Physicians and practice managers may sometimes feel like they are running after dimes and nickels. However, the cost of collecting those coins can quickly add up, especially if you do not have an efficient billing system, which is why some medical practices decide to outsource their billing.
Consider the following most common outsourcing pros and cons when making your decision:
The pros Provides professional billing performance. The billing company creates core competencies, such as coding properly, meeting compliance standards, credentialing accurately, and applying necessary updates, to help the practice achieve its desired success, says Tim Anderson, owner of ACS, a billing and collections firm in Lafayette, LA.
Limits hiring and training. The benefit of hiring an experienced billing company is that it limits the amount of staff members needed to fulfill each task, says Owen Dahl, owner of Owen Dahl Consulting in New Orleans. Also, less training is required for staff members to learn new billing software or understand payer contracts.
Maintains consistent flow. The billing company can instill better relationships between payers and patients to ensure bills are paid. For example, staff members don't send billing information; they do not have to call insurance companies to ask questions about each patient's account or send out reminder letters to patients to pay their bill.
Lessens the need for technology upgrades. The practice avoids the hassle of installing new software systems that may be costly and time-consuming.
The cons Allows less control. You no longer have direct access to your patients' or payers' billing accounts, says Donna Lupinski, billing manager at Physicians to Women in Stuart, FL.
You cannot see the statements before they go out to the patient, you cannot call or talk to them directly about the problem, and you cannot conduct a random audit to check on overall productivity. Also, there is no way to know whether the billing company is adequately processing, following up, and fully adjudicating patient claims, Dahl adds.
Limits access to data. You may not have full disclosure of all your patient collections or the ability to review billing reports. There isn't always electronic access to these files. The practice may not have a suitable billing contract from the company that details the specific billing services they will provide, Anderson says. For example, if a payer agrees to reimburse your practice 120% of Medicare, be sure the contract specifies the dollar amount.
Lacks solid partnership. The practice does not have the opportunity to develop a peer-to-peer relationship with the billing company the same way it would internally, Dahl says, making it harder to call and ask about a patient's bill or a denied claim.
Shannon Sousa is the editor of The Doctor's Office. She may be reached at Ssousa@hcpro.com. This story was adapted from one that first appeared in the June edition of The Doctor's Office, a publication by HealthLeaders Media.
Deaths and hospital stays from a drug-resistant intestinal superbug almost doubled in recent years, according to a report by the U.S. Centers for Disease Control and Prevention. The study found that the death rate from the dangerous germ rose to 2.3% in 2004, from 1.2% in 2000. Additionally, the number of Americans hospitalized with the disease grew to 291,000 in 2005 from 134,000 in 2000.
A bill that passed the state Senate this week would require California hospitals to step up prevention of drug-resistant infections, requiring that hospitals report new infections to the California Department of Public Health. The bill also requires that hospitals clean and disinfect a variety of sites, ranging from television consoles and telephones to cardiac monitors and feeding pumps, all of which are capable of carrying drug-resistant bacteria that can subsequently spread to other patients.
Imagine a scenario where a patient comes to the ER needing an emergency laparotomy to address bleeding caused by a large ulcer penetrating the pancreas. The five-person surgical team consists of colorectal and hepatobiliary specialists, a breast surgeon, a minimally invasive surgeon, and a surgical oncologist. The ideal person to handle the operation—a general surgeon—is nowhere to be found.
That was the futuristic picture painted by a recent Wall Street Journalblog post that examined how increasing subspecialization is cutting into the ranks of general surgeons. Since 1992, for example, the number of surgeons pursuing subspecialty fellowships after training has increased from 55% to 70%, and during the same time the number of general surgeons per capita has fallen by 25%.
The effects of subspecialization aren't limited to surgical specialties. Primary care has been struggling for a while to keep medical students from pursuing medical subspecialties that often offer higher pay and better lifestyles. From a new physician's perspective, spending a few extra years in a fellowship is a sound career move.
The trend toward subspecialization has also benefited the industry as a whole in many ways. As treatments have become more complex, highly-focused specialists have been able to expand their respective fields of knowledge and improve patient care. The Hippocratic Oath even instructs physicians to "avoid attempting to do things that other specialists can do better."
But has specialization in medicine gone too far? The "do one thing and do it well" model makes sense when there are enough physicians to cover the entire spectrum of patient care needs. But as we're facing a shortage of physicians in all specialties, the lack of primary care physicians and versatile specialists and surgeons is going to make the burden of meeting tomorrow's healthcare demands tougher.
Subspecialists tend to congregate in large markets where the impact of physician shortages is already minimal. An ophthalmologist specializing in oculoplastics will have a tough time finding many subspecialty-specific procedures at a small hospital in a rural area, for example. And that small hospital has very little need for an oculoplastics specialist. From its perspective, the market needs less, rather than more, specialization. Primary care and general surgery are the lifeblood of rural care, but trends in physician training are shrinking the pool of available candidates and exacerbating the effects of existing shortages.
So how can the trend be reversed? The simplest answer is money. In the short term, that means facilities may have to offer higher salaries to attract primary care physicians, general surgeons, and other traditional specialists. But in the long term, the answer becomes more complicated. The physician payment system is structured to reward physicians for performing specialized procedures, and generalists are also burdened by a higher reliance on Medicare and Medicaid reimbursement. Changing that is beyond the control of an individual hospital or physician practice.
As long as physicians can earn an additional $50,000-$150,000 annually for subspecializing, they'll continue to do the math and perpetuate a trend that amplifies the industry's existing shortage of doctors.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
A Commonwealth Fund report examines how states perform on 13 different indicators in five categories: access to care, quality of care, cost, potential to lead healthy and productive lives, and equity in the quality of care provided regardless of race, income, or insurance status. It ranked states within each category and then assigned states a final overall ranking. Some say the findings show a need for a larger federal role in setting minimum standards to encourage better coverage and care for children.
All Ontario, Canada, hospitals will have to start reporting on the number of cases they have of the potentially deadly C. difficile bacteria starting Sept. 30. Critics claim Ontario was too slow to come up with a plan to deal with C. difficile after it claimed 2,000lives in Quebec in 2003, and insist some of the 260 deaths reported so far in seven Ontario hospitals could have been prevented. They also say the public has a right to know the extent of the C. difficile outbreak in all 157 hospitals in the province.
Common bacterial infections can cause some cases of sudden infant death syndrome, according to the British researchers. According to the American SIDS Institute, the rate of SIDS has dropped dramatically since 1983 because of concerted prevention efforts. Researchers conducted autopsies on 546 infants who had died suddenly between the ages of 7 and 365 days.
In this posting, Robert Wachter, MD, who writes the blog Wachter's World, questions why there's so much buzz out there about medical errors while diagnostic errors go on everyday with little notice. He says that someday we may reach a point when all pneumonia patients receive antibiotics and heart patients are given aspirin in a timely manner, but if the doctors giving those orders are wrong in their diagnosis, we really won't have made any advances in patient safety.
Ohio-based health system Catholic Healthcare Partners ranked fifth for quality care in a recent study published in the Joint Commission Journal on Quality and Patient Safety. The report compared 73 hospital systems using data publicly reported by the Centers for Medicare and Medicaid Services. The study included systems with six or more acute-care hospitals and examined data on 19 quality indicators.
Olathe (KS) Medical Center has kicked off the $20.85 million first phase of a construction project that will include the addition of imaging and other outpatient services, new streets and walkways, and park-like landscaping with a water feature. The cost for the first phase of the benefit-district construction is $4.35 million. First-phase plans for a new Olathe Medical Center Pavilion in the expansion area call for a two-story 42,000-square-foot multipurpose outpatient care center.
