Capturing revenue from the specialized practice

Three tips and tricks for firms looking to increase their bottom line.

Two out of three doctors surveyed at the LUGPA regional meeting last spring cited rising costs and falling reimbursements as one of the main challenges they face in the era of COVID-19 care. . It’s a challenge that requires a fresh look at ways to increase efficiency and revenue, even as labor shortages and pandemic-specific hurdles weigh on resources.

For example, supply chain challenges, such as a shortage of contrast dyes that prevent some patients from receiving CT scans to monitor tumors or even detect a kidney stone, not only make it difficult to treat health issues patients, but also monitoring the progression of the disease. This creates scenarios where patients who are more symptomatic may receive diagnostic tests while others go without. It is too early to say what the long-term impact of this crisis might be.

Then there are the factors that continue to prevent people from pursuing the care they need, from fear of being exposed to the coronavirus to concerns about the cost of care, long wait times for appointments, you and the tendency of some patients to put the care needs of family members, especially the care needs of their children, before their own.

How can specialist care practices strengthen quality of care, access and income in the face of such challenges? Here are three approaches to consider.

1. Explore opportunities to expand ancillary service offerings and promote them widely. For example, at Genesis Healthcare Partners in Los Angeles, the urology practice offers genetic testing to family members of prostate cancer patients, given the increased risk of aggressive prostate cancer in men. with a family history of this disease. Among the top ancillary investments for urology practices alone, according to an analysis by McGuire Woods: radiation therapy, surgery centers, lithotripsy, and on-site labs and pharmacies.

Ancillary services make care more convenient for patients by providing a one-stop experience to meet their comprehensive care needs for a specific condition. It also eliminates travel to multiple destinations for patients whose health makes it physically difficult to navigate facilities. Increasingly, specialty practices are entering into administrative and financial partnerships to manage ancillary services and access funding to launch new services or expand existing ones.

One way to promote existing service lines more broadly is to leverage patient data to identify patients who could benefit from a particular in-house service. Examples in specialties include nutrition counseling, a sleep apnea clinic, a cystitis clinic, physiotherapy, and behavioral health services.

2. Make chronic care management more meaningful. Leading practice specialties explore chronic care management (CCM) and primary care management (PCM) to improve outcomes for patients with chronic conditions while increasing revenue. This year, the Centers for Medicare & Medicaid Services (CMS) added four new codes for PCM, which allow physicians to receive additional reimbursement for their work in managing a single chronic condition. To qualify, the condition must put the patient at risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, with reimbursement dependent in part on a disease-specific plan of care. The CCM, on the other hand, reimburses medical practices for care provided to a Medicare patient with two or more chronic conditions outside of the patient’s regular office visit. But capturing CCM and PCM activities—a necessity for reimbursement—requires a software platform to track and manage care activities for this population, many of whom have multiple health needs.

3. Look for ways to make virtual care more effective. As care evolves into a hybrid environment – ​​part in-person, part virtual, depending on the preferences and needs of the patient and the comfort level of the provider – there are many opportunities to improve the virtual care experience for doctors and patients. For example, rather than letting the doctor initiate the virtual care appointment, assign this task to a physician assistant, who can prepare the patient and doctor for the encounter, initiate the call, and alert the patient and doctor when ‘it’s time to live’ with care. This ensures that the tour starts as smoothly as possible. It also preserves doctors’ time for real patient care activities, rather than the administrative work associated with the encounter.

Telepatient monitoring (RPM) and therapeutic telemonitoring (RTM) are two other activities eligible for CMS reimbursement and, when used effectively, can significantly reduce hospital readmissions (by 64% for patients alone). cardiac patients). The key to operational efficiency and better outcomes: a tool that analyzes real-time RPM and RTM data and alerts medical assistants when patient vital signs signal a need for intervention.

By exploring opportunities to strengthen patient care and services while creating new revenue streams, specialty practices will be better positioned to engage members with complex care needs, to minimize provider and staff burnout. clinic and to protect their results.

Shirley H. Lee, CRNP-FNP, MPH, is Director of Patient Navigation and Nurse Practitioner for Genesis Healthcare Partners, PC. She is also Vice President of Clinical Strategy for Preveta. She is based in Los Angeles.

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