Contents
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From the Publisher
8
Physician Spotlight Miguel A. Rivera, M.D.
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Legal Corner Healthcare Compliance is Good Healthcare Management
Two Worlds, One Hybrid Solution
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Wealth Management Two Worlds, One Hybrid Solution
Recognizing the need for hybrid physicians who can interpret both the business of medicine and the human anatomy leads to more efficient practice management both professionally and personally.
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Doctor’s Life Congratulates Robert Williams
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Feature At the Front Desk
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Feature How to Grow and Strengthen Your Practice Through Partnerships
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Adopting a Roadmap for Your Success
At the Front Desk The front desk staff is key to the success of any practice. They are a patient’s first impression, whether in person or over the phone.
How to Grow and Strengthen Your Practice Through Partnerships 2
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Advertisers BioSpine Institute 4 Burr & Forman 11 Full Circle PR 9 Jarred Bunch 7 JW Marriott Panama 15 PNC Bank 24 Publix 3 Suncoast Advisory Group 23 The Florida Orchestra 21
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Adopting a Roadmap for Your Success Doctor’s Life Tampa Bay
Issue 4, 2015
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REVOLUTIONIZING HOW SPINAL SURGERY IS PERFORMED! With over 30,000 patients treated and 13,000 surgeries performed, BioSpine founders Dr. James J. Ronzo and Dr. Frank S. Bono wouldn’t have it any other way. They’re skill and relentless passion for perfection will make the experience as comfortable as possible. An extension of Gulfcoast Spine, The BioSpine Institute provides the latest breakthroughs in minimally invasive technology with an emphasis on strategies that encourage the body’s natural healing responses.
5 KEY FACTORS WHEN CHOOSING A SPINE SURGEON 1
Surgeon’s Experience • Dr. Ronzo and Dr. Bono have over 23 years of combined experience. • Dr. Ronzo and Dr. Bono have successfully treated over 35,000 patients for spine-related disorders. • Dr. Ronzo and Dr. Bono have performed over 14,000 successful minimally invasive spinal surgeries. • Dr. Ronzo and Dr. Bono are among the top spinal surgeons in the nation as documented by Consumer Reports, Newsweek, ProPublica & Health Grades.
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Minimally Invasive Approach
• Minimally invasive spinal surgery requires an incision that is only 3/4” in length. That’s the same as the diameter of a United States penny. • In minimally invasive spinal surgery, muscles are gently separated and not cut. • Smaller incisions and less invasion into surrounding tissue and muscles means quicker recover times.
3
Nationally Ranked Outcomes
• Dr. Ronzo and Dr. Bono have been rated in the top 5 in the nation for back surgery results. • After more than 14,000 surgeries, Dr. Ronzo and Dr. Bono’s infection rate is almost non-existent and is dramatically less than the national average.
4
Length of Surgery
• Drs. Bono & Ronzo's minimally invasive spinal surgery averages 45 minutes in length. By comparison, traditional spinal surgery can last several hours.
5
Recovery Time
• All patients receiving minimally invasive spinal surgery are able to return home on the same day of the surgical procedure. • Recovery time for BioSpine patients is consistently half of that for patients who have received traditional spinal surgery.
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From the Publisher
W
www.doctorslifetampabay.com
hat is Practice Management? Practice management is the business strategy intended to help medical facilities and practices overcome the challenges of the fast changing healthcare industry and adapt to the ever-evolving needs and wants of patients. Though this term originally referred to medical practices, other types of businesses, such as lawyers and financial advisers, are adopting practice management strategies. I’m sure this definition could be given in a more lengthy and detailed manner. However, it seems the most important portion of Practice Management is just that, the management of your practice, facility or office. As physicians, you practice medicine. Depending on how or where you practice medicine, depends on if you have to practice management and how much time you spend on it. This issue of DLM focuses on areas of practice management. We look into everything from the importance of managing your front desk, a clear roadmap to ensure success in your practice, to your personal practice management in our Wealth Management section. We invited Rochelle Glassman, founder and CEO of United Physicians Services back to provide insight on several additional preventive care services that are raising her client’s cash flow. The Physician Spotlight in this issue is with Dr. Miguel Rivera, President of Select Physicians Alliance. We sat down with Dr. Rivera and discussed the success of the alliance and where he visions the future. Finally, we congratulate Robert Williams, Partner at Burr & Forman and our Legal Corner contributor on page 14 for being awarded The Herbert G. Goldburg Award this year. It is the highest award given by the Hillsborough County Bar Association’s Trial and Litigation section. We would love to hear about all of your fantastic summer getaways that you had this summer. Please email us at publisher@doctorslifetampabay.com. I hope you enjoy this issue of DLM. As always, we thank all of our supporters, contributors and readership.
TAMPA BAY
Tampa Headquarters 1208 East Kennedy Blvd. Tampa Fl, 33602 813-419-7788 Group Publisher Edd Suyak publisher@doctorslifetampabay.com Creative Director Rob Stainback Editorial Director Danielle Topper Associate Publisher CJ Cooper Advertising Account Executive Ryan O’Neil Editorial Advisory Board Scott Jarred Robert V. Williams
Be well,
Contributing Writers Heather Urquides Scott Jarred Robert Williams Rochelle Glassman Rick O. Helbing
-Edd Edd Suyak Group Publisher publisher@doctorslifetampabay.com
™
Doctor’s Life Magazine, Tampa Bay is always seeking events, stories and remarkable physicians. Please email the publisher if you have an event, an editorial idea or you know of a doctor or dentist who may have done something extraordinary. We want your suggestions and feedback. publisher@doctorslifetampabay.com Doctor’s Life Magazine, Tampa Bay does not assume responsibility for the advertisements, nor any representation made therein, nor the quality or deliverability of the products themselves. Reproduction of articles and photographs, in whole or in part, contained herein is prohibited without expressed written consent of the publisher, with the exception of reprinting for news media use. Printed in the United States of America.
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Doctor’s Life Tampa Bay
Issue 4, 2015
Physician Spotlight
Miguel A. Rivera, M.D. Tampa Bay E.N.T.
Board Certified Otolaryngologist Miguel A. Rivera, M.D. graduated from the University of Nevada School of Medicine and trained at the University of South Florida Department of Otolaryngology. Dr. Rivera’s interests lie in pediatric E.N.T., thyroid surgery, allergy, and sinus surgery, including in-office balloon sinus dilation.
1. How long have you lived in the Tampa Bay area? I graduated High School from Hillsborough High School and returned to Tampa for Otolaryngology residency training at the University of South Florida after seven years of U.S. Air Force service and four years of medical school at the University of Nevada. 2. What is your favorite Tampa Bay restaurant? La Casona. They serve delicious Puerto Rican cuisine, but never as good as my mother’s cooking. 3. Where is your favorite place in Tampa Bay to relax? I relax when fishing in the intercostal waters of the Bay area. It takes me away from the daily indoor routines to enjoy the beautiful nature that surrounds us. 4. How important is it for physicians to be involved with their communities and how important is it to you personally? I believe that physicians should be an important member of the local and medical community. We are very busy professionals who can get inundated with medical responsibilities. We have enough work to stay busy 24/7 and have to make time to spend with our families and friends. I’m personally involved with the Judeo Christian Clinic for medical treatment for those in financial distress, I take care of the veterans at the James A. Haley Veterans Hospital, I teach Otolaryngology residents from the University of South Florida, I’m past president of the Florida Society of Otolaryngology, and despite all that together with a very busy private practice, I find time to spend with my children in their volleyball and little league baseball activities. 5. What is the Select Physicians Alliance (SPA) and what role do you currently hold there? Select Physicians Alliance is the consolidation of 11 different Otolaryngology practices throughout the Tampa Bay Area. We have been together and I have served as the President of SPA for nearly 4 years. 6. Why and how was the SPA formed? Otolaryngology is a very demanding specialty. 8
We cover any head and neck complications and life threatening airway emergencies in most local major medical facilities. This requires us to be immediately available while continuing to care for our patients in our busy practices. The long hours and the stressful complicated cases that we deal with take a toll on our quality of life. We treat from the neonates to the very old for complex ear diseases, sinusitis, allergies, voice changes, head and neck cancers, facial fractures, facial plastics, trouble swallowing, thyroid and parathyroid diseases, sleep apnea, chronic tonsillitis, and many dermatologic abnormalities of the head and neck. We decided to come together to provide a more comprehensive care to our community by combining our experienced and fellowshiptrained physicians to handle the many subspecialties of Otolaryngology. We were also able to improve our quality of life by having more physicians share the responsibilities of the emergency room coverage. 7. What are the major benefits? In addition to the improved quality of life and a more comprehensive Otolaryngology care, we were able to improve our malpractice fees, retirement program, electronic medical records, employment benefits, and hire a more experienced management team. The size of our group has received more considerations from insurance companies during negotiations. Many of our divisions have consolidated to a one practice model to increase ancillary service revenue and to decrease overhead cost per physician by maximizing utilization of space and staff. The government has been imposing new requirements in exchange of financial penalties. The management group at the CBO level has helped the many divisions of SPA to implement and meet requirements to receive meaningful use payments. 8. What have been your greatest challenges? Physicians are intelligent, self-driven, and independent individuals that are trained to determine the best treatment options for patients based on data collected from the history taken, the physical examination, and the results Doctor’s Life Tampa Bay
from diagnostic testing and procedures. We make smarter decisions when the information is presented to us. The greatest challenge is to make sure all of the data is presented to our physicians before making major decisions. We have been able to do this before and after our consolidation. Over 98% of our simple and complex decisions have been voted unanimously as a result of our due diligence in each topic of discussion. 9. How do individual physicians or running practices join the SPA? Our initial group is made up of Otolaryngologist, but we named it SPA in order to accommodate other specialist groups with treatment commonalities with us. Some of those specialties include allergists, pulmonologists, gastroenterologists, endocrinologists, and some plastic surgeons. For more information, anyone can call 813-571-7184 to speak with our Chief Operating Officer, Mrs. Sheryl Watts. 10. It seems that most of the practices in the alliance are ENT or Cosmetic Surgery practices. Is that for a reason and if so why? It was much easier to initially come together with a single specialty and then proceed with others as we grow and opportunities come up. 11. Where do you see the SPA five years from now and do you believe this is the future of private practice medicine and why? I see SPA as a consolidated practice composed of multiple specialists with common treatment modalities. I also see most physicians joining large physician practices to gain the benefits I mentioned earlier. 12. Knowing yourself: If you could go back in time and provide your younger self advice, what would it be? I would have recommended to always ask more questions until I was comfortably clear in any subject. We can’t know it all and especially at a younger age, but I was guilty of not clarifying many issues because I wanted to figure it out on my own. I now understand that success is the result of hard work, opportunity, and being surrounded by great people with extensive experience to give the proper advice for the right decisions. Issue 4, 2015
Legal Corner
HEALTHCARE COMPLIANCE IS
Good Healthcare Management
N
By Robert Williams
o discussion of health care management should ignore the current legal environment in which all physician practices operate. Indeed, given the potential sanctions, to do so would be tantamount to managerial negligence. What are those potential sanctions? There are many, all very dangerous. For example, a violation of the Federal Anti-Kickback Statute has both civil and criminal implications. What is a “kickback”? The answer to this simple question, unfortunately, is anything but simple. Indeed, because it depends on the specific facts and circumstances under investigation, it is often far more complicated than it would appear. One thing is certain, however, the concept of kickback under the Anti-Kickback Statute is far broader than most doctors - and most lawyers - realize. On the civil side of the statute, a violation of the Anti-Kickback Statute can be the basis of a civil enforcement action under the Federal False Claims Act. And while only civil in nature, the monetary exposure is theoretically ruinous, e.g., actual damages plus a potential multiplier of three, plus the assessment of a civil money penalty for each false claim of between $5,500 to $10,000, and the assessment of legal fees and litigation costs under certain circumstances. On the criminal side, a violation of the Anti-Kickback Statute is a felony which, upon conviction, will almost certainly result in prison time. A corollary, but distinctly different, sanction can also arise from a violation of the federal Physician Self-Referral Act, often referred to as the Stark Act after its congressional sponsor, Congressman Pete Stark of California. Like the Anti-Kickback Statute, violations of the Stark Act can be draconian to say the least. There is at least one significant difference, however. While the Anti-Kickback Statute is an
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intent based statute (i.e., to prevail, the government must prove an element of intent to violate the statutory prohibitions), the Stark Act is a strict liability statute. This means that the government is not required to prove an intent to violate the statute; if the prohibitive language of the statute applies to the relevant facts, and no exception applies, then the statute is violated and the statute’s potential sanctions will apply. Finally, a violator of either the Anti-Kickback Statute or the Stark Act, in addition to damages and penalties, can also be excluded from participating in federal healthcare programs. And, in addition to federal sanctions, the State of Florida has enacted state analogs to these federal statutory schemes. The state statutes, like their federal counterparts, have both civil and criminal penalties, including possible prison sentences. With the above in mind, it would also be foolish to ignore the cost - both monetary and non-monetary - of defending a claim brought under any of the statutes. That expense, much less the cost of any settlement itself, can cause a practice to self-destruct. The solution, of course, is how to avoid these problems in the first place. The answer - while not foolproof - is to make regulatory compliance an integral part of your group’s practice. And, fortunately, this can be accomplished without an inordinate investment of either time or money. It does, however, require a commitment, both initially and ongoing. The initial step is to appoint a compliance officer. This is critical for a number of reasons, all of them obvious. First, someone has to drive the group’s compliance initiative and, concomitantly, inculcate the concept of compliance into the group’s day to day culture. And, if someone does not embrace this effort, it simply will not get done. In short, selecting the right person to be the compliance officer, and giving him or her the requisite authority, is critical if any meaningful compliance is to take place. Once appointed, the compliance officer should embark on a selfeducation process that will enable him/her to conduct a compliance audit, Doctor’s Life Tampa Bay
Issue 4, 2015
create and establish appropriate compliance standards and procedures, implement meaningful training and ongoing education, and create appropriate monitoring techniques to detect compliance problems. To do this, the compliance officer, together with the group’s governing body, must be prepared to not only detect compliance issues, but it must also be willing to respond appropriately. Compliance means open lines of communication between all stakeholders. It means taking corrective action both quickly and consistently. It means informing all concerned what the group expects and what may happen if those expectations are not met. In short, disciplinary standards must be established, be fully publicized, and then adhered to consistently. All of these attributes must be set forth in writing and reinforced on a regular basis. The above factors are not original with the author - they are straight out of the Compliance Program for Individual and Small Group Physician Practices promulgated by the HHS Office of the Inspector General (“OIG”) almost fifteen years ago. This Compliance Program provides the necessary template
for any physician oriented compliance initiative and, as the OIG stated therein, “emphasizes a step by step approach to follow in developing and implementing a voluntary compliance program.” None of the above concepts are esoteric in the slightest, nor are they difficult. In fact, they are no more than simple common sense. But common sense or not, if there is no will to achieve them, they simply will not happen!
CONCLUSION This article has been structured to convince the reader that creating and maintaining voluntary compliance programs is not only a wise move legally but is also a good management move as well. Indeed, the OIG has been advocating for voluntary compliance since the late 1980s. After reading this article, hopefully the management value of an effective compliance program is self-evident. But if not that management decision is no longer voluntary and has not been voluntary since the Patient Protection and Affordable Care Act was enacted by Congress in 2010. Among the many aspects of that law was a provision that requires any health care organization that participates in either Medicare or Medicaid to adopt and implement a compliance program that includes the seven basic components that are identified in the guidance referred to above. Thus, if you have not already adopted and fully implemented such a compliance program, it should be added to the top of your management objectives list immediately. The legal protection it will provide is, by itself, worth the effort. And the management benefits derived will more than pay for the cost of those efforts.
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From physician practices, hospitals, long-term care, and home health, to medical devices, pharmaceuticals, and lenders, our capabilities cover practically every angle of the industry. If results matter to you, and you want them to matter to your law firm, give us a call. predictability.
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Wealth Management
TWO WORLDS, Medicine and the human body, business and finance: two worlds whose separation is often displayed by the tradition of physicians sitting on one side of the table and business people on the other side. However, it is becoming an increasing problem that there are not many people sitting in the middle of the table; those who understand both the business of medicine and the human anatomy. Recognizing the need for hybrid physicians who can interpret both languages leads to more efficient practice management both professionally and personally.
P
By Scott Jarred, CFP®, CEO of Jarred Bunch Consulting
icking a seat at the tables of practice management is becoming a critical separator among today’s physicians. Sitting on one side or the other can leave you blind to numerous decisions, the effects of which can make it seem as though you’re not even sitting at the table. Picking up on this, several universities and medical schools have begun offering business related degree and certification programs. These same philosophies have enacted a similar, vital need for physicians to implement practice management in their personal life as well.
The Role of Practice Management While physicians may not think of their personal life when hearing the term practice management, it is important to note that it plays an essential role both professionally and personally. At its basic level, practice management is a strategy that is intended to help physicians weather changes in the medical landscape and to adapt to evolving patient needs. A core principle of practice management lies in effectiveness; a practice must be able to operate at a fast pace, but also be flexible enough to respond to regulatory changes or other challenges it may face. Perhaps this definition is what leads us to believe that it can only be applied in a professional setting. But, don’t physicians need a strategy to help their financial life weather market fluctuations, adapt to changing information and to ensure their wealth’s longevity? Shouldn’t their strategy 12
keep them in a position where they can positively react when “life” happens? Shouldn’t physicians be able to run their financial life just like a practice, understanding the information at hand so they can make smarter financial decisions? Yes, to all of the above.
Practice Management: Professionally In order to make effective decisions, physicians have to understand and interpret data from all of the different components that make up a business. When it comes to practice management, many physicians lack the same data-driven discipline they enact when treating patients. And while part of effective practice management is having access to the right team of people who are tasked with monitoring data for you, there are still five reports that physicians themselves should be able to extract insights from: • Profit & Loss Statement: Are you managing costs and on track to meet your goals? • Accounts Receivable: Are you letting revenue linger in the “potential” phase too long? • Adjustments: Are you avoiding vague categories and large dollar amounts? • Credit Balances: These are liabilities; ignoring this report can be a costly mistake. • Patient Balances: Patient financial responsibility is at its highest peak; are they paying? A hybrid physician who can gain valuable insight from this data is critical whether they are running a small practice or are part of a large health network. When challenges arise or data isn’t adding up, you have to be able to recognize those red flags and know where to go management-wise or personnel-wise in order to overcome them.
Practice Management: Personally In order to make effective decisions concerning their personal finances, physicians also have to be able to interpret data from all of the different aspects of their financial life. Doctor’s Life Tampa Bay
Issue 4, 2015
ONE HYBRID SOLUTION The largest hindrance of the “junk drawer” methodology is that you rely on others to make decisions for you, and you can’t see how these play out across your entire financial life. This is why physicians require a framework to give their financial life structure, and to break down its complexity into four domains: • Cash Flow: How is your wealth being allocated, and is it growing or dwindling? • Assets: Is your wealth being put to work for you? • Liabilities: Are these outweighing your assets and bringing down your net worth? • Protection: Is your full economic value protected from predators and threats? Organization may be the first stop in enhancing the ability to interpret your financial data, but this is wasted if insights can’t be extracted from the data at hand. This is why the true value in personal practice management is accessing the ability to maintain financial balance, continuously optimizing your current financial position. Extracting insights from a real-time information feed of your complete financial life allows you to turn data into effective actions, ultimately leading to smarter financial decisions.
Issue 4, 2015
Doctor’s Life Tampa Bay
Regaining Control Professionally & Personally Practice management is attractive to people who want to be leaders; leaders in the fact that they are a rare hybrid breed; leaders in the fact that they are running a successful medical practice; leaders in the fact that they are forging their own financial path. Understanding how to operate as a hybrid in the professional space isn’t just prudent to interpreting the financial implications of running a business; it also helps you gain insight into the entire patient experience you’re providing. Operating as a hybrid in your personal life doesn’t just enact sounds reasoning behind your financial decisions, but allows you to constantly evaluate your changing risk exposure. When effective practice management can be implemented professionally, the difference between strategic small business units and “home office” medical practices of the past is evident. The same is true on a personal level; a physician’s financial life can and should indeed be run as a strategic small business, with a team of people to help monitor their financial well-being and guide decision making. Both can lead to enhanced performance and increased chances of success. Both put control back into the physician’s hands.
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DOCTOR’S LIFE CONGRATULATES
Robert Williams for Being Awarded The Herbert G. Goldburg Award!
R
“From sun-up to sun-down, although sometimes prone to pontificate, a nonpareil storyteller, a man of infinite wisdom, a lawyer’s lawyer and, most importantly, an outstanding friend and mentor, there are just not enough superlatives to describe Rob Williams; a most deserving recipient of the Herbert G. Goldburg Award!” - Ralph Mangione, Partner Burr & Forman
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obert Williams with Burr & Forman LLP is the contributor for Doctor’s Life Legal Corner section. Rob has been a pleasure to work with and a very knowledgeable resource. It was no shock when I heard he had been awarded the highest award given by the Hillsborough County Bar Association’s Trial and Litigation section. The award is given annually to a trial lawyer who, during the course of a distinguished career, has exhibited fairness, integrity, courtesy, zeal, forensic skill, legal acumen, good sense and respect for his fellow lawyers. You can always measure a person easily when they display extreme passion for what they do, which they are and what they stand for. Rob has always displayed all the above with all of our conversations, every email and with every word he has ever written. At Burr & Forman, Williams is a member of the firm’s Commercial Litigation practice
group where he counsels clients in complex business, healthcare and securities litigation. He has successfully advised on a wide range of litigation matters, including disputes and claims related to breach of contract, business tort, securities fraud, real estate and construction, corporate governance and other business organization matters, statutory and constitutional tort, negligence and medical malpractice, employment discrimination and white collar criminal prosecutions. It has been an honor to work with you and my honor to congratulate you. Looking forward to more of your insight and wish you many more accolades that demonstrate your character and professionalism. On behalf of myself and the entire Doctor’s Life team we thank you and celebrate your award.
“Congratulations and well deserved! Rob has been a friend first but also a mentor and Law Partner for 30 years. No one more deserving.”
“Rob Williams is the lawyer’s lawyer. He’s passionate about the practice of law. He immerses himself in his cases, and he studies the law and facts beyond what most lawyers would ever do. And he approaches ever challenge with an unmatched level of professionalism and integrity.”
- Bill Schifino, Partner Burr & Forman (also Florida Bar President-Elect)
Doctor’s Life Tampa Bay
Be well, Edd Suyak Group Publisher
- John Schifino, Partner Burr & Forman
Issue 4, 2015
AFRICA
ASIA
EUROPE
LATIN AMERICA
MIDDLE EAST
NORTH AMERICA
&
At the
Front Desk It was 40 minutes past Michele Bearden’s appointment time with a South Tampa internist, and she hadn’t received so much as a word of apology from the front desk staff.
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Doctor’s Life Tampa Bay
Issue 4, 2015
“I remember just sitting there steaming because no one was acknowledging that I was there way past my appointed time, like my day was not important,” said Bearden, a Tampa freelance writer. To further irritate matters, when she went up to inquire how much longer it might be, the answer was, “I don’t know, when we get to you.” The front desk staff is key to the success of any practice. They are a patient’s first impression, whether in person or over the phone. Does your front desk staff project a message of caring and compassion? Or do they seem bothered and overworked? So many complaints about a practice, especially those on online physician rating sites, have nothing to do with the care itself. It’s about the people working at the front desk and whether they made the patient feel valued. Was it easy for that patient to make an appointment? Or did the receptionist put him or her on hold or ask them to call back? Was the person who answered the phone both knowledgeable and courteous? Or did the patient hang up without getting the needed information, or worse, feeling like they were being a bother? Sharon Miller, longtime office manager at Dermatology Associates of Tampa Bay, understands how important a role the front desk plays. “They can make or break you,” she said. “We always look for someone with a pleasant personality that can easily communicate with patients. We want patients to feel like they are a part of the family, and our receptionists have to be able to build a rapport with patients.” Mike Juhasz, a Clearwater operations director, injured his foot this summer and needed to see an orthopedic specialist quickly. Issue 4, 2015
The appointment started on a great note. The receptionist was friendly and the “paperwork” he was handed was actually an iPad that allowed him to breeze through the required documentation. Then his wait began. And continued. And continued some more. In all, he waited 90 minutes to see a doctor for less than five minutes. “The reason I didn’t complain was because of how pleasant the receptionist was,” he said. “She recognized that I was waiting and did a good job of managing my hostility.” “If she had been rude with me I’d have probably left.” Still, he said he isn’t likely to return, not even for his follow-up appointment. Ron Wilk is the director of operations at Tampa Bay Radiation Oncology, which has four offices in the bay area. The people who work at the front desk were overtaxed, he said. Not only do they greet patients and check them in for appointments, they also fill out detailed intake forms for new patients over the phone, verify insurance coverage and manage waits. It was too much, he said. Patients were feeling rushed, like they weren’t getting 100 percent of the front desk person’s time because of all the multi-tasking going on. “You can tell when you call an office and they’re rushing you through the conversation,” he said. He’s in the process of separating Tampa Bay Radiation Oncology’s intake and checkin duties to facilitate more personal and relaxed patient interactions. Now the person on a lengthy intake form call also won’t be responsible for greeting patients who walk in. He now envisions a receptionist who will have time to pan the room, spot the patient who’s been waiting for over 10 minutes, and walk over to say, “I know you’re waiting. Someone will be with you shortly.” Cancer patients getting radiation treatment come in daily for weeks at a time. They’re often nervous about treatment and the costs, he said. That’s why it’s so important for the front desk to have time to explain benefits, copays and “to leave patients assured that they’re in very good hands.” As for Bearden, she isn’t ready to give up on her South Tampa internist just yet, but partly because changing doctors is so difficult. She was struck by the contrast in that Doctor’s Life Tampa Bay
TIP BOX Hire a Secret Shopper Many offices, not just medical practices, hire a third party to secret shop their front desk staffs to make sure your perceptions match reality. Full Circle PR, a medical marketing firm that does secret shops for practices, said they often encounter many offputting behaviors during secret shops, such as being placed on hold forever, feeling rushed and being asked to call back later.
Simplify Your Phone Tree Patients who need help with an appointment or have a simple question don’t want to have to spend five minutes every time they call navigating a long phone directory.
Manage Waits Doctors get behind. It happens. It’s important to acknowledge when patients are waiting, let them know in generic terms why the doctor is running behind, and provide a realistic estimate on how much longer it will be. Providing free Wi-Fi and coffee can help buy patience.
Be Nice This really shouldn’t have to be said, but so often patient complaints are centered around a person’s tone as much or more than an action. It pays to be nice, even if you can’t give them the exact appointment they want or they’re upset about the specialty copay.
office compared to a recent trip to a new dermatologist. There, the staff immediately welcomed her, acknowledged it was her first visit, and said they hoped she enjoyed it.
Simple words. Big impact. “I thought, ‘Wow, they really care that I’m here. I’m not just an insurance number,” she said.
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How to Grow and Strengthen Your Practice through
Partnerships By Rochelle Glassman, President and CEO of United Physician Services
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.
T
here 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.
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Weight Management 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. Behavioral Therapy Stats
CPT Code
G0447 CPT Code
G0473 G0447 G0473
Weekly
Behavioral Description
Therapy Stats MC Reimb. $ (120 patients) Face-to-face Behavioral counseling for obesity $25.97 $3,116.40 Weekly 15-mins Description MC Reimb. $ (120 patients) Face-to-face Behavioral counseling for obesity, group $12.47 $1,496.40 Face-to-face Behavioral counseling for obesity $25.97 $3,116.40 30-mins 15-mins Subtotal: Face-to-face Behavioral counseling for obesity, group $12.47 $1,496.40 Less Psychologist **National Average salary: 30-mins Total Additional Revenue Generated: Subtotal:
Annually
$162,052.80 Annually
$77,812.80 $162,052.80 $239,865.60 $77,812.80 $72,000.00 $167,865.60 $239,865.60
Less Psychologist **National Average salary: $72,000.00 Total Additional Revenue Generated: $167,865.60
Medical Nutrition Therapy Stats Description Medical Nutrition
CPT Code
97802 97803 CPT Code 97804 97802 G0270 97803 G0271 97804
Medical Nutrition individual initial visit Medical Nutrition individual Description subsequent visit Medical Nutrition Nutrition individual initial visit Medical MNT reassess 15-mins Medical Nutrition individual subsequent visit MNT reassess 30-mins Medical Nutrition
G0270 G0271
MNT reassess 15-mins MNT reassess 30-mins
Doctor’s Life Tampa Bay
MC Reimb. $ Therapy Stats $34.95 $29.99 MC Reimb. $ $16.05 $34.95 $29.99 $29.99 $16.05 $16.05
Weekly (120 patients)
Annually
$4,194.00 Weekly $3,598.80 (120 patients) $1,926.00 $4,194.00 $3,598.80 $3,598.80 $1,926.00 $1,926.00
$218,088.00 $187,137.60 Annually $100,152.00 $218,088.00 $187,137.60 $187,137.60 $100,152.00 $100,152.00
$29.99 $3,598.80 Subtotal: $16.05 $1,926.00 Less Registered Dietitian **National Average salary: Total Additional Revenue Generated: Subtotal:
$187,137.60 $792,667.20 $100,152.00 $65,000.00 $729,667.20 $792,667.20
Less Registered Dietitian **National Average salary: $65,000.00 Total Additional Revenue Generated: $729,667.20
Issue 4, 2015
Behavioral Therapy Stats CPT Code
G0447 G0473
Description
MC Reimb. $
Face-to-face Behavioral counseling for obesity 15-mins Face-to-face Behavioral counseling for obesity, group 30-mins
Weekly (120 patients)
Annually
$25.97
$3,116.40
$162,052.80
$12.47
$1,496.40
$77,812.80
Subtotal: $239,865.60 Less Psychologist **National Average salary: $72,000.00 Total Additional Revenue Generated: $167,865.60
Diabetic Patients
Medical Nutrition Therapy Stats
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 DiabetesWeekly Self Management CPT Code Description MC Reimb. $ (120 patients) Annually Training within aindividual continuous 12-months and up to two hours of follow$218,088.00 up training 97802 (DSMT) Medical Nutrition initial visit $34.95 $4,194.00 97803yearMedical Nutrition individual subsequent visitthis by training $29.99 each after the initial year. You can do existing$3,598.80 resources$187,137.60 or adding 97804 staff Medical Nutrition $16.05 $100,152.00 $1,926.00 another person to support this effort. G0270 reassess 15-mins $3,598.80 $187,137.60 Tap intoMNT HEDIS for diabetic patients as well, and invite a$29.99 specialist to evaluate for diabetic G0271 MNT reassess 30-mins $16.05 $100,152.00 $1,926.00 retinopathy in your office. Diabetic patients should have a complete eye exam once a year, Subtotal: $792,667.20 but 80 percent of patients do not have those eye exams. So why not bring an ophthalmologist Less Registered Dietitian **National Average salary: $65,000.00 into your practice on a regular basis to provide this service. Total Additional Revenue Generated: $729,667.20 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.
Diabetic Management Codes CPT Code
G0108 G0109
Description
Diabetic management training; per individual 30-mins Diabetic management training; 30-mins
MC Reimb. $
$53.10 $14.26
Weekly (120 patients)
$6,372.00 $1,711.20
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. References: * Steven M Schwartz, M.D. FAAP, FACN, AGAF professor of pediatric children’s hospital at Downstate University of New York Medical Center; ** wwwpayscale.com; ***indeed.com
Annually
$6,360.00 $31,657.20
Total: $38,017.20
Issue 4, 2015
Doctor’s Life Tampa Bay
19
Adopting a Roadmap for Your Success By Rick O. Helbing
The rise of managed care over the past decade or so has caused physicians to consider the need for better fiscal management.
O
ne common strategy is the creation of a sound business or strategic plan. Over my 25 years of financial and practice management, I have determined that there are two types of physicians. First, doctors who own their practice. They have a vision but spend a good share of the day putting out fires. Second, doctors who have abandoned a vision of ownership and either work for an established practice or a HMO and more recently, private or public hospitals. The goal for this article is to encourage physicians who own their practice to work on not in their practice, which can be accomplished by adopting a strategic business plan in concert with a financial life plan that will assist in creating vision, goals, and aspirations for their practice and themselves. A coordinated strategic business and financial life plan will then assist in increasing efficiency and reduce stress through an organized process and system that will be repeatable on a daily basis. “Sixty-seven percent of physicians do not have a strategic business plan�, according to Dick Hansen of Medical Group Management Association. This leads to three questions physicians should be asking themselves in order to develop a road map for their practice:
Where do I want to go? How will I get there? How will I monitor results?
According to Judy Capko, a Practice Management Consultant in Chicago, the top ten reasons why medical practices fail to maximize revenue are:
1. Most office systems and procedures are weak 2. Bills contain inaccurate and outdated codes 3. Fee schedules are not updated 4. Physicians miscode their level of services 5. Accounts Receivables are not collected consistently 6. Financial procedures are weak 7. Staff are underutilized and ratio to physicians is low 8. Physician productivity is not maximized 9. Patient service is not top priority 10. Practices do not have a business plan (continued on page 22)
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Doctor’s Life Tampa Bay
Issue 4, 2015
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Adopting a Roadmap for Your Success In addition, Peter Lucash, author of Medical Practice Business Plan Workbook – Second Edition and blogger, lists his top ten concerns that medical practices may face now and in the future:
1. Flat and declining reimbursements 2. Pressure to improve and measure quality 3. Patient demand for more time with physicians 4. Incomplete data about patients 5. Risk of being sued for malpractice 6. Revenue cycle that is inefficient and uncertain 7. Unraveling of traditional physicianpatient relationships 8. Loss of status, prestige, and income 9. Widespread dissatisfaction with work of physicians 10. High and increasing overhead load I have added one more major concern - the new health care legislation. Are you prepared for all the possible mentioned consequences? Peter Levinson, a noted author concerning medical practices points out, “the margins of management error have dramatically decreased, with low reimbursement and increased practice expenses, even a small management 22
(continued from page 20)
misstep can mean a fiscal mess.” So, let’s take a journey back to medical school. Your professors assisted you to become an excellent, competent and caring physician. However, probably none of them had any idea what steps it takes to build a successful and efficient medical enterprise. You have become an effective technical practitioner versus a successful entrepreneur who works balanced hours, has little stress, leads a rich family and financial life that is diverse, fulfilling and provides a continuous return on your investment. How does a physician create a strategic business plan or road map to success that will assist in meeting personal goals and aspirations along with adopting a vision for a successful medical practice? Consider developing a team approach that consists of the following:
not only as a reward for an outstanding year, but to assist in adopting next year’s business plan while reviewing and evaluating the previous year’s results. By adopting an annual strategic business plan your practice will develop a road map to success while avoiding major pitfalls while also increasing revenue and efficiency that should provide a healthy and happy work environment for your employees and you.
Practice Administrator who will fill the management role of the practice. CPA, Tax and Business Attorney, along with Financial Life Advisor, who will assist in filling the entrepreneur role. Have the team, including the physician, spend time discussing your vision, goals, and aspirations for your practice and personal life. Transfer this information into a written plan that will put all the business principles in one place. As an example, identify the key functions of your practice, along with essential processes that link those functions. Identify the results your team have determined your practice will produce. Consider engaging your staff in this process with weekly review meetings. I have a physician who meets every Wednesday morning with the office management group to discuss current issues, solutions, and opportunities. Consider annual retreat for the entire staff, Doctor’s Life Tampa Bay
Issue 4, 2015
Serving PhySicianS for over 25 years and named among
THE BEsT Financial advisErs For docTors by medical economicS magazine for *
FivE yEars in a row, Rick O. Helbing cFP, chFc 941.375.7320
www.suncoastadvisorygroup.com *based on credentials, educational background, experience, size of the firm, minimum portfolio requirements and noteworthy professional achievements. See www.medicaleconomics.com.
Investment advice and advisory services offered through Suncoast Advisory Group, a Registered Investment Advisor