aaham hfma presentation march 2011
TRANSCRIPT
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Proprietary & Confidential
Copyright Intermedix Corporation 2010
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HITECH
Privacy &
Security
RAC Audits
ICD-10
EHR
Limited time
offer
5010
Economic
Challenges
HealthCare
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Local Delivery
Local AccountabilityPhysician Leadership
Coordinated,
accountable care across
the continuum of care
Performance Measures
(transparency)
Financial rewards tied to
quality more than
volume or cost
Improve health
outcomes, slow cost
growth
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Why do physicians want to becomeemployees?
1. Improved work-life balance
2. Competitive benefits & retirement package
3. Job satisfaction
4. Increased annual income
5. Consistent income
Source: PricewaterhouseCoopers 2010 Report
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Does physician integration makesense to your facility?
Your business model will change
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e Physician fee schedules are often structured using
the RBRVS, assigning relative values (RVU) to each
CPT code for services on the basis of the resourcesrelated to the procedure rather than simply on the
basis of historical trends.
Physician work component (55%)
Practice expense component (42%)
Professional liability insurance component (3%)
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Average Salary is $160.00/hr for an ED provider
$1,401,600.00 in physician salaries annually for a
single coverage ED ($116,800 a month)
Add Malpractice expenses
Add Benefits
Add Medical Director stipend ($5,000-$20,000/month)
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18,000 annual visit emergency department
Single coverage ED
730 hours a month
730/120 (full time ED provider hours) = 6 FTEs required
2 patients per hour
$60 - $130 per patient collections:
$1,080,00000 - $2,340,000.00
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Cumulative costs for provider: $1,401,600.00 (Salary)
$ 120,000.00 (Malpractice) (Plus tail coverage)
$ 400,000.00 (Benefits) $ 10,000.00 (Medical Director Stipend)
Total physician cost $1,971,600
Possible revenue: $1,890,000.00 ($105.00 per patient)
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Length of visit increases
More legal exposure
Employee liability is direct to the hospital, groupkeeps liability if separate entities
Difficulty implementing production based models
Eventually employee physicians always wantdetailed financial information and profit sharing
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Problems with scheduling and recruitment arenow hospital issues
Disciplining the doctor(s) becomes a hospitalissue
Total risk of bad collections falls on thehospital
Liability for coding problems falls on thehospital
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Hospital may feel they have more control
Implement a benchmarking tool to increaseproductivity and tie directly to incentiveprogram.
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High volume, low dollars
ED Physician coding is complex
Understanding E/M levels
Ongoing physician documentation training
Identify, track, report and improve documentation
deficiencies
Monitoring contracts for underpayment/working denials PQRS (Physician Quality Reporting System)
System changes required for optimal reporting
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Handling physician credentialing
Experienced with the nuances of ED coding
Attending ACEP coding courses?
Monitoring contracts and allowances
Negotiating payer contracts
Generating ED specific reports
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Monitoring/reporting PQRS statistics
Discussing with ED physicians regarding
documentation deficiencies and providing
ongoing training
Calculating RVUs
Consistently following up on ED accounts
Working denials and appeals
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Control of Staff
Control of Costs
Bundled payments
One patient statement for global charges
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Strain on current staff
HR issues, vacations, medical leave, etc.
Limited hiring pool Space limitations
Lack of clinical knowledge
Physician documentation training
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Keeping up with current coding regulations,
state rules and regulations, changes with
the payer rules, etc.
ICD-10 challenges
RACs, etc.
HIS limitations
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EMRs!!
Compliance Concerns:
Cloning (reference handout)
Templates
Over documentation
Automated coding
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Financial Impact
Certified Coders arent cheap
2009 AAPC estimates $53,700 (loaded)
Revenue decrease with no lobbying efforts
by provider organizations (HBMA,EDPMA)
Revenue decrease with inadequate
provider managed care negotiations
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Reduced liability
No HR issues, ongoing training, certifications,
space management, etc.
No management of other services:
Physician credentialing
Billing statements
Postage, return mail
RACs, etc.
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Fees based on revenue collected
No claims clearinghouse cost
Coding and billing expertise in the
specialty
Peer to peer physician documentation
training
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Lack of control
Cost of collection
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DONT SHOOT THE MESSENGER!
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Taxes
Vacation pay
Sick pay
Paid holidays
Medical Insurance
Work Comp
Unemployment
Personnel Turnover/Training Costs
Non-labor costs (furniture, equipment, space, utilities, etc.)
average nationwide expense of employing someone, depending on the benefits package-
35-40% over the annual salary amount
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Management of Staff $60,278 $ 15,069
Salary for Certified Coder (CPC) $53,352 $ 53,352
Salary for Biller $47,736 $ 37,000
Claims Clearinghouse Cost $ 4,500
Mailing Costs ($1.25 per statement) $ 33,750
1.5 statements per account
Salary for Payment Poster $42,120 $ 13,500
Salary Patient Call Center $47,028 $ 13,500
(in-bound calls, self pay)
Salary for Patient Acct. Rep $47,028 $ 27,000
(outbound calls, insurance, denials) Physician Credentialing Cost
More turnover in the ED $ 4,500
Total:
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$931,829 $1,738,800
$105 avg. patient collection
lost reimbursement due
to inaccurate documentation &
inexperienced coders
lost revenue for A/R
holding costs and inconsistent f/u
$105 avg. patient collection
8% contingency fee (Range 7-9%)
All inclusive fee
NET REVENUE
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Cumulative costs for provider: $1,401,600.00 (Salary)
$ 120,000.00 (Malpractice) (Plus tail coverage)
$ 400,000.00 (Benefits) $ 10,000.00 (Medical Director Stipend)
Total physician cost $1,971,600
Possible revenue: $1,890,000.00 ($105.00 per patient)
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RVU/Pt
increase
@ 18,000 visits @ $30/RVU
collection rate
@ $35/RVU
collection rate
@ $40/RVU
collection rate
0.10
RVU/pt
1800 RVU
increase/year
$54,400
increase/year
$63,300
increase/year
$72,200
increase/year
0.33RVU/pt
5940 RVUincrease/year
$178200increase/year
$207900increase/year
$237600increase/year
0.50
RVU/pt
9000 RVU
increase/year
$270000
increase/year
$315000
increase/year
$360000
increase/year
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Do they handle specialized coding and billing?
Can they provide onsite physician documentation training
specific to the specialty?
Can they manage contracts and payer negotiations?
Do they patient accounts?
What are the fees and any additional costs?
Do they understand compliance and acuity levels!
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ED has always been considered the
red-headed stepchild
There is not a one size fits all answer
Depends on your facility, your
resources and your overall strategies tofulfill your hospitals mission.
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Judy Griffith
Director of Business Development
Intermedix
303-656-8790
mailto:[email protected]:[email protected]