As regulatory demands and office expenses increase, insurance reimbursement seems flat or on a slow decline, says Howard Wooding Rogers, M.D.
“The instinct for physicians in that sort of environment where your overhead keeps going up but your revenue per patient doesn’t, is to see more patients or do more procedures. At that point, we kind of get on a hamster wheel. We’re running faster and faster and not seeming to get anywhere. The fact that more physicians are experiencing burnout is indicative of that,” he said.
But the key, Dr. Rogers said during a talk at the American Academy of Dermatology annual meeting, is to work better ― not necessarily harder.
Conduct a financial analysis to determine how best to support and strengthen the practice without adding more patients, he says. But if adding more patients is unavoidable, adopt practice management strategies to maximize income and decrease expenses. Some of these include adding more office hours; cultivate referrals for new services; or hire a new dermatologist.
But above all, increase efficiency:
1. Use a scribe so the physician can spend less time documenting the visit and more time with patient.
2. Improve scheduling. Schedule patients during downtimes.
3. Keep wait times to a minimum. Mail or email paperwork to patients in advance of the visit.
4. Utilize prepopulated prescriptions, instructions and education forms.
5. Adopt a computerized patient recall system to reduce no-shows. “In my office, we have a system that calls every single patient. The computer does it two days before their appointments. For expensive and time-consuming procedures, my staff calls the patient personally the day before. Those are blocks that we can’t have empty,” Dr. Rogers says.
6. Add nurse practitioners or a physician assistant to the team. They can meet with less complex follow-ups which frees the dermatologists to address complicated cases.
7. Optimize billing. This can increase the average reimbursement for each patient. A lot of dermatologists bill at allowable lower levels to avoid audits. “If you’re providing a service and are documenting it properly, bill to the appropriate level,” he says.
8. Maximize new patient visits. New patient visits may reimburse more than established patient visits, so the physician should focus on these cases, while established patients meet with a nurse practitioner or physician assistant or, they can call with follow-up questions.
9. Renegotiating insurance contracts. “Everybody thinks their insurance contracts are set in stone, but they’re not,” he says. An insurance company, for example, might be more inclined to renegotiate contracts for physicians who serve in underserved communities.
10. Renegotiate recurring office expenses. “I hired an office manager who loves to negotiate and she is phenomenal at it. She’ called every one of my vendors and said, ‘I think we can do better elsewhere,’ [reducing] cable prices, telephone prices, garbage pickup, hazardous waste prices, liquid nitrogen prices…. No one will give you a lower price unless you ask.”
11. Changing insurers. If an insurer is paying a dermatologist at a subpar level, you may want to consider dropping the insurer. “You don’t want to do that because it hurts patients, but at the same time, you’re running a small business—not a charity.”
“C019 Advanced Practice Management,” Pendharkar, Kim, Regula, et al. American Academy of Dermatology 2018 annual meeting. 1 to 4 p.m. Sunday, Feb. 18, 2018. https://www.aad.org/scientificsessions/am2018/SessionDetails.aspx?id=11426