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Billing Transition in Medical Imaging - a 2010 presentation by Rob Maroszek


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Billing Transition in Medical Imaging - a 2010 presentation by Rob Maroszek
- Trends in Patient Bulk-Billing in Australia
- Viability of Billing Scheme
- Cost vs. Revenue of Radiology Service Providers
- Value vs. Pricing Strategy
- Implications
- Education & Embracing Change
- Outcomes
- Presentation and discussion by MEDIMCO

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Billing Transition in Medical Imaging - a 2010 presentation by Rob Maroszek

  1. 1. The Billing Transition Reasons & Implications Need for Change (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 1
  2. 2. Bulk Billing on the Decline? Copyright, Medicare 2008 (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 2
  3. 3. In the News • Medicare environment makes it increasingly difficult for GPs to rely solely on bulk-billing “Several GPs told Australian Doctor that claims for the $5 and $7.50 MedicarePlus incentives for patients who they believed were clearly eligible — including an 80-year-old pensioner — had been rejected since the HIC started checking patients’ concessional status before paying GPs on 15 November. .. …Sydney GP Dr Barrie Leon said he was livid the HIC had not paid him the $5 incentive for three claims, despite the fact he had sighted the patients’ concession cards. .. …The rejection of 50 of his incentive claims was the last straw for Dr Tony Nigro, of Hurstville, Sydney, who said he planned to stop bulk-billing — which he currently does two days a week — and move to private billing for all patients from January.” (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 3
  4. 4. In the News • The decline of GPs who bulk-bill is imminent. Is it definite? “…The proportion of doctors who bulk bill all patients will fall from 18% today (down from 26% a year ago) to less than 4% in 12 months time… Similarly, the proportion of doctors who do not bulk bill will rise from 12% today (up from 6% a year ago) to 19% over the next year… More than 60% of doctors will reduce the number of patients that are bulk billed…” (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 4
  5. 5. In the News • AMA continues suggesting MBS needs revision. • Past Revisions ”…a 15-minute GP consultation is currently valued at around $27.00. A bulk billing doctor receives only $22.95 under Medicare… Our independent modelling of the RVS shows that the real value is at least $44.00… No wonder, then, that doctors are shifting away from bulk billing in droves… If the MBS is not revised, doctors will simply have to turn away from Medicare, the Government insurer," (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 5
  6. 6. In the News “…Mr Scott said he went into Dr Nachiappan’s Surgery on the town square this week seeking a referral but was told there were no bulk bill appointments available and he should try again at the end of the month…” “…It’s made things quite difficult,” Ms Rebbeck told the BDT. She said bulk bill appointments were always the first to go at the surgery which did offer Mr Scott an emergency appointment…” “…In the interest of sound clinical practice we have emergency appointments available daily although once bulk billing facilities are exhausted, then only the paying slots area available...” (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 6
  7. 7. In the News • The decision to phase out bulk-billing becomes much easier once we realise it is the only way for a practice to survive… “…Bulk-billing just "unviable", says Wendouree doctor Ballarat recorded the greatest drop in bulk billing in the nation, with rates dropping from 52.8 per cent to 43.8 per cent in the first three months of the year… Dr Colin Crook said it was a unanimous decision by the five doctors at the Gillies St Medical Clinic in Wendouree to stop bulk-billing… "It was a decision we took about a year to make so it wasn't taken lightly," he said…” (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 7
  8. 8. In the News • Some large practices made a risky move (patients could have simply turned away) but ultimately made the right move… “AUSTRALIA'S largest medical centre operator has scrapped bulk-billing for most of its South Australian patients - charging $30 an appointment for the same service it provided freelast week. The Australian Medical Association yesterday warned the number of free doctors was dwindling because Medicare rebates were seen to be too low for medical centres to remain viable... ” (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 8
  9. 9. In the News • Bulk-billing alone is NOT a viable patient reimbursement scheme "The Medical Benefits Schedule was established over 20 years ago and since then has never kept pace with either average weekly earnings or the cost of medical services, and the other problem is that there is an increasing burden of red tape and administrative costs and it's no longer sustainable to continue charging at bulk-billing rates for the majority of medical services… “- says AMA state president Dr Andrew Lavender (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 9
  10. 10. In the News • This mentality is a major “stumbling block” • Practitioners provides a truly valuable service, yet themselves are undervaluing it… “…I bulk-bill, not because it’s financially viable, I do it because many people are economically stressed, and secondly, I don’t feel I should collect for this service,’’ Dr Ladhams said. ``That’s a philosophical argument, but when people are sick it is often harder for them to stay financially stable...’‘ (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 10
  11. 11. In the News • Pathology firms had to adjust their pricing model in the past • Ones that didn’t are struggling financially ``…We have all received letters from the major pathology companies informing us of the reduced Medicare benefit provided by the Federal Government for their services,’’ he said. ``…They’ve requested that we do not request all patients be bulk-billed for pathology services. Bulk-billing is to be restricted to pensioners, health card holders and possibly those with chronic and complex conditions that require multiple testing...’’ (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 11
  12. 12. High-end Service + Bulk Billing Low-end Service Bulk Billing High-end Service Privately Billing Low-end Service Privately Billing C o s t Profitability Billing Policy & Pricing Strategy Cost of running the Practice (Equipment, people) Cost vs. Revenue (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 12
  13. 13. • GP Clinic Bulk-Billing Trends applicable to Radiology Service Providers? The “4 Quadrants” of Radiology Provider Types Value vs. Billing (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 13
  14. 14. High-end Service + Bulk Billing Low-end Service Bulk Billing High-end Service Privately Billing Low-end Service Privately Billing Relying on Medicare Relying on Medicare + Patient payments - Radiologist on-site - Electronic reports - Updated equipment - Excellent technologists - Marketing & Communication with referrers - Better patient service - Older equipment - No on-site Radiologist - Limited services - focus on patient turnaround - Overworked MITs (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 14
  15. 15. High-end Service + Bulk Billing Low-end Service Bulk Billing High-end Service Privately Billing Low-end Service Privately Billing Fast, premium service, value- added Low cost service for undemanding patient Company is loosing money. Unique cases only Unaware Patient. Will not come back (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 15
  16. 16. High-end Service + Bulk Billing Low-end Service Bulk Billing High-end Service Privately Billing Low-end Service Privately Billing C o s t Profitability TRANSITION Viable & Sustainable Solution (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 16
  17. 17. Transformation Steps •Aware of the Need •Desire to Change Awareness + Desire •Benefits & Implications for Practice, Patients, Referres •Educate Referrers Understanding + Education •Support the Change •Communicate about Negative feedback (from Patients & Referrers) Collaboration •Support the Change •Take Action if required Commitment •Take initiative to sustain & improve the performance Advocacy (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 17
  18. 18. Competence Confidence (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 18
  19. 19. All about communication to the Marketplace! Marketplace Participants: (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 19
  20. 20. Communication Pipeline Radiologist Radiology Marketing Radiology Front Office Referrer Patient (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 20
  21. 21. Clinical Avenue of Communication MSI Radiologist Referrer • Present the Value Added Component • Personalise the Service and Experience • Achieve Mutual Understanding about Sustainable Billing Policy (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 21
  22. 22. “Liaison” Avenue of Communication Radiology Marketing Referrer • Sell Service, Competency & Value, NOT billing • Focus on commitment to the Patient experience, NOT Patient turnover • Listen carefully, address concerns (from Clinicians & Patients) (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 22
  23. 23. “Front Line” Communication Admins & Front Office Referrer Patient • CRUCIAL line of Communication • Empathetic Listening • Focus on Benefits and True Value • Stay committed to the positive change • Educate the patient about forms of Medicare reimbursement (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 23
  24. 24. Short-term & Long-term Benefits “KEEPING AFLOAT” - Bulk Billing is only a short term benefit for the patient, in the long term Radiology Practice is in jeopardy ATTRACT & RETAIN GREAT DOCTORS - Private Billing will enable having excellent hands-on Radiologists on site INCREASE PATIENT CARE TIME More accurate results less patient anxiety Better with children LESS PATIENT WAITING TIME BETTER FACILITIES FASTER RESULTS Better Report Turnaround Time NEWER EQUIPMENT (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 24
  25. 25. Satisfied Patients • Patients as consumers appreciate less the items that are “free” • “Basic Psychology of Consumer Choice” paying for something, even symbolically $1 creates commitment • With private billing, Patients will expect more, but will also be more involved in the process • Ultimately if treated right will leave the practice more satisfied EVERY TIME! (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 25
  26. 26. Questions & Discussion (c) MEDIMCO, Presenter: Rob Maroszek2010-2011 26