of the main reasons they are seeking hospital employment.
-74% of primary care physicians responded that they lack financial controls over their practice.
-83% reported being affiliated with a medical practice that had been the victim of employee theft or embezzlement.
While physicians have generally received extensive training on how to care for patients in their chosen specialty, most have received minimal training on how to run the business of a medical practice. Given the complexity inherent in running the business operations of a practice today, it is no wonder that many independent physicians are struggling to remain viable. Today's successful practice requires significant automation and sophistication to keep up with coding rules, claim filing requirements, increasingly complex plan designs that allocate payment responsibilities to primary, secondary payors and patients and to efficiently monitor payments against often outdated fee schedules.
Many small to mid-sized practices that are still opting to try and "go it alone" have 1-2 people responsible for the revenue cycle processes. These staff will be responsible for patient check in, insurance verification, collecting co-pays and other patient responsibilities, taking phone calls from patients who have questions about their bill, submitting claims on a timely basis, handling often indecipherable rejections from clearinghouses, post payments from stacks of paper EOBs, stay current with coding rules and the appropriate use of modifiers and somehow find the time to aggressively follow up on the mounds of denials that almost always get put on the bottom of the ‘To Do’ pile. To make matters worse, they are often doing this work without the benefit of advanced revenue cycle systems that can streamline these processes. And then what happens when this person is out sick or on vacation or leaves?
Little wonder that physicians are increasingly looking to hospitals and other partners to provide additional resources and structure. But what about the physician who wants to remain independent? The physician who wants to control their own destiny, run their own operation with the type of culture and environment they are comfortable with, who want to structure their services, their hours and their schedules on their terms?
There is an option for these practices but today's increasingly demanding regulatory and government environment leaves little wriggle room for missteps. Physicians will need to look at their operation with the same critical eye that they bring to the process of diagnosing a problem with a patient. They need to embrace ‘best practices’ at all steps in the revenue cycle - front-end intake, collecting patient responsibility and payor follow up; invest in business automation tools that streamline things like eligibility verification, electronic submission and electronic posting; and, incorporate intelligent systems that aid in coding and hold payors accountable to paying timely and correctly. Then they will need to hire and train a team large enough and sophisticated enough to manage these new processes and leverage these new tools.
If a practice has access to significant capital to invest in these systems and this type of team, they are the unusual practice. For the practices that don't; luckily, they don't have to go it alone.
The practices that would like to remain independent but don't have unlimited financial or human capital should consider "in-sourcing" as an option. With insourcing, practices can leverage the resources and capabilities of a trusted, stable partner that has the significant expertise, technical knowhow and capital required and is focused on ensuring the practice's financial success. In this way, practices can leverage the benefits of operational scale, technical expertise and capital investment of a business partner. The right partner will bring the tools and systems to ensure patient intake procedures are optimized and services are coded accurately and have the skills and knowledge to hold payors accountable to pay for the services provided.
By working with a company that is wholly focused on business operations and revenue cycle optimization, practices can maintain control over all clinical decisions and thrive as an independent practice. Read the White Paper Here