Chris Carson, a Managing Director in the Health Solutions practice at FTI Consulting Inc. in Atlanta, relates that he, his spouse, and friends recently dined at a restaurant for the first time in months. Upon entering, they were stunned by the sight of workers wearing masks and gloves. Tables had no tablecloths. Moreover, while waiting for a table, he and his spouse had to move twice at the bar to adhere to social distancing. Then, when seated, they noted they had nearly an entire section of the restaurant to themselves. When the restaurant owner came by to check on them, he was wearing a hockey-like face mask. The owner said they were only serving at 50% capacity, but the place was busy and doing well.
Restaurants suddenly have something in common with medical practices. Both have been hit hard by the COVID-19 pandemic and need to continue providing services while taking precautions to prevent transmission of the coronavirus that causes COVID-19. In the case of medical practices, a major challenge will be to maintain patient volume while ensuring the safety of caregivers and patients.
“It’s going to take experimentation, flexibility, a positive attitude, and thinking through all parts of the business,” Carson said.
Many of his medical practice clients have expanded their office hours to get more patients in the door, he said, adding that some health systems are open for patient visits in the evening and on weekends to compensate for social distancing requirements during the weekdays.
Surgical practices net about 37% of every dollar they bill to an insurer, but “every dollar saved is a dollar kept”, said Chris Zaenger, the Principle of Z Management Group, Ltd., based in Elgin, Illinois. “They really ought to focus on both ends of the ledger – what they can generate and save,” he said.
Zaenger suggests looking at all areas of spending to identify places to cut costs, such as medical and office supplies. Providers may be able work with other practices to get volume discounts on medical supplies or seek out places to get office supplies at lower prices. “It’s okay to go to Target,” he said.
Debra Phairas, President of Practice & Liability Consultants LLC in Napa, California, suggests holding staff contests that challenge employees to find the best way to save money each quarter, with a reward given to the winner. She also recommends that practices, as they ramp up after reopening, make anticipatory budget 6-month forecasts of expenses, taking into account changes in patient volume.
Rent and payroll usually are an organization’s biggest expenses, so practices should look at those first, Phairas said. If a practice is not billing as much as before the pandemic, they may want to consider such cost-cutting measures as reducing hours worked by medical assistants, whose workload is tied closely with that of doctors, she said.
Groups also can consider whether they should downsize their practice space. Practices should look at morning and afternoon shifts to determine how rooms are used each day, Phairas said. “They can’t afford to have empty rooms while doctors are in surgery or doing procedures,” she said.
Medical groups also might consider merging with other groups or renting out space to complementary providers, she said.
An obvious way to increase a group’s income is to see more patients. But as practices reopen, some patients may have gone to other physicians or opted to forgo nonemergent services. All offices have an inventory of charts from patients who have not been seen at the practice recently, Zaenger said. Staff should follow up with these patients to make appointments or at least to stay connected.
“How many orthopedic doctors call parents of kids who had a fractured forearm to see how they are doing?” he asked. “This is a great time to build goodwill and add to physician presence.”
In addition, practices should review referral networks and touch base with physicians who had been a regular source of referrals. Many electronic medical record systems track who is sending patients to a practice. Practices that find out providers who used to give referrals are not doing so any longer should call those providers to let them know they are still taking new patients, Zaenger said.
Administrative staff can also play a role in increasing income. It is imperative to send out insurance claims with clean billing and coding to get reimbursed as quickly as possible, Carson said. More than 500 new CPT codes are being released next year, he said. Practices can start reviewing how these new codes might impact their billing.
Having an online portal through which patients can pay bills helps increase a group’s revenue stream, Zaenger said. Front desk staff should be knowledgeable about directing patients to the portal and ensuring they understand how to pay there. Staff should also be asking for balances and copays at the time of service, a major area of income often missed in practices.
Lab bills are another area frequently overlooked when money is tight, Zaenger said, adding that these bills are frequently wrong. Differences in coding between third-party payers and laboratories can result in practices paying more for lab services and potentially losing money. Staff should review lab bills monthly to ensure that third-party reimbursements match the amounts billed.
Telehealth offers another way to maintain and potentially boost revenue. Many practices are already performing visits this way. Carson said one of his clients went from no telehealth visits to 5000 such visits a week. Assuming regulations on telemedicine visits remain favorable, this modality could be a great way to increase caseload and income, especially for practices that serve large numbers of older, less mobile, patients and those in rural areas, Zaenger said. Expanded use of telehealth can help providers better manage patient visits, increase the number of patients seen, and potentially reduce the need for some office space and staff.
“What the pandemic did was give telemedicine an adrenaline shot; it catalyzed it as a new way to look at the practice,” Zaenger said.