There are many ways that practices can partner with specialists and other providers to bring more services in house and increase revenue. Here are a few examples.
There are many cost effective ways to grow, strengthen, and stay competitive in an existing practice. One of them is by bringing new specialty services in-house.
No longer do we use practice management systems (PMS) to “just” process claims like we did in the nineties. Today, almost all of the PMS programs allow you to not only manage your billing but also grow your practice cost effectively and proactively by utilizing existing patient data. This data is critical when making business decisions. Many physicians still do not think of their practice as a small to medium-sized business, and they make decisions based on feelings or what an associate said.
One of the most cost effective and accurate ways to make decisions about expanding your practice is at your finger tips in your PMS. This data can detail, by diagnosis codes, how many patients you have with specific chronic diseases, which is great information when you are looking to grow and bring on a specialist or develop an internal program with ancillary providers.
Armed with this data, you can look at adding specific revenue-generating services and specialists to your practice. Here are a couple of examples of how a practice can do this.
Under the Affordable Care Act (ACA) there are many preventative services that require no out of pocket co-payments or deductible from the patients. For example, if you are a primary care physician you can check Body Mass Index (BMI) for those patients who appear overweight and be reimbursed. Those patients with a BMI >30 are classed as morbidly obese and are usually covered for 26 weight management office visits. According to the CDC in 2012 35.1% of all adults over the age of 20 are obese. *21-24% of children and adolescence are overweight and between 16-18% are obese.
If your practice has over 120 obese patients—and with these numbers most practices should meet this criteria—you can not only charge for the BMI test and 26 visits, but it makes financial sense to add either a dietitian or a nutritionist to help with diet and exercise. You might also consider getting a psychologist to provide behavioral therapy.
If you have diabetic patients in your practice, and you are primary care or an endocrinologist, your patients can receive up to 10 hours of Diabetes Self Management Training (DSMT) within a continuous 12-months and up to two hours of follow up training each year after the initial year. You can do this by training existing resources or adding another staff person to support this effort.
Tap into HEDIS for diabetic patients as well, and invite a specialist to evaluate for diabetic retinopathy in your office. Diabetic patients should have a complete eye exam once a year, but 80 percent of patients do not have those eye exams. So why not bring an ophthalmologist into your practice on a regular basis to provide this service.
These are just a few examples of ways to expand your practice by offering services supporting by specialists. There are many others. The best way to consider what types of specialty services to offer is by looking at your patient data.
It is important that before you add any service to your practice you contact the health plans and have them add the service to your contract and confirm the reimbursement. You should always develop a financial pro forma that includes all your costs to make sure that the services that you bring in not only provide patient convenience and improve quality care but also add revenue to your bottom line.