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

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Enhancing Services to New and Existing
Physician Clients

• Suzanne Denzine, CPA, CHCC
• sdenzine_at_KolbCo.com

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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

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In Addition to Physicians

• Expand your definition of Health Care
  owners/stakeholders
• MDs, DOs, Behavioral Health Practitioners
• Advanced Level Practitioners (NPs and PAs)
• Dentists
• Veterinarians

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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

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How to Enhance My Services to New or Existing
Medical Clients?

• Add value to existing services
• Understand their Revenue Cycle challenges be
  proactive
• Additional Specialty Services to consider for
  building on your health care niche

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Current Services

• Change Management
• 2012-2013 substantial changes occurring in health
  care
• 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

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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

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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

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Polling Question
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Management with SMART Ideas

• S Systems
• M Management Outsourcing
• A Accounts Receivable
• R Revenue Cycle
• T Targeting the low hanging fruit

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Management with SMART Ideas

• S Systems
• EMR systems
• Recall systems
• Collections fees
• Desktop power station

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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

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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
  collect

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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

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Management with SMART Ideas
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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

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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

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Industry Benchmarks

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

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Industry Benchmarks

• Exhibit B

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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

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The Business of Medicine
Exhibit C
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Flaws in the Analysis

• Bundling of owners benefits into operating cost
• Comparative analysis missing from the financial
  statements

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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

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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

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Polling Question
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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

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Merging Medical Practices

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

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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

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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
  type(s)
• Episodic care reimbursement (global payment
  inclusive of all care provided)
• Quality initiative components

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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

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ACO/MSO/IPA Formation/Utilization

• MSO (Managed Service Organizations)
• Specialty specific
• Payer contracting
• Not as viable in the current insurance environment

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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

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Changing the Physician Compensation Formula

• Reasons for change
• Fairness
• Current formula is not working
• Stark provisions
• Other client service issues

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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

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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

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Polling Question
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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

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Implementation of EMR

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

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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

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Help Build New Revenue Opportunities

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

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Review and Implementation of Practice Internal
Controls

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

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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

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Are You Taking Care of the Physicians Personal
Finances?

• Risk management insurance review
• Retirement plan options
• Wealth management
• Tax planning
• Huge for 2013 and going forward

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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

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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

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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

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Clinical Encounters

• Documentation and compliance
• Utilizing extenders
• Continuity of care

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Provider Work RVUs

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

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Referring Doctor Trends

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

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Organizations to Join

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

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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

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Questions and Answers

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