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Title: Enhancing%20Services%20to%20New%20and%20Existing%20Physician%20Clients

Enhancing Services to New and Existing
Physician Clients
  • Suzanne Denzine, CPA, CHCC
  • sdenzine_at_KolbCo.com

Your Presenter
  • Suzanne Denzine, CPA, CHCC
  • Shareholder and Health Care Consultant
  • Expertise in operations and personnel management,
    physician compensation arrangements, business
    analytics, HIPAA regulations and assessments,
    OSHA compliance, fee analysis, compliance
    programs, physician/hospital relationships,
    third-party payer contracts and negotiations, and
    practice start-ups

In Addition to Physicians
  • Expand your definition of Health Care
  • MDs, DOs, Behavioral Health Practitioners
  • Advanced Level Practitioners (NPs and PAs)
  • Dentists
  • Veterinarians

Why I Dont See Value in My CPA
  • From the client perspective
  • Current on upcoming Health Care reform issues
  • Proactive planning ideas included with financial
    statements not just historical financial data
  • What are the numbers telling me?
  • Value of service not demonstrated

How to Enhance My Services to New or Existing
Medical Clients?
  • Add value to existing services
  • Understand their Revenue Cycle challenges be
  • Additional Specialty Services to consider for
    building on your health care niche

Current Services
  • Change Management
  • 2012-2013 substantial changes occurring in health
  • SGR - Potential Medicare reduction in
    reimbursement rates again for 2013
  • How will practices be able to absorb a 30
    reduction in Medicare reimbursement?
  • Commercial payers fee schedules at less than 100
    of Medicare reimbursements
  • Implementation of electronic medical records
  • How practices meet 1st stage meaningful use in
  • 2012 or 2013

Current Services
  • Change Management
  • Health care consolidation choices
  • Requires in-depth knowledge
  • Of the organization
  • Of the health care industry
  • Of the medical practice model
  • Knowledge-base to work through changes in
    critical parts of a practice

Current Services
  • Look for other ways to add value
  • Do you review the financial reports with your
    clients in person?
  • Are your statements presented in a format
    specific to medical practices?
  • Is a production analysis report part of your
    business analysis?
  • Example provide gross and net collection rates
    global and by provider

Polling Question
Management with SMART Ideas
  • S Systems
  • M Management Outsourcing
  • A Accounts Receivable
  • R Revenue Cycle
  • T Targeting the low hanging fruit

Management with SMART Ideas
  • S Systems
  • EMR systems
  • Recall systems
  • Collections fees
  • Desktop power station

Management with SMART Ideas
  • M Management Outsourcing
  • Be an adviser on what is right for a practice
  • Is there a right answer?
  • Examples
  • Coding expert
  • Business analytics consulting
  • Cost accounting
  • Transcription

Management with SMART Ideas
  • A Accounts Receivable
  • Basic Tenets of a Good Collection Strategy
  • Developed written financial policies
  • Verify patients insurance coverage
  • Set clear expectations
  • Collect at time of service
  • Make easy and convenient to pay
  • Offer flexible payment options
  • Create team responsibility and incentive to

Management with SMART Ideas
  • What are the benchmarks that count?
  • Net collection rate
  • 99 or better is a STAR
  • Days in A/R
  • Under 35 days in total is a STAR
  • Exhibit A

Management with SMART Ideas
Management with SMART Ideas
  • R Revenue Cycle
  • Is a practice leaving money on the table?
  • Managed care contract analysis
  • Payer mix, service codes
  • Constantly changing payer requirements
  • Missing patient encounter information

Management with SMART Ideas
  • T Targeting the low hanging fruit
  • Staffing per FTE physician vs. provider
  • Co-payment collection rates
  • Surgery deposits prior to the encounter
  • Denial percentage
  • Scrubbers/PPM prior to submitting to insurance
  • Knowledgeable coding staff

Industry Benchmarks
  • Available through the MGMA and other outside
  • RVUs by specialty and geographic area
  • Production, Cost and Compensation data
  • Overhead (See Exhibit B)
  • Revenue Cycle

Industry Benchmarks
  • Exhibit B

The Business of Medicine
  • Incorporate financial statement format aligned to
    the health care practice (see Exhibit C)
  • Income tax basis
  • Health care nuances
  • Owner/Doctor segregation

The Business of Medicine
Exhibit C
Flaws in the Analysis
  • Bundling of owners benefits into operating cost
  • Comparative analysis missing from the financial

Overhead Analysis
  • Personal costs
  • Practice development costs
  • Malpractice practice insurance
  • Bank Charges
  • Staffing/Benefits
  • Rent
  • Computer service related expenses
  • Repair maintenance expenses
  • Miscellaneous expenses
  • Other income

Developing New Specialty Services
  • Add value to services
  • Services independent of one another
  • Identify additional skill sets/tool box
  • Employee benefit costs
  • Forensic accounting analysis
  • Internal control analysis
  • Revenue cycle system analysis
  • HIPAA privacy security assessments

Polling Question
Merging Medical Practices
  • Consolidation in the independent physician group
    practice to
  • Specialty groups merging (Ex., cardiologists,
    cardiac surgeons and electro physiologists or
    ortho with physiatry and podiatry)
  • Larger, multi-specialty groups
  • Hospital system purchase
  • Accountable care organizations

Merging Medical Practices
  • Reasons
  • Accountable care organizations benefits and
  • Lower payer reimbursements
  • Payer contracting efficiencies
  • Payment methodologies
  • Fee for Service
  • Episodic payments

Merging Medical Practices
  • Reasons
  • Overhead cost reductions
  • Eliminate duplication of services and site costs
  • Gain multiple service discounts
  • (malpractice insurance etc.)
  • Issues
  • Site(s) maintain or eliminate
  • Governance
  • Personnel reduction
  • Production and profit distribution formulas

ACO/MSO/IPA Formation/Utilization
  • Accountable Care Organizations
  • New type of organization
  • Members can be health care organizations and/or
    employed physicians, independent providers
  • Addresses accountability for new HC reimbursement
  • Episodic care reimbursement (global payment
    inclusive of all care provided)
  • Quality initiative components

ACO/MSO/IPA Formation/Utilization
  • Accountable Care Organizations cont.
  • IPAs (Independent Physician Associations)
  • Many merging to ACO structure
  • Primary purpose of IPAs are
  • Payer contracting
  • Quality Initiatives w/ Medicare or other
    commercial payers
  • Service arrangement cost reductions
  • Provider system support
  • PM system
  • EMR system

ACO/MSO/IPA Formation/Utilization
  • MSO (Managed Service Organizations)
  • Specialty specific
  • Payer contracting
  • Not as viable in the current insurance environment

Adding a Physician or Other Ancillary Staff
  • Basis for
  • Volume expansion
  • New sites
  • Payer or service areas
  • Expansion into another service
  • Ex. Ortho - foot ankle
  • Next generation
  • Owners are five or less years to retirement

Changing the Physician Compensation Formula
  • Reasons for change
  • Fairness
  • Current formula is not working
  • Stark provisions
  • Other client service issues

Changing the Physician Compensation Formula
  • Factors in change
  • Base formula factors shared vs. direct
    compensation and expenses
  • Managing physician director
  • change in baseline factors
  • 90/10 to 70/30 equalization
  • Meeting Stark provisions for ancillary services
  • Volume considerations
  • Maximum OH allocations

Changing the Physician Compensation Formula
  • Factors in change
  • Initiating more factors on compensation on
    quality indicators, patient satisfaction and
    achieving certain disease quality indicators
  • Adding Quality metrics
  • RVU compensation models

Polling Question
Office Sharing with Another Practice
  • Assist a small practice to establish an office
    with a shared overhead arrangement
  • Assist the client with analysis of the shared
    overhead arrangement
  • Establish the shared space

Implementation of EMR
  • EMR implementation activity increasing due to
    government incentives
  • Practices need assistance with planning and
    project management

Make Stakeholders out of the Employees
  • Driven by management
  • Promote TEAM environment
  • Merit bonus plans vs. COL increases
  • Mission statement driven
  • Patient quality and service areas
  • Patient surveys can facilitate the review
  • Hotline for patient complaints

Help Build New Revenue Opportunities
  • Practice areas
  • Use of EMR
  • Meet Meaningful Use attestation for incentive
  • Adding physician extenders
  • Review specialty specific competitors
  • Ob/Gyn weight loss clinic
  • Acupuncture healing center (cancer treatment
  • Ortho add OT/PT, podiatry etc

Review and Implementation of Practice Internal
  • Separation of Duties
  • Controls in systems
  • Dual access and management
  • Limitations on access
  • Time off requirements require staff to take
  • Workflow analysis and access
  • Determine weak areas in controls
  • Work with CPA to monitor and provide business

Look for Signs of Financial Problems
  • Declining revenue current and over time
  • Payer mix analysis
  • No show rates
  • Patient seen rates per day/provider
  • A/R days outstanding increasing or higher than
    specialty specific benchmarks
  • Prior authorization issue UHC/Humana

Are You Taking Care of the Physicians Personal
  • Risk management insurance review
  • Retirement plan options
  • Wealth management
  • Tax planning
  • Huge for 2013 and going forward

Examples of Specialized Service
  • Physician compensation structure
  • Billing revenue cycle audit
  • Practice start-ups
  • Practice on-going management
  • Compliance plan development or update
  • Strategic planning
  • Shareholder code of conduct
  • HR services recruitment

Examples of Specialized Service
  • HIPAA Privacy and Security assessments
  • Technology deployment
  • Employment agreements
  • Buy/sell agreements
  • Structuring buy-in/buy-out
  • Merger and acquisition analysis and facilitation
  • Practice valuations

Practice Management Reports
  • CPA prepared
  • A/R analysis
  • Provider analysis
  • Service line revenue/cost analysis
  • PM dashboards
  • Daily A/R reports
  • Denial rates
  • Referral base tracking reports

Clinical Encounters
  • Documentation and compliance
  • Utilizing extenders
  • Continuity of care

Provider Work RVUs
  • Portion of Medicare and other payer reimbursement
  • Used in physician compensation formula
  • Provider production analysis

Referring Doctor Trends
  • How do new patients get referred to the practice?
    Do you know?
  • Is reporting available?
  • Why are referral patterns important?

Organizations to Join
  • HCAA (National CPA Health Care Advisors
  • PVN (Physicians Viewpoint Network)
  • MGMA (Medical Group Management Association)
  • State MGMA associations
  • HIMSS (Health Information and Management Systems

Keys to Success
  • Look for ways to add value
  • Go beyond the numbers
  • Look for opportunities that can be replicated in
    other practices
  • Compliance plan
  • Make your health care niche known
  • LinkedIn, Twitter, Facebook page etc.
  • Form an advisory group of professionals for your
    area quarterly meetings

Questions and Answers
  • Thank you!
  • Sue Denzine
  • sdenzine_at_KolbCo.com
  • 800/461-8843
  • www.KolbCo.com
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