Optimizing Revenue
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Webinar presentation for DecisionHealth/PartBNews on how to replace revenue from Medicare sequestration an other losses in revenue.
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Optimizing Revenue
- 1. Presented by David J. Zetter, PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC Presented by David J. Zetter, PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC © 2013 Zetter HealthCare 1 Optimizing Revenue: Reversing Medicare Sequestration & Other Revenue Killers
- 2. • No copyright claimed on government material or information. This material is designed to offer basic information. The information presented is based on the experience, training and interpretation of the author. Although the information has been carefully researched and reviewed for accuracy and completeness, neither the author or DecisionHealth accept any responsibility or liability with regard to errors, omissions, misuse or misinterpretation. 2 © 2013 Zetter HealthCare Disclaimer 2
- 3. Venture into the dark Revenue losses Now and on the horizon Venture into the dark recesses Bring you back into the light Bolster existing revenue streams Develop new, relatively easy revenue streams Bolster the bottom line © 2013 Zetter HealthCare 3 Takeaways
- 4. Current 2% Medicare sequestration cuts $11B cuts in physician revenue How much does this affect you? $700,000 x 30% = $210,000 $210,000 x 2% = $4,200 © 2013 Zetter HealthCare 4 Revenue Losses
- 5. Current & On the horizon Non-compliance w/ Meaningful Use Non-compliance w/ eRx Non-compliance w/ PQRS © 2013 Zetter HealthCare 5 Revenue Losses
- 6. You thought sequestration was bad? Continued poor hiring & staff turnover Continued lack of training, education & oversight Continued lack of structure, policies & procedures Increased utilization review © 2013 Zetter HealthCare 6 Revenue Losses
- 7. © 2013 Zetter HealthCare 7 On The Horizon Initial Offerings: California
- 8. © 2013 Zetter HealthCare 8 On The Horizon Source: Robert Glus, FSA, MAAA Conrad Siegel Actuaries Initial Offerings: Oregon
- 9. The practices that develop good processes, policies & procedures are the ones that are going to survive the approaching stage of changes in the healthcare industry Go after low hanging fruit first Patient SATISFACTION is the key! © 2013 Zetter HealthCare 9 What To Do?
- 10. Verify the cuts are just that Verify you are getting paid what you should Renegotiate your contracts with your payers Payment PRIOR to delivery of service Collect ALL of your co-pays Obtain permission to use credit cards © 2013 Zetter HealthCare 10 Build the Revenue
- 11. Collect the “unknown” monies up front Taking advantage of those preventive services visits Annual wellness visits Recalls Take advantage of the incentives Quality incentives from commercial payers © 2013 Zetter HealthCare 11 Build the Revenue
- 12. Time to evaluate all par plans Inspect what you expect Benchmark your expenses & revenue Utilize metrics to evaluate staff Build a financial policy that means something STOP the “no-shows” © 2013 Zetter HealthCare 12 Build the Revenue
- 13. Re-evaluate A/R collection process Other option: utilize attorney Court/justice system Civil actions Costs usually low Preparation/documentation is key No shows = not many Results in more revenue collected sooner © 2013 Zetter HealthCare 13 Build the Revenue
- 14. Addition of Ancillary services Labs Pathology Rx dispensary In-office ablations © 2013 Zetter HealthCare 14 Build the Revenue
- 15. Let’s talk about… Patient satisfaction… Important? Patient surveys © 2013 Zetter HealthCare 15 Build the Revenue
- 16. Benchmark your expenses & revenue NSCHBC statistics (validated) http://www.nschbc.org/statistics/index.cfm Shop all insurance policies Healthcare benefits are costing more Other benefits Be careful on what you give Incentives You don’t have all the ideas © 2013 Zetter HealthCare 16 Build the Bottom Line
- 17. Lay-offs rarely help Help staff to be productive Reduce -> remove OT Remove the waste Refer-out services with razor thin margins © 2013 Zetter HealthCare 17 Build the Bottom Line
- 18. Do nothing Do something © 2013 Zetter HealthCare 18 The Decision – The Action
- 19. Sequestration Other revenue killers Coming changes in insurance What you can/should do Building the bottom line Change keeps coming, will you take advantage of the opportunities? © 2013 Zetter HealthCare 19 Review
- 20. © 2013 Zetter HealthCare 20 For Follow-up & Further Questions Contact: David J. Zetter, PHR, CHCC, CHCO, CPC, CPC-H, PCS, FCS, CHBC 717.691.7100 Email: djzetter@zetter.com Subscribe to our newsletter at Follow us on www.twitter.com/djzetter and www.linkedin.com/in/djzetter
Editor's Notes
- There’s a sound that you hear in the background That sound is a “sucking” sound that is sucking the revenue out of your practice How do you get rid of the sound and reverse the revenue losses?
- Into the dark where you do not want to go
- Need numbers and percentages here for all of these programs Meaningful Use eRx PQRS 2015 1% 2012 1% 2015 1.5% 2016 2% 2013 1.5% 2016 2.0% 2017 3% 2014 2.0% Bill being proposed in Congress to move up the payment adjustments for PQRS and increase them and increase them more quickly What about going through meaningful use audits and not being able to pass the audit… return the money
- Utilization reviews to include: all level 4s & 5s Modifier -25 Out-of-network referrals (Labs, imaging, etc) Expanded extrapolations
- Higher deductible plans are coming with the onset of the insurance marketplace (AKA exchanges)
- Highest deductible in Oregon is currently $12,500 How do you ensure you don’t lose any of that money that is now part of the patient responsibility?
- You need to decide what the low hanging fruit is
- Verify you the Medicare is only taking the 2% Hold the payers accountable to what is in your contract Obtain all payer reimbursement fee schedules Renegotiate the rates as well as the language Reimbursement timeframe Clawback timeframes Ability to collect on non-covered services Email consults Telephone consults Electronic insurance verification & eligibility of benefits
- Don’t see the value in $17 to $25 reimbursements for screenings on alcohol use, depression and intensive behavioral therapy for cardiovascular disease and obesity… Every dollar counts. Preventive services turn into additional services Recalls for preventive services, specialty exams and procedures (colos, derm skin scans, etc)
- Should you keep accepting Medicaid patients? Is it time to close your panel? Is it time to drop a plan… all the plans? Should you drop Medicare? Perform the calculation… If you remove this type of patient from your practice, can you fill the schedule with better paying patients? Who determines whether they are better paying patients (know your contracts) ophthalmology, cardiology, internal medicine, orthopedics and other specialties , Medicare is your bread and butter. Be careful what you wish for Inspect – Perform daily, weekly and monthly reconciliations to ensure all the cash in the door gets into the bank
- Some ancillaries will bring bigger revenue and profits, but there is an investment cost as well Examples of putting in additional equipment and profit increases nearly $400,000 over 5 years in a prior loss producing lab Perform the ROI calculation PRIOR to making any investment in equipment or construction
- Are your patients generally “satisfied” with your practices and services rendered? Are your staff sympathetic, empathetic, patient focused, practice focused? You want more than just satisfaction… you want them to sing your praises Example: Aspire This is what guarantees your practice existence
- NSCHBC statistics – validated against tax returns, not obtained through a survey Malpractice, P&C, D&O, Life insurance, etc Health, dental, vision costs are all going up. The size of your practice will determine the level of expense Wellness programs Employee requirements of wellness, preventive services, etc i.e. Don’t get a flu shot, could be fired Vacation, sick, personal (PTO) Carry overs affect budgets every year Too much time off will affect the productivity and morale of the other employees What about those that don’t take their vacation… someone is lurking Force the vacations What you give should not be taken away Morale will suffer and so will productivity Bonuses are better than raises Reward people when the practice does well – utilize milestones and metrics
- Layoffs just put more work and stress on retained employees Evaluate positions and work duties to determine the proper amount of staff There are no benchmarks for this… every practice is different and every employee is different Provide expectations, job descriptions, training, education Help Staff be more productive Negotiate Out-of-network claims Patient reminder calls – outsource at much lower cost than labor Electronic check-in/payment collection - outsource at much lower cost than labor Electronic insurance verification - outsource at much lower cost than labor Electronic eligibility of benefits - outsource at much lower cost than labor Electronic remittance posting - outsource at much lower cost than labor Obtain ideas from staff on waste removing ideas Reward them with a % of savings Razor thin margins – drug therapies / infusions Evaluate your process – i.e. infusions provided in one chair over the week vs two chairs on one day Ties up less nurse time, preparation and clean-up
- Even a laissez-faire business approach needs to include checking payer reimbursements against fee schedules. “Many of these are things you should be doing all the time whether there’s a 2% cut or not,” Healthcare is an industry that will guarantee job growth for many years to come What are you going to do to ensure you keep yours, but even more, ensure you are sought after
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