CASE STUDY: Medical Group, Union NJ (2 Providers)
An Internal Medicine/Primary Care office located in Union, NJ was quite overwhelmed with the overbearing costs, administrative hassles, staff issues and gross collection deficits. An administrative decision to sell the group was earnestly deliberated. With an average monthly collections between the 2 providers totaling less than $60,000 while estimated hospital based physician salary is nearly $220,000, a quick resolution was necessary. In 2011, in an attempt to save the group, ClinicSpectrum was hired by the administrative team. Immediately, imperative key issues were discovered, and a revenue maximization strategy for cost efficiency was implemented.
Step 1: Operational Restructure through Hybrid Workflow Model
ClinicSpectrum immediately identified all the office tasks including inventory management, cleaning of exam rooms, scanning of documents, appointment confirmation, eligibility services, preparing patient in exam room before physician walks in, and many others. We assigned those tasks/activities between LOCAL EMPLOYEES in the office and OFFSHORE employees in our back-office operation. Our back-office employees took over eligibility verification, indexing of scanned documents; follow up on outstanding claims, transcription services, appointment confirmation, missed appointments management and procedure recalls. The group’s local team members were then separated into an administrative team, billing team and clinical team combined with DAILY REPORTING to build self-accountability.
RESULT: With the above planning in place the practice is running smoothly and seeing 55+ patients’ on a daily basis without depending on an “Individual Team” member to run the office. Step 1 took care of operational efficiency and cost reduction through our back office team members.
Step 2: Medically Necessary Tests/Procedures for better Outcomes and Risk Management
ClinicSpectrum introduced a concept of collaborative medicine by joining an IPA (Independent Physician Association) which has turned into an ACO now. By joining an IPA, we participated in several incentive programs for Risk Management and reducing cost of care for payers. We created a clinical team that went through each patient’s clinical notes. Based on medical necessity and evidence based medicine we recommended TESTS/Procedures that were urgently needed. This resulted into better care for patients. Utilization of clinical resources/teams and diagnostic equipment made a difference in patients’ lives and saved money for Insurance companies.
RESULT: The implementation of Step 2 has resulted in significant revenue growth averaging an additional $30,000 per month over the last 4 years. At present the practice collects $1.1M per year.
Step 3: Monthly Audit
Nothing is taken for granted. Every task/office function gets audited randomly across the practice. A knowledgeable audit team focuses on the following areas: End of week supplies inventory check, daily closing report for copay/co-Insurance/deductibles, outstanding balances, patient clinical non-compliance, reminders for tests/procedures, follow up with insurance companies with outstanding claims, medical necessity compliances, proper documentation, complaint resolution and voice message tracking.
RESULT: Efficient checks and balances mechanism in place lessened errors, and improved efficiency.