Arun C. Jethani

As I write this blog, I reflect on 2010 and how many practices and imaging centers struggled to take action due to the unknown potentially negative consequences that the government and other forces might impose.

Therefore, we saw a great deal of turmoil and noise that actually defeated practices and imaging centers making them less powerful and less profitable. In 2011, I encourage all of you to focus on the practice elements that are in your control and effectively manage them.

Calculated risk will lead you to produce more income in the current environment, while mitigating any potential blow from our government in the future. We must accept: 1) the assertion that market and political forces are designed to lower our incomes and profits; and 2) it is our responsibility to innovate and act proactively to manage change.

With this acceptance we can actually improve our income and profits rather than sitting on the sidelines as a helpless non-participant. Please join us this year with this mind set as our focus.

Each week, we will be writing about something new to focus on. These themes will be broken down by our experts in five main categories:

1) Partner dynamics (led by Tim Stampp)
a. Being the best partner for one another - what this means and how to act to improve your situation and that of your partners
b. The dominant Joint Venture Relationship for you – what types of joint ventures work and how
c. Hospital-radiology strategic offers - making more money for both enterprises while improving patient care.

2) Revenue growth (led by Zach Bauer)
a. Adopting new services to yield better outcomes and significant revenue potential
b. Empowering the patient’s choice, which leads to more volumes
c. Enhancing communications with your referring physicians, which leads to more volumes
d. Obtaining more practices

3) Collection maximization (led by Bill Gurney)
a. Who’s accountable to collect the most for your practice/center?
b. Redesigning your work flow with current economic trends
c. Designing new structures and relationships with payers that help you both win and make more

4) Operations and productivity (led by David Rushing)
a. Aligning positive/negative consequences with productivity
b. Determining whether you are paying too much for supplies
c. Improving your negotiating power

5) Future of radiology (led by Arun Jethani)
a. Mergers and acquisitions
b. Hospital ownership and consolidation
c. Accountable care

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We must accept: 1) the assertion that market and political forces are designed to lower our incomes and profits; and 2) it is our responsibility to innovate and act proactively to manage change. With this acceptance we can actually improve our income and profits rather than sitting on the sidelines as a helpless non-participant. Please join us this year with this mind set as our focus.

No More Déjà Vu - Improving Your Practice in 2011

Capturing all your money matters. Here’s why

) I explained why it matters to capture as much revenue as possible. Let’s recap some of the major reasons for doing this. 

You make more money: No matter what the economic environment, you could always use more.

Improved hospital relationships: This may help minimize the subsidy a hospital may pay, thus strengthening the relationship between the radiology practice and the hospital.

Less government control: More revenue mitigates the continuous threat of changes in government and commercial insurance reimbursements, thus allowing you to pay your physicians a consistent annual compensation.

Less conflict: Having more money on hand avoids conflicts among practice, hospitals, and imaging centers due to inaccurate or bad data.

Growth: Having cash in reserve creates space for you to develop projects that protect and increase your compensation for the future. You can take advantage now while others are just panicking.

Now, how do you get there? Several relatively simple strategies can put you on the path to better capturing all of your revenue. 

First make sure that your partners all agree. Of course, everyone will say, “Yes, find me more me more money.” But you need agreement that there is an empowering body (one person or all; however your group dynamics work) that will champion this project. This means that if employees or vendors are not aligned, you agree to have consequences. You should have positive consequences for those who help, too.

Second, assess the incentives within each of your work relationships. A classic disconnect is a case where there is an activity that increases your overall revenue capture but implementing it means less in profits for your billing/collection department or vendor. For example, you figure that going after patient overdue balances can increase your collections by $20,000 a month, but doing so costs another $3000 and you are already paying 5% ($1000) for billing and collections. Your vendor will be threatened. 

 Many times we see practices go to collections, pay more than 30% on the dollar, and end up with a bad stigma for their brand. Collect earlier in a customer-friendly way. There is new software that is inexpensive; leverages existing technology, such as dialers; and can maximize your returns.

Third, break-up your revenue cycle capture program into specific workflows and assess the incentives and performance of each function. These workflows should include:  

. On average, about 13% of your collections should happen at the front desk. This leads to less collection work on the back end. Also, best practices can significantly reduce denials and no-pay patients. In order to do this, you must check for benefit eligibility, load fee schedules and calculate patient due balances before arrival, produce financial counseling worksheets that help your patients understand their benefits and what is due, and have easy access for patients to make payment.

. Elements include demographic and insurance capture, coding, and submitting claims (including secondary claim submission).

. Elements include collecting patient due balances (use an early-out program), ensuring proper payments from payers, and assessing denials and improving front desk services.

. Elements include compliance, reporting and practice management, payer negotiations, and improved communications between hospital and practice to capture better data

 	 Note that many billing companies are incentivized only to perform basic information capture and billing. Make sure there is someone either internally or externally who is accountable to measure each activity for you. 
 

Design a solution that involves multiple parties, including your own employees, and rewards collaboration with a more effective outcome. Make change with knowledge of what will work, and do not experiment. I have made mistakes in the past and have learned. I would hate to see others go through the same.

Don’t be scared. The longer you wait, the more frustrated you will become with your current process and the less confident you will be in other aspects of your business. 




Mr. Jethani is CEO of Medical Imaging Specialists. He can be reached by e-mail at jethani@medicalimagingspecialists.com. 

In my last report (Capturing all your money matters. Here’s why) I explained why it matters to capture as much revenue as possible. Let’s recap some of the major reasons for doing this.

Capturing all your money matters. Here’s how

When we ask radiologists about their collections, they usually say, “We capture most of our revenue, but you know how radiology is, you can’t collect it all.” 

 Stop thinking this way and open yourself to maximizing your collections. 

 When we investigate the billing practices being used in radiology, they do not match the trends happening elsewhere in healthcare. These trends include:  1) rises in high-deductible and HSA plans; 2) more restrictions and pre-authorization for procedures; 3) increases in patient-due balances; and 4) uncertainty in the self-pay population.  

 Radiology billing and collection practices tend to follow the same workflow they have for more than 20 years. We wondered why so little has been done to make things better. Here is what we have found: 

Groups are comfortable in what they are being compensated

Groups do not know how to make effective changes

Groups are afraid of volatility in cash flow given the current economic environment.

These are great reasons for not acting, but you should be open to the benefits that increasing your collections brings. Among them it: 

Mitigates the continuous threat of changes in both government and insurance reimbursement rates, thus allowing you to pay your physicians a consistent annual compensation

Makes you less vulnerable to decreases in reimbursement

Avoids conflicts among practice, hospitals, and imaging centers due to inaccurate or bad data

Helps minimize the subsidy a hospital may pay, thus strengthening the relationship between the radiology practice and the hospital

Creates space for you to develop projects that protect and increase your compensation for the future

My next report will spell out steps you can take to improve collections. Here are five processes that we will cover: 

Communication between hospital and radiology practices.

Mr. Jethani is CEO of Medical Imaging Specialists. He can be reached by e-mail at jethani@medicalimagingspecialists.com.

When we ask radiologists about their collections, they usually say, “We capture most of our revenue, but you know how radiology is, you can’t collect it all.”

Are you ready to engage your partners in a serious conversation about aligning your practice around shared goals and challenges? If so, here is a series of steps you can take that move the practice in that direction. 

 But first, a caution. In my last 

, I suggested that you and your partners have similar fundamental concerns. If you believe this is not the case, you should revisit this subject before taking any action to move forward. It does not make sense to be in conversation about aligning around goals and challenges if you think that you and your partners hold vastly different concerns. You may want to hold a serious, offsite meeting before you move any further. 

 If you think you and your partners have similar fundamental concerns, how can you team up together? 

 Here are three practices that have worked for our groups: 

: Take time to meet quarterly to discuss the state of your business, opportunities you have, and what risks/threats you are looking to avoid. These meetings should be properly structured with a specific agenda that has some or all of the following topics: 1) partner concerns/achievements, 2) customer/client satisfaction, 3) financials, 4) milestones/outcomes you are looking to achieve. Try to avoid administrative items such as new healthcare plans and vacation schedules.

: Respect that someone needs to be the leader and that administration is important. If you are running a large practice with multiple hospital/imaging center contracts, then you need to make sure there are radiologists on the ground feeding your lead managing partner information. Do not criticize or challenge your managing partner during the course of the day. Write down specific issues and present them to him or her during a designated weekly or monthly session. Remember that your managing partner holds multiple concerns (profitability, administration, client delivery, interpretation, etc.) and that you have elected her/him to make the best decision for the group at that specific moment.

: Come up with plans (no more than two a quarter) that will allow you to thrive. Get help where you and your partners may lack specific knowledge on how to make improvements. Get your partners involved. Here are a couple of examples. 

Situation: Your hospital client is losing volume due to operational issues.

 Solution: Invite the hospital administration to join you in putting together a strategic plan to address the issues. Set specific outcomes (improve volumes by 5%, quality metrics by 6%, etc.) and track your progress.

Situation: Your monthly collections are down due to an increase in self-pay and patient-due issues.

 Solution: Work with your billing department to take steps to improve collection of patient-due revenues. Ask other groups or your hospital clients how to improve. See what others are doing.

Are you ready to engage your partners in a serious conversation about aligning your practice around shared goals and challenges? If so, here is a series of steps you can take that move the practice in that direction.

Arun C. Jethani

Articles

No More Déjà Vu - Improving Your Practice in 2011

Capturing all your money matters. Here’s how

Capturing all your money matters. Here’s why

Align your practice around shared goals and challenges