565093
research-articleXXXX
FASXXX10.1177/1938640014565093Foot & Ankle SpecialistMONTH XXXXvol. X no. X Foot & Ankle Specialist
8
Feb 2015
Foot & Ankle Specialist
〈 Cutting Edge—The Business of Medicine 〉 Tuning Your Practice
Strategies to Consider in a Changing Health Care Environment
U
ncertainty in the provision of health care has become the norm, not the exception. Around the corner, in 2015, we must consider the influence of accountable care organizations (ACOs), International Classification of Diseases–10th Revision (ICD-10), decreasing reimbursements, hospital consolidations, and health care employment models that may affect us directly or at the least some referral sources. Many practice managers will throw in the towel and continue to see and treat their patients without trying to do anything to improve the practice or the practice revenue. Others will see opportunity and seize it. A year ago, Foot & Ankle Business Innovations (FABI) was created to help practices that wanted to improve their financial position and grow their practices. Nearly a year into this experience, eleven physicians representing nine practices from all around the country have experienced increased billings (30% to 40%), increased revenues (15% to 30%), and increased excitement (100%) for their chosen profession compared with the same time in the past year. There are many strategies to consider when creating a plan to improve your practice. Marketing, employee training, finding new revenue sources, ensuring
accurate coding and collections, team building, and employee satisfaction are some examples that can pay dividends for your practice. We are going to look at 5 ways to improve patient care while enhancing revenue. There is an overall reluctance to invest in technology. It’s costly. You don’t know if it will be reimbursed. You don’t know if you will use it. Will it break? I’ve heard all the excuses and they are real concerns. Musculoskeletal ultrasound investment is a smart choice for patient care and an in-office imaging modality that is uniquely suited to a foot and ankle practice. Not only can it help diagnose pathologies of the foot and ankle, it has been shown with many studies that ultrasound-guided injections are more efficacious.1-5 Properly performing those studies (which are reimbursed by most insurances) allows a physician the opportunity to diagnose in a more timely fashion and start appropriate treatment, leading to higher patient satisfaction. Using that same ultrasound device, more accurate placement of injections will enhance your patient experience with less pain during the procedure, better results following the procedure and create a “wow factor” that should not be discounted. Patients want a modern and
Lowell Weil Jr, DPM, MBA Weil Foot & Ankle Institute, Chicago, Illinois
progressive experience and will comment on that regularly. The reimbursement associated with this improved procedure is well worth the time and effort. There is a wide array of costs for ultrasounds but there are many affordable devices on the market. They may not have all the bells and whistles of other devices but are extremely effective. For small groups who refer 2 to 4 magnetic resonance imaging (MRI) studies a week, consider purchasing your own extremity MRI. There are extremely affordable extremity MRIs that are powerful enough to pass all the requirements of insurance companies. These units are small enough to fit into a treatment room in your office without much retrofitting necessary. With proper training, office staff can perform the studies, which can yield excellent pictures and help you diagnose pathology more efficiently and start treatments more quickly. Furthermore, patients love the convenience of being able to get their MRI at a familiar location and knowing that their physician will have ready access to the information obtained. Plantar fasciitis continues to be a common ailment and one of the most frequent reasons for a foot and ankle
DOI: 10.1177/1938640014565093. For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Copyright © 2014 The Author(s)
Downloaded from fas.sagepub.com by guest on June 6, 2016
vol. 8 / no. 1
consultation. Extracorporeal shock wave therapy (ESWT) has the benefit of peer-reviewed support and a successful treatment for a variety of orthopedic and wound related problems. ESWT is a perfect addition to any practice that sees plantar fasciopathy, Achilles tendonapathy, and other tendonopathies as well as bone and wound problems. While ESWT is not typically covered by insurances, cash pay is commonly accepted by patients given the alternative of surgery and recovery. The cost of ESWT has changed tremendously and now in-office devices are very affordable. You may look at these options and wonder how to afford them. There is no better time to use small business loans to invest in your practice. The historically low interest rates give you the opportunity to use debt in a very positive way. The increased revenue that these technologies will provide can easily offset the loan payments. Most offices offer a limited amount of durable medical equipment (DME), like removable walking boots and surgical shoes. However, there are so many opportunities with DME that your patients need and appreciate. There are numerous companies that provide bracing for the ankle, foot, and toes that are extremely beneficial and if used properly are insurance reimbursable. When it comes to DME, most people get caught thinking they won’t get reimbursed or they will just give it away. Learning the proper coding and using the DMEs appropriately can ensure better patient results with increased revenue. A problem that many people run into with DME is inventory. Proper inventory management is crucial to a successful DME program. Providing physical therapy services is a great way to improve the patient experience. For some reason, physical therapy of the foot and ankle have been underutilized compared with other orthopedic disorders. For every knee, hip, and shoulder surgery, patients are referred to physical therapy. Why would the foot and ankle be any different? Is the range of motion of the first metatarsal phalangeal joint less important
Foot & Ankle Specialist
than the knee joint? Of course not, but it has not been the standard to make those referrals. A great way to provide physical therapy services within your office is to foster a relationship with a local physical therapist or physical therapy company. Explain to them your needs and desires, and after sending them some patients offer them the opportunity to rent space in your office (for fair market value) and you will refer appropriate cases so that your patients have the convenience of on-site physical therapy care. Many people have talked and written about the benefits of providing retail options in your office. The reality is that when done correctly, it works extremely well. Providing patients with products that they would otherwise have to search for themselves at stores or online is usually appreciated. When getting started in this arena, begin with things that are needed by many patients like arch supports, topical creams such as fungal medications, and other low-cost products like attractive compression stockings. When deciding which arch support to carry, don’t choose one that is readily available at other stores or online, but pick some that are more unique. There are many companies that provide such arch supports. Don’t be afraid that it will cut into your orthotic business. Use it as a bridge to orthotics. It takes orthotics several weeks to be fabricated and the arch supports can be used in the interim. Once you feel good about your retail offerings, moving into shoes is the real winner. Patients are very receptive for shoe advice and recommendations from their physician. There are several companies that now offer attractive, supportive shoes that patients will really appreciate. Take on retail in a thoughtful way and you will see the dividends for your patients and practice. Research is often thought of as a daunting thing that the very academic in our profession participate. While that can be true, there are numerous opportunities to get involved in clinical research. Research benefits patients as they may get cutting-edge technology that they otherwise wouldn’t have access. Additionally, some of the technology is
Downloaded from fas.sagepub.com by guest on June 6, 2016
cost prohibitive for physicians to use but when performing research, it is obviated for the study. Not all research is on hugely expensive devices or products and can be on more seemingly mundane things that are in all of our practices. Research is a necessity for medical advancement and by participating; you help improve the delivery of medical care for the world. When participating in research, there are usually payments involved on a per patient basis from the sponsoring companies. Those payments can be in the $100/patient range to the multiple thousands of dollars for more advanced studies. We have created a resource whereby we connect interested physicians with sponsoring companies to facilitate that research. We all hear that things are getting tougher and practice is getting harder. Are you satisfied with surviving or are you interested in thriving? Join Foot and Ankle Business Innovations in January to explore these areas further and others to help spring your practice into 2015 and beyond. Visit FABI2015.com for more information.
References 1. Morgan PA, Monaghan W, Richards S. A systematic review of ultrasound-guided and non-ultrasound-guided therapeutic injections to treat Morton’s neuroma. J Am Podiatr Med Assoc. 2014;104:337-348. 2. Amber KT, Landy DC, Amber I, Knopf D, Guerra J. Comparing the accuracy of ultrasound versus fluoroscopy in glenohumeral injections: a systematic review and meta-analysis. J Clin Ultrasound. 2014;42:411-416. 3. Furtado RN, Pereira DF, da Luz KR, et al. Effectiveness of imaging-guided intraarticular injection: a comparison study between fluoroscopy and ultrasound. Rev Bras Reumatol. 2013;53:476-482. 4. Nam SH, Kim J, Lee JH, Ahn J, Kim YJ, Park Y. Palpation versus ultrasound-guided corticosteroid injections and short-term effect in the distal radioulnar joint disorder: a randomized, prospective single-blinded study. Clin Rheumatol. 2014;33:1807-1814. 5. Ustün N, Tok F, Yagz AE, et al.Ultrasoundguided vs. blind steroid injections in carpal tunnel syndrome: a single-blind randomized prospective study. Am J Phys Med Rehabil. 2013;92:999-1004.
9
research-articleXXXX
FASXXX10.1177/1938640014565093Foot & Ankle SpecialistMONTH XXXXvol. X no. X Foot & Ankle Specialist
8
Feb 2015
Foot & Ankle Specialist
〈 Cutting Edge—The Business of Medicine 〉 Tuning Your Practice
Strategies to Consider in a Changing Health Care Environment
U
ncertainty in the provision of health care has become the norm, not the exception. Around the corner, in 2015, we must consider the influence of accountable care organizations (ACOs), International Classification of Diseases–10th Revision (ICD-10), decreasing reimbursements, hospital consolidations, and health care employment models that may affect us directly or at the least some referral sources. Many practice managers will throw in the towel and continue to see and treat their patients without trying to do anything to improve the practice or the practice revenue. Others will see opportunity and seize it. A year ago, Foot & Ankle Business Innovations (FABI) was created to help practices that wanted to improve their financial position and grow their practices. Nearly a year into this experience, eleven physicians representing nine practices from all around the country have experienced increased billings (30% to 40%), increased revenues (15% to 30%), and increased excitement (100%) for their chosen profession compared with the same time in the past year. There are many strategies to consider when creating a plan to improve your practice. Marketing, employee training, finding new revenue sources, ensuring
accurate coding and collections, team building, and employee satisfaction are some examples that can pay dividends for your practice. We are going to look at 5 ways to improve patient care while enhancing revenue. There is an overall reluctance to invest in technology. It’s costly. You don’t know if it will be reimbursed. You don’t know if you will use it. Will it break? I’ve heard all the excuses and they are real concerns. Musculoskeletal ultrasound investment is a smart choice for patient care and an in-office imaging modality that is uniquely suited to a foot and ankle practice. Not only can it help diagnose pathologies of the foot and ankle, it has been shown with many studies that ultrasound-guided injections are more efficacious.1-5 Properly performing those studies (which are reimbursed by most insurances) allows a physician the opportunity to diagnose in a more timely fashion and start appropriate treatment, leading to higher patient satisfaction. Using that same ultrasound device, more accurate placement of injections will enhance your patient experience with less pain during the procedure, better results following the procedure and create a “wow factor” that should not be discounted. Patients want a modern and
Lowell Weil Jr, DPM, MBA Weil Foot & Ankle Institute, Chicago, Illinois
progressive experience and will comment on that regularly. The reimbursement associated with this improved procedure is well worth the time and effort. There is a wide array of costs for ultrasounds but there are many affordable devices on the market. They may not have all the bells and whistles of other devices but are extremely effective. For small groups who refer 2 to 4 magnetic resonance imaging (MRI) studies a week, consider purchasing your own extremity MRI. There are extremely affordable extremity MRIs that are powerful enough to pass all the requirements of insurance companies. These units are small enough to fit into a treatment room in your office without much retrofitting necessary. With proper training, office staff can perform the studies, which can yield excellent pictures and help you diagnose pathology more efficiently and start treatments more quickly. Furthermore, patients love the convenience of being able to get their MRI at a familiar location and knowing that their physician will have ready access to the information obtained. Plantar fasciitis continues to be a common ailment and one of the most frequent reasons for a foot and ankle
DOI: 10.1177/1938640014565093. For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Copyright © 2014 The Author(s)
Downloaded from fas.sagepub.com by guest on June 6, 2016
vol. 8 / no. 1
consultation. Extracorporeal shock wave therapy (ESWT) has the benefit of peer-reviewed support and a successful treatment for a variety of orthopedic and wound related problems. ESWT is a perfect addition to any practice that sees plantar fasciopathy, Achilles tendonapathy, and other tendonopathies as well as bone and wound problems. While ESWT is not typically covered by insurances, cash pay is commonly accepted by patients given the alternative of surgery and recovery. The cost of ESWT has changed tremendously and now in-office devices are very affordable. You may look at these options and wonder how to afford them. There is no better time to use small business loans to invest in your practice. The historically low interest rates give you the opportunity to use debt in a very positive way. The increased revenue that these technologies will provide can easily offset the loan payments. Most offices offer a limited amount of durable medical equipment (DME), like removable walking boots and surgical shoes. However, there are so many opportunities with DME that your patients need and appreciate. There are numerous companies that provide bracing for the ankle, foot, and toes that are extremely beneficial and if used properly are insurance reimbursable. When it comes to DME, most people get caught thinking they won’t get reimbursed or they will just give it away. Learning the proper coding and using the DMEs appropriately can ensure better patient results with increased revenue. A problem that many people run into with DME is inventory. Proper inventory management is crucial to a successful DME program. Providing physical therapy services is a great way to improve the patient experience. For some reason, physical therapy of the foot and ankle have been underutilized compared with other orthopedic disorders. For every knee, hip, and shoulder surgery, patients are referred to physical therapy. Why would the foot and ankle be any different? Is the range of motion of the first metatarsal phalangeal joint less important
Foot & Ankle Specialist
than the knee joint? Of course not, but it has not been the standard to make those referrals. A great way to provide physical therapy services within your office is to foster a relationship with a local physical therapist or physical therapy company. Explain to them your needs and desires, and after sending them some patients offer them the opportunity to rent space in your office (for fair market value) and you will refer appropriate cases so that your patients have the convenience of on-site physical therapy care. Many people have talked and written about the benefits of providing retail options in your office. The reality is that when done correctly, it works extremely well. Providing patients with products that they would otherwise have to search for themselves at stores or online is usually appreciated. When getting started in this arena, begin with things that are needed by many patients like arch supports, topical creams such as fungal medications, and other low-cost products like attractive compression stockings. When deciding which arch support to carry, don’t choose one that is readily available at other stores or online, but pick some that are more unique. There are many companies that provide such arch supports. Don’t be afraid that it will cut into your orthotic business. Use it as a bridge to orthotics. It takes orthotics several weeks to be fabricated and the arch supports can be used in the interim. Once you feel good about your retail offerings, moving into shoes is the real winner. Patients are very receptive for shoe advice and recommendations from their physician. There are several companies that now offer attractive, supportive shoes that patients will really appreciate. Take on retail in a thoughtful way and you will see the dividends for your patients and practice. Research is often thought of as a daunting thing that the very academic in our profession participate. While that can be true, there are numerous opportunities to get involved in clinical research. Research benefits patients as they may get cutting-edge technology that they otherwise wouldn’t have access. Additionally, some of the technology is
Downloaded from fas.sagepub.com by guest on June 6, 2016
cost prohibitive for physicians to use but when performing research, it is obviated for the study. Not all research is on hugely expensive devices or products and can be on more seemingly mundane things that are in all of our practices. Research is a necessity for medical advancement and by participating; you help improve the delivery of medical care for the world. When participating in research, there are usually payments involved on a per patient basis from the sponsoring companies. Those payments can be in the $100/patient range to the multiple thousands of dollars for more advanced studies. We have created a resource whereby we connect interested physicians with sponsoring companies to facilitate that research. We all hear that things are getting tougher and practice is getting harder. Are you satisfied with surviving or are you interested in thriving? Join Foot and Ankle Business Innovations in January to explore these areas further and others to help spring your practice into 2015 and beyond. Visit FABI2015.com for more information.
References 1. Morgan PA, Monaghan W, Richards S. A systematic review of ultrasound-guided and non-ultrasound-guided therapeutic injections to treat Morton’s neuroma. J Am Podiatr Med Assoc. 2014;104:337-348. 2. Amber KT, Landy DC, Amber I, Knopf D, Guerra J. Comparing the accuracy of ultrasound versus fluoroscopy in glenohumeral injections: a systematic review and meta-analysis. J Clin Ultrasound. 2014;42:411-416. 3. Furtado RN, Pereira DF, da Luz KR, et al. Effectiveness of imaging-guided intraarticular injection: a comparison study between fluoroscopy and ultrasound. Rev Bras Reumatol. 2013;53:476-482. 4. Nam SH, Kim J, Lee JH, Ahn J, Kim YJ, Park Y. Palpation versus ultrasound-guided corticosteroid injections and short-term effect in the distal radioulnar joint disorder: a randomized, prospective single-blinded study. Clin Rheumatol. 2014;33:1807-1814. 5. Ustün N, Tok F, Yagz AE, et al.Ultrasoundguided vs. blind steroid injections in carpal tunnel syndrome: a single-blind randomized prospective study. Am J Phys Med Rehabil. 2013;92:999-1004.
9
