Transcript Practice Management Series 2004

ASCO
Clinical Practice
Series
Practice Management
Series
2004 - 2005
Practice Management Curriculum
1. Adapting to Changes in Medicare
2. Generating Practice Efficiencies
3. Organizing for Service Expansion
Generating Practice Efficiencies
Streamlining work flow
Increasing patient flow per physician
Maximizing charge capture
Managing expensive inventories
Lowering cost
Who should attend
Physician Leader of the Practice
 President of the PA, Founder
Practice Administrator
 CEO, Executive Director, COO
Contracting Officer
 Contract Administrator, Director of Billing
Clinical Manager
 Medical Director, Nursing Team Leader
After this session, you will be able to:
Understand the need for assessment and benchmarking.
Perform a simple assessment to identify areas where cost
savings may be found.
Develop plans to implement beneficial changes based on
this assessment.
Describe cost savings and efficiency techniques to assist
your practice as reimbursement changes.
Efficiency:
 Ability to produce the desired effect with
a minimum of effort, expense or waste
Webster’s New Twentieth Century
Dictionary, Unabridged
Why is efficiency important?
The oncology world has changed….
…life as you know it is over
Medicare Prescription Drug Improvement and
Modernization Act (MMA) 2003
Why us?
It’s not personal!
Medicine is being impacted just like every other
industry in our economy
It’s all about…
↑ quality
↓ cost
The Old Days
Median Per FTE Medical Oncologist
Compiled from MGMA Cost Survey through 2004 Report on 2003 Data.
2004 trending by third order polynomial by Oncology Metrics, LP
$3,500
R2 = 0.989
$3,000
$2,500
R2 = 0.9902
Thousands
$2,000
$1,500
R2 = 0.9208
$1,000
$500
$-
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Total Medical Revenue
Total Operating Costs
Rev. After Operating Costs
MMA Impact
Per Oncologist with projections by Oncology Metrics
$2,000,000
$1,800,000
$1,600,000
$1,400,000
$1,200,000
$1,000,000
$800,000
$600,000
$400,000
$200,000
$2000
Drug Cost
2002
2003
Drug Revenue
2004
2005
Drug Marginal Revenue
Practice Efficiency:
Focus on Largest Expenses First
AOHA/MGMA 2003 Report on 2002 Data
Ancillary Supp
staff 2%
Support staff
benefits
3%
Mid Level
Provider
1%
Prof liability
insurance
0%
Clin. Support
Staff 6%
Physician
26%
COGS
62%
Set Your Priorities
1. Drug Management
2. Physician Efficiency
3. Staffing
Benchmarking
Why?
 Benchmark your practice metrics to
discover potential work flow and/or staffing
efficiencies
 Lower the cost of practice operations
 Better inventory control
 Improved patient scheduling
 Streamlined work flow from clinic to billing
office
Benchmarking
How?
 Informal – conversations, visits with
colleagues, oncology practice list
serves
 More formal – use a standard such as
MGMA’s Cost Survey for Hematology
Oncology Practices
 Most important to benchmark against
yourself over time
COGS Benchmarking
Using the MGMA AOHA Hematology/Oncology Cost Survey: 2003 Report Based on 2002 Data
Table 1.8b
2003 Report Based on 2002 Data
Per FTE
Physician
Count
Mean
25th
Median
75th
90th
Total Chemo Med
Surg. Costs
45
$1,133,798
$ 751,859
$ 1,053,518
$ 1,387,087
$ 2,165,165
COGS Benchmarking
Using the MGMA AOHA Hematology/Oncology Cost Survey: 2003 Report Based on 2002 Data
1. Write down your COGS for 2004
2. Divide it by $1,250,000 (2004 trend based on
2002 data from MGMA/AOHA survey; median COGS
per physician)
3. Result is the number of physicians that your
COGS would support
4. Compare this to actual physicians and if it is
much higher or lower, keep asking why
Drug Management
Drug procurement and inventory management processes
must be tight
 Contracting
 Ordering
 Shrinkage
 Inventory management
 Monthly reports - compare inventory levels to billed
units
 Who is managing this process for your practice?
Drug Management
Look at how you add new drugs to your practice
formulary to assure financial feasibility
Practice standardization, pharmaco-economics
review
 Start simple - hydration, anti-emetics
 Then look at treatment protocols by disease, one
disease at a time
 Knowledge is power, you can’t control what you
don’t measure
Drug Management
Pharmacy safety
 OSHA fines are expensive
Nursing policies
 Errors are expensive – charge capture errors,
chemo preparation errors
Who is mixing your drugs?
 Recent articles indicate ~50% nurses, 50%
pharmacists
 Dependent on practice size, state regulations
Drug Management – Looking Ahead
In 2006, CMS is proposing a Competitive Acquisition
Program (CAP) for drugs
Providers will choose between CAP and ASP + 6%
Do you understand your pharmacy costs?
 Are you managing inventory, controlling shrinkage,
collecting co-pays on drugs?
If you can buy drugs at or below ASP…and you can
collect all of your co-pays…can you run your pharmacy
on 6%?
Know your costs - get ready for 2006
Physician Productivity Benchmarking
Using the MGMA AOHA Hematology/Oncology Cost Survey: 2003 Report Based on 2002 Data
Table 1.8b
2003 Report Based on 2002 Data
Per FTE
Physician
Count
Mean
25th
Median
75th
90th
Consultations
& New Patients
39
308
185
231
345
442
Physician Productivity Benchmarking
Using the MGMA AOHA Hematology/Oncology Cost Survey: 2003 Report Based on 2002 Data
• Write down the number of consultations and new
patients (99241-99255, 99201–99205) in 2004
• Divide it by 231, the survey median of consultations per
physician in 2002
• Result is the number of physicians that your new patient
service volume would support
• Are you above or below the actual number of physicians
in your practice?
• Why?
Relative Benchmarks
1. New Patients and COGS are both greater than
the actual number of physicians and yielding
about the same physician count
 Indicates good physician utilization and pharmacy
control
2. New Patients about right but COGS shows
higher number of physicians
 Indicates potential savings for COGS management
Increasing Patient Flow
Physicians Should…
Communicate with referring physicians – this drives
practice growth
See new patients – this drives practice growth
Be seen at the hospital, participate in medical staff life
See follow-up patients on a regular, clinically appropriate
basis
Delegate some follow-up visits to other providers as
appropriate – PA, NP, RN
Ensure quality of care throughout practice
Increasing Patient Flow
Physicians Should Not…
Routinely be late for clinic
Spend time filling out forms (ex. disability, tumor
registry)
Provide routine patient education
Return routine patient phone calls (prescription refills,
etc.)
Micro-manage staff
Undermine authority of administrator
Increasing Patient Flow
Administrators Should…
Assure that there are adequate exam
rooms for each physician
Provide appropriate patient scheduling,
individualized by physician if necessary
Use other staff, clinical and
administrative, to free up physician time
whenever possible
Increasing Patient Flow
Administrators Should Not…
Practice medicine or offer their clinical
opinion to anyone, ever!
Undermine the clinical authority of any of
the practice physicians
Undermine the business and leadership
authority of the physician leader
Increasing Patient Flow
Should you consider a Non-Physician Practitioner?
Also known as “mid-level providers,” includes PA, NP,
CNS
Increase patient volume at less expense than adding a
physician
Allow more flexibility in scheduling patient visits, more
consistent schedule than physicians
Generate revenue for practice even if physician is out of
office
Coverage for physician vacations – better continuity of
care
Increasing Patient Flow
Non-physician Practitioners Should…
Work as an adjunct to the physicians
See routine follow-up patients, chemotherapy
visits, other routine visits
Allow physicians to see more new patients,
consultations
Serve as a resource for nurses, other staff
Increasing Patient Flow
Non-physician Practitioners Should Not...
See new patients
Practice beyond their state scope of
practice
Practice Efficiency
Staffing
Ensure that you are using all staff in the most
appropriate way for the size of your practice
Manage your overtime
Task Analysis




Who does it?
Can anyone else do it?
How do they do it?
Can it be done better?
Practice Efficiency
Nurses Should…
Administer chemotherapy – patient assessment, check
doses, discuss side effects, mix chemo in many practices
Counsel patients – symptom relief, social issues
Phone triage - answer patient’s symptom-related phone
calls
Patient education
Help with drug assistance programs and indigent drug
forms
Practice Efficiency
Nurses Should Not…
File
Schedule appointments
Handle pre-certs, pre-auths
Practice Efficiency
Patient Flow
How do your patients get from waiting room to
exam room?
Who checks vital signs, preps patients for their
visit?
Who assists the physician with exams?
Who gives injections?
Does it have to be a nurse?
Practice Efficiency
Chart flow
Can you find a chart when you need it?
How does it get from file to desk or file to exam
room?
Who gets it there?
Do you have a policy on charts leaving the office?
How long (and how many staff) does it take to
find a chart that is MIA?
Other Efficiency Opportunities
Billing is important
 Review your billing processes – is charge capture
fast and accurate?
 How quickly are your charges sent to insurance?
 Is your charge ticket updated every year? Are all
new codes included?
 Make sure all of your staff is trained on billing and
coding changes as they occur
 Are you billing for the demonstration project for
every eligible patient?
Other Efficiency Opportunities
Collecting is important too!
 Financial Counseling
 Identify patients with no insurance, poor insurance
 Identify patients with no 2nd insurance
 Refer patients to appropriate resources - sources
for 2nd insurance, Medicaid if appropriate
 Inform the physician and nurse of insurance issues
as soon as they are identified
Other Efficiency Opportunities
Purchasing
 Chemotherapy Drugs – shop wholesalers
 Medical supplies – put out to aggressive
bidding process
 Office supplies – who’s in charge? Don’t let
the little things add up
Other Efficiency Opportunities
Information Systems
 Practice management system
 Network administration
 Software and hardware support
 Clinical Management Systems –
LIS, CPOE, EMR
Efficiency:
 Ability to produce the desired effect with
a minimum of effort, expense or waste
Webster’s New Twentieth
Century Dictionary, Unabridged