Capturing specialty practice revenue

Two out of three physicians surveyed at the LUGPA regional meeting this past spring cited rising costs and declining reimbursement as one of the top challenges they face in a COVID-19 era of care. It’s a challenge that requires a new look at ways to increase efficiency and revenue, even as workforce shortages and pandemic-specific obstacles strain resources.

For instance, supply chain challenges—such as a contrast dye shortage that prevents some patients from receiving CT scans to monitor tumors or even detect a kidney stone—not only make it hard to treat patients’ health conditions, but also monitor progression of disease. This creates scenarios where patients who are more symptomatic may receive diagnostic testing while others go without. It is too early to tell what the long-term impact of this crisis might be.

Then there are the factors that continue to keep people from pursuing needed care, from fear of exposure to the coronavirus to concerns about the cost of care, long wait times for appointments and a tendency among some patients to put family members’ care needs—especially their children’s care needs—above their own.

How can specialty care practices strengthen quality of care, access, and revenue amid challenges such as these? Here are three approaches to consider.

1.Explore opportunities to expand ancillary services offerings—and promote them widely. For instance, at Genesis Healthcare Partners in Los Angeles, the urology practice offers genetic testing for family members of prostate cancer patients, given the increased risk for aggressive prostate cancer in men with a family history of this disease. Among the top ancillary investments for urology practices alone, according to a McGuire Woods analysis: radiation therapy, surgery centers, lithotripsy and on-site laboratories and pharmacies.

Ancillary services make care more convenient for patients by offering a one-stop experience for meeting their comprehensive care needs for a specific condition. It also eliminates travel to multiple destinations for patients whose health makes it physically difficult to navigate facilities. Increasingly, specialty practices are entering into administrative and capital partnerships to manage ancillary services and access funding to launch new services or grow existing services.

One way to more widely promote existing service lines: Leverage patient data to identify patients who might benefit from a particular in-house service. Examples across specialties include nutrition counseling, a sleep apnea clinic, a cystitis clinic, physical therapy, and behavioral health services.

2.Make chronic care management more meaningful. Leading specialty practices are exploring chronic care management (CCM) and principal care management (PCM) to strengthen outcomes for patients with chronic conditions while boosting revenue. This year, the Centers for Medicare & Medicaid Services (CMS) added four new codes for PCM, which allows physicians to receive additional reimbursement for their work in managing a single chronic condition. To qualify, the condition must put the patient at risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, with reimbursement depending in part on a disease-specific care plan. CCM, on the other hand, reimburses physician practices for care provided to a Medicare patient with two or more chronic conditions outside the patient’s regular office visit. But capturing CCM and PCM activities—a necessity for reimbursement—requires a software platform for tracking and managing care activities for this population, many of whom have multiple health needs.

3.Look for ways to make virtual care more efficient. As care shifts to a hybrid environment—part in-person, part virtual, depending on the patient’s preferences and needs and the provider’s comfort level—there are numerous opportunities to make the experience of virtual care better for physicians and patients alike. For instance, rather than having the physician initiate the virtual care appointment, assign this task to a medical assistant, who can prep the patient and the physician for the encounter, start the call and alert the patient and the physician when it’s time to “go live” with care. This ensures the visit kicks off as smoothly as possible. It also preserves physicians’ time for true patient care activities, rather than administrative work associated with the encounter.

Remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) are two other activities that are eligible for reimbursement from CMS—and, when used effectively, they can significantly reduce hospital readmissions (by 64% for cardiac patients alone). Key to operational efficiency and better outcomes: a tool that analyzes RPM and RTM data in real time and alerts medical assistants when the patient’s vital signs signal a need for intervention.

By exploring opportunities to strengthen patient care and services while creating new avenues for revenue, specialty practices will be better positioned to engage members with complex care needs, to minimize provider and clinical staff burnout, and to protect their bottom line.

Shirley H. Lee, CRNP-FNP, MPH, is Director of Patient Navigation and a Nurse Practitioner for Genesis Healthcare Partners, P.C. She is also Vice President of Clinical Strategy for Preveta. She is based in Los Angeles.