Pain Practice Management Increasing Value, Efficiency and Health in your Pain Practice Ashley M. Classen, DO, FAOCA Adjunct Clinical Professor Department of Surgery Anesthesiology / Interventional Pain Medicine University of North Texas Health Science Center Fort Worth, Texas Medical Director, Trinity Pain Medicine Associates, PA Fort Worth, Texas
Overview-Objectives Staffing – Office vs Office-Hospital-ASC practice Marketing – Web/personal visits/PR talks/ hospital staff exposure Supply Sources and Cost Management Access to hospital supply chains EMR Selection – Stand-alone vs high use with billing feature included Run the Numbers – Keeping the practice healthy procedure mix--maximizing collections Summary
Efficiently Staffing Your Practice Determine the levels of employees to best staff your practice Executive Director – Total Practice Oversight (main fire wall –success based on complete trust – wide knowledge base of all areas of management – Policy/Procedures and Employee Handbook, contracts, adding partners, Cleaning service for physical plant and oversight, etc) Mid-levels (NP/PA) patient volume and procedure mix; Level of delegation for new patient, hospital vs outpatient only, reevaluation and minor procedure volume/complexity Nurses – need determined by IV use, pump management, post surgical care -- degree of liability Medical Assistants may be used providing you have well-trained and competent people - not licensed: Possibly significant legal issue depending on practice status as PA vs DBA. Clerical personnel – Front desk, Records Management, Scheduling, billing and collections
Marketing Your Practice Web-Based presence essential – Many people seek pain management by the internet – double-edged sword Personal Visits to other Physician Offices to discuss what you offer and the impact of your abilities and training – Offers opportunity to discuss the medication management area in view of the opioid crisis and new TMB oversight policies Public Relations Venues – can be sponsored by various venders to enable practitioner groups and the public to be educated on what you offer –costs vary according to venue (Radio-TV, Billboard, Newspaper, magazine vs talks to retirement communities, civic and church groups. Hospital Staff Exposure – important to be on staff at local hospital if willing to take ER or house pain call. Good PR to be available to other specialty physicians and mid-level practitioners.
Supply Chain and Costs Important to have access to hospital/ASC buying networks – more likely by volume of procedures done in the office. (Cardinal, Henry Schein, McKesson, Medline, Compounding Pharmacy) Limited by payers – ie SCS/pump trial, Kypho-Vertebroplasty Blocks, RF, pump refills in office---perm SCS/pump implant in ASC/hospital- SI joint stability implant, Vertiflex, StabiLink, Minuteman, etc… ASC/hospital only. Supply Costs determined by ability to sterilize non-disposable instruments (stainless steel, glass) vs all disposable in the PBO - ASC investment or ownership has advantages but with vastly higher costs.
EMR Selection and Use Several available – stand alone vs many with varied complexity and billing features including built-in billing service (Athena) Desirable features include High level Security (encryption, firewalls for HIPPA compliance, I-Pad interface, fax interface with laboratory imaging vendors, hospital and ASC dictation. Practitioners doing hospital consults must be able to download in real time in house consults etc by Wi-Fi. Does it communicate with patients ? – Portal for filling out new patient intake forms, physician and office for timely copying to referral and consultant physicians Is there an automated feature to flag coding/billing errors prior to submission to insurers?
What Makes a Practice Healthy ??? Run the Numbers ! Determine numbers of New Patients, Re-evals, Injections, Surgical procedures needed to break even, then increase from there. Cover building costs, (debt service, utilities, taxes, maintenance, insurance), payroll, supplies, professional liability insurance and other operating expenses. Conversion of new patient or re-eval to additional procedures. Effective follow-up and subsequent therapy (PT, OT, office visits) For SCS and Pump patients use portal notification and phone reminder for follow up visits. Owning one’s own building offers the opportunity for laboratory and PT services by flat monthly space rental rate. Legal ownership must be under trust or other entity. Avoid ownership in labs, etc which can be seen as Stark Law violation. Collections: Co-pays at front desk are a MUST – not doing so opens you up for a fraud allegation. Keep an eye on First Pass and follow-up working of claims
Summary Take-Home Points Keep a hands-on approach and attitude: it is YOUR practice and YOU are responsible for its profitability as well as its shortcomings. Be familiar with coding as to what is appropriate and will get you paid vs what is not and can get your work denied for payment or worse yet, get you accused of fraud. Have a tight compliance program in place from day 1 – be familiar with federal, state and local requirements – Develop a plan to review 10% or more of your records weekly. Designate an attorney familiar with compliance to review your management of the practice at least annually. Consult professional compliance help to aid and sharpen your review process – (ACE – Audit for Compliance and Education, Decision Health, AAPC, to name a few) You want to find “Red Flags”
References Rainer, C. Practice Management, 2 nd Ed. Wyndham Hall Press, Lima, OH 2010 Capko, J. Secrets of the Best Run Practices, 3 rd Ed. Greensbranch Pub. Phoenix, Md. 2017 Iriye BK, Sciccione A, O’Keeffe D, A Contemporary Guide to Practice Management, 2018, Coppell, Tx.
Pain Practice Management Increasing Value, Efficiency and Health of your Pain Practice Thank you for your Attendance
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