Engaging Physicians in Revenue Cycle Management

Size: px

Start display at page:

Download "Engaging Physicians in Revenue Cycle Management"

Osborn Mason
8 years ago
Views:

1 Engaging Physicians in Revenue Cycle Management A Texas Health Physicians Group Case Study Sam Civello, Vice President - Texas Health Physicians Group Frank Marshall, President - MedSynergies

2 Health Systems Today Mergers & acquisitions Market share Competition Reimbursement Healthcare reform EMR/ICD-10/Meaningful Use Aligning with physicians 2

3 Poll What are Physicians Thinking? 3

5 5

6 Poll What is the top motivator driving physicians to seek/accept employment models? *Source: HealthLeaders Physician Alignment Survey sponsored by MedSynergies,

7 7

8 Poll What is the top threat to the physician alignment strategy with your local hospital? *Source: HealthLeaders Physician Alignment Survey sponsored by MedSynergies,

9 9

10 Poll What is the top concern keeping physicians awake at night? *Source: MedSynergies National survey of 285 providers 10

11 Current Physician Environment Average group size of less than 5 providers Declining revenue per unit (RVU) forecast Increased operating expense trend line Over 50% employee turnover Average 4 full-time employees per provider Overhead rates exceeding 65% of revenue Current cost of practice startup ranges from $300K - $600K Change in work-life balance profiles Less access to capital than historically available 11

employees per provider Overhead rates exceeding 65% of revenue Current cost of practice startup ranges

12 Health System-Physician Alignment Employment Models Affiliated physicians Independent physician associations (IPA, PHO) Practice support models Co-management models Employment models 12

13 Employment Model Success Factors Clear vision, detailed plan, delivering Non-hospital leadership; strong governance model Communication channels with physicians at multiple levels establishing trust Sound operational foundation Commitment to sustainable success as a group 13

Communication channels with physicians at multiple levels

14 Physician Economics 3 financial levers to practice performance 14

15 Physician Economics Productivity Volume & Quality Outreach & Online Scheduling Navigators Collections Five Key Metrics Time of Service (TOS) Collections Coding Assessment Clinic workflow enhancement Case Study: THR Go-to-Green 15

Key Metrics Time of Service (TOS) Collections Coding

16 Physician Economics Productivity Patient Continuum of Care: Outreach Process Patients are identified and qualified for outreach by analyzing patient data or patient registries Outcomes reports are delivered to the practice monthly Clinical algorithms are applied to determine the types of services that the patient needs Patient records are monitored for response to reminder messages The patient is contacted by the method of choice and advised of needed care and diagnostics Arrangements for the patient s appointment are made by live call or call-back 16

determine the types of services that the patient needs Patient records are monitored for response to reminder messages The patient is

17 Physician Economics Productivity Patient Continuum of Care: Outreach Impact Campaign Results % patients scheduled Automated vs. live calls yielded comparable results Incremental organic practice growth 17

18 Physician Economics Productivity Patient Continuum of Care: Navigator Program Patient Navigator program designed to ensure coordination of care within physician network. Key Benefits: 1. Dedicated staff within clinic to coordinate and assist all referrals 2. Patient advocate 3. Build confidence and loyalty to key network relations 18

19 Physician Economics Productivity 19

20 Physician Economics Productivity Revenue Cycle Optimization: TOS Collections Mandatory Training instructor-led soft & hard skills education to improve: Patient experience Employee development & customer service skills CGCAHPS surveys Overall patient collections: THPG annualized run-rate incremental opportunity of $15MM 20

Patient experience Employee development & customer service skills CGCAHPS

21 Physician Economics Productivity Revenue Cycle Optimization Clinic Workflow Enhancement Schedule templating & simplification for staff Same day appointments No phone trees! (unless at capacity) Web-based patient forms MA work-up Minimize provider attendance during diagnostics 21

Physician Economics Productivity Coding Assessment Assessment Independent chart audit Documentation compliance Peer-to-peer provider education Results on large primary

22 Physician Economics Productivity Coding Assessment Assessment Independent chart audit Documentation compliance Peer-to-peer provider education Results on large primary care acquisition in Fort Worth, TX: Increased compliance & reduced risk Appropriate E&M Acuity coding has yielded $4.4MM net collections opportunity on 80 providers 22

Physician Economics Productivity Revenue Cycle Optimization: Case Study THPG Go-to-Green Project Identified all practices that fell beneath the 90 th percentile of MGMA AR Management, and produced

23 Physician Economics Productivity Revenue Cycle Optimization: Case Study THPG Go-to-Green Project Identified all practices that fell beneath the 90 th percentile of MGMA AR Management, and produced coordinated practice specific action plans to address core RCM optimization areas of opportunity within the Life Cycle of a Claim. Objective: move practices into Green based on following control limits. 23

24 Physician Economics Productivity Revenue Cycle Optimization: Case Study Go-to-Green Results Within 4 months moved 43% of under performing practices within the 90 th percentile of MGMA Green Currently have 80% of all primary care practices within Green Strengthened provider engagement in RCM process Payment per RVU optimized for primary care at $45 per RVU, or 132% of Medicare 24

25 Questions? 25

26 Engaging Physicians in Revenue Cycle Management A Texas Health Physicians Group Case Study Sam Civello, Vice President - Texas Health Physicians Group Frank Marshall, President - MedSynergies

December 2008. Outsourcing, Enablement, Enlightenment. John R. Thomas President and Chief Executive Officer MedSynergies, Inc.

December 2008. Outsourcing, Enablement, Enlightenment. John R. Thomas President and Chief Executive Officer MedSynergies, Inc. December 2008 President and Chief Executive Officer Revenue cycle management (RCM) for healthcare includes a series of complex processes: charge entry, claims production, payment processing, A/R management,