Practice Management Series 2004 - 2005 ASCO Clinical Practice Series.
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Practice Management Series
2004 - 2005
ASCOClinical Practice
Series
Practice Management Curriculum
1. Adapting to Changes in Medicare
2. Generating Practice Efficiencies
3. Organizing for Service Expansion
Generating Practice Efficiencies
Streamlining work flowIncreasing patient flow per physicianMaximizing charge captureManaging expensive inventoriesLowering 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 economyIt’s all about…
↑ quality
↓ cost
The Old DaysMedian 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
R2 = 0.989
R2 = 0.9902
R2 = 0.9208
$-
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Thousands
Total Medical Revenue Total Operating Costs Rev. After Operating Costs
MMA ImpactPer Oncologist with projections by Oncology Metrics
$-
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
$1,400,000
$1,600,000
$1,800,000
$2,000,000
2000 2002 2003 2004 2005
Drug Cost Drug Revenue Drug Marginal Revenue
ThenNow
Practice Efficiency:Focus on Largest Expenses First
AOHA/MGMA 2003 Report on 2002 Data
Set Your Priorities
1. Drug Management 2. Physician Efficiency 3. Staffing
BenchmarkingWhy?
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
BenchmarkingHow?
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 BenchmarkingUsing the MGMA AOHA Hematology/Oncology Cost Survey: 2003 Report Based on 2002
Data
Table 1.8b2003 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
#1 Cost
COGS BenchmarkingUsing the MGMA AOHA Hematology/Oncology Cost Survey: 2003 Report Based on 2002
Data
1. Write down your COGS for 20042. 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
#1 Cost
Drug ManagementDrug 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?
#1 Cost
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
#1 Cost
Drug ManagementPharmacy 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
#1 Cost
Drug Management – Looking Ahead
In 2006, CMS is proposing a Competitive Acquisition Program (CAP) for drugsProviders 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 1.8b2003 Report Based on 2002 Data
Per FTE Physician
Count Mean 25th Median 75th 90th
Consultations & New Patients 39 308 185 231 345 442
#2 Cost
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?
#2 Cost
Relative Benchmarks1. 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 FlowPhysicians Should…
Communicate with referring physicians – this drives practice growthSee new patients – this drives practice growthBe seen at the hospital, participate in medical staff lifeSee follow-up patients on a regular, clinically appropriate basisDelegate some follow-up visits to other providers as appropriate – PA, NP, RNEnsure quality of care throughout practice
#2 Cost
Increasing Patient FlowPhysicians Should Not…
Routinely be late for clinicSpend time filling out forms (ex. disability, tumor registry)Provide routine patient educationReturn routine patient phone calls (prescription refills, etc.)Micro-manage staffUndermine authority of administrator
#2 Cost
Increasing Patient FlowAdministrators Should…
Assure that there are adequate exam rooms for each physicianProvide appropriate patient scheduling, individualized by physician if necessaryUse other staff, clinical and administrative, to free up physician time whenever possible
#2 Cost
Increasing Patient FlowAdministrators Should Not…
Practice medicine or offer their clinical opinion to anyone, ever!Undermine the clinical authority of any of the practice physiciansUndermine the business and leadership authority of the physician leader
#2 Cost
Increasing Patient Flow Should you consider a Non-Physician
Practitioner?
Also known as “mid-level providers,” includes PA, NP, CNSIncrease patient volume at less expense than adding a physicianAllow more flexibility in scheduling patient visits, more consistent schedule than physiciansGenerate revenue for practice even if physician is out of officeCoverage for physician vacations – better continuity of care
#2 Cost
Increasing Patient Flow Non-physician Practitioners Should…
Work as an adjunct to the physiciansSee routine follow-up patients, chemotherapy visits, other routine visitsAllow physicians to see more new patients, consultationsServe as a resource for nurses, other staff
#2 Cost
Increasing Patient Flow Non-physician Practitioners Should
Not...See new patientsPractice beyond their state scope of practice
#2 Cost
Practice EfficiencyStaffing#3 Cost
Ensure that you are using all staff in the most appropriate way for the size of your practiceManage your overtimeTask Analysis
Who does it? Can anyone else do it? How do they do it? Can it be done better?
Practice EfficiencyNurses Should…
Administer chemotherapy – patient assessment, check doses, discuss side effects, mix chemo in many practicesCounsel patients – symptom relief, social issuesPhone triage - answer patient’s symptom-related phone callsPatient educationHelp with drug assistance programs and indigent drug forms
#3 Cost
Practice EfficiencyNurses Should Not…
File Schedule appointments Handle pre-certs, pre-auths
#3 Cost
Practice EfficiencyPatient 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?
#3 Cost
Practice EfficiencyChart 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?
#3 Cost
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
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