Are You Making These 5 Financial Mistakes In Your Medical Practice?

We know doctors don’t get finance or accounting training during the time they spend in medical school. As a result, they tend to rely heavily on practice managers, accountants and other financial experts with managing their money.

 

But as medical practice owners (aka small business owners), the buck stops with the doctor. Thus, it is wise not to rely blindly on the “experts” and from time to time take a look at areas of the business for yourself.

screen-shot-2016-03-26-at-11-33-49-amBelow are five areas I’m going to suggest for you to explore. Get acquainted with these suggestions. You never know. Overlooking them may be affecting your practice’s bottom line.

1 – PAYING HIGH-INTEREST RATE LOANS

Loans can be great financial tools to help practices remain liquid (aka have cash in hand) when cash flow is low or if an unexpected expense arise.

But practices that mismanage these loans can end up paying fees and interest that eat up what are already thin margins.

It is important to be aware that not all bank loans are created equal. Equally important is understanding terms – interest rates vary depending on the type of loan – and knowing concepts like the difference between a secured loan vs. a non-secured loan.

Overusing loans, not reevaluating them periodically and failing to adjust to current circumstances or failing to stay informed on interest rates are all things that can erode business’ income.

2 – OVERLOOKING HOW YOUR CREDIT CARD MAY BE CHARGING YOU INTEREST

Doctors love to credit cards to pay for practice expense. Why? For the credit card points, of course. A single doc can potentially accumulate six figures in points by paying for vaccines alone. Free airfare anyone?

Even though you may pay the balance in full every month, I suggest to look carefully at the card’s fine print first to understand how the credit card charges interest. Because some cards charge a daily interest based on the daily balance.

Let’s say you have a credit card that charges 10% monthly interest. But you’re not concern about the interest because no matter how much you charge the card in a month, you pay it off – in full – at the end of the month.

Banks are well aware of this. So to make money off people that pay their balance in full, they divide the monthly interest by 28 (cycle days). So a 10% monthly interest, the credit card will charge you .0357% daily on your balance.

3 – MAXING OUT CREDIT CARDS

Thirty percent of your credit score is based on how much of your available credit you are using. If the card is in your name, and you have cards maxed out, your credit score drops.

Low credit scores can be an issue, of course, when applying for a loan of any kind; high credit card balances often lead to denied applications.

Are you paying a higher interest rate on some of your credit cards because you carry high balances on others? It’s worth checkin.

4 – NOT PLANNING FOR A RAINY DAY

Most practices are tremendously unprepared financially for unforeseen circumstances. Partly because most, if not all, the money that comes into the practice is spent or distributed in full to each partner at the end of the year.

You don’t need to be around long to know the unexpected comes by often. Hence, the practice should always have a reasonable amount of money set aside because sooner or later you’re going to need it.

Not only is it crucial for your business to set money aside for financial emergencies, but it also is good business practice.

Not to mention that with cash reserves, instead of drawing from those high-interest loans or maxing out your credit card, you’ll have what I like to call a cushion fund for times when we need money to get us through a rainy day.

5 – NOT DRAFTING A PARTNERSHIP AGREEMENT

I’ve seen this happen before. A few docs decide to quit their employment to start their medical practice.

The group aligns with the vision of serving patients better, the lure of sticking it to the man and the prospect of increasing their income.

The excitement of opening up your practice with friends or like-minded coworkers and everybody coming together towards a common cause often puts the task of drafting a partnership agreement on the back burner.

Don’t delay a partnership agreement. In fact, do it as soon as possible. Here is why:

a) It’s the wise thing to do.

b) It is better to work out details when everybody tends to be happy excited and looking forward to the future than to work out the details during a nasty, vicious divorce.

Drafting a partnership agreement when you are angry, resentful, feel duped or taken advantage of is… well, I don’t have to tell you it’s bad.

It is also important to review and update your agreement every few years with your attorney to ensure it reflects current circumstances.

 

 

Are Practice Management Consultants Worth Hiring?

In the end, the practices who invest in themselves are, almost always, the top performers. You’ll see among best performing practices, that many have engaged – and continues to engage – consultants on matters that are outside their expertise.

This is a guest post from Chip Hart. Chip is a frequent contributor to PediatricInc and former co-host of the highly revered Pediatric Management Awesomecast. When Chip isn’t protecting independent pediatric practices against evil conglomerates, naysayers, and the League of Shadows, you can find him at PCC doing… something (I’ve never figured out what is it that he does at PCC, exactly). 


I will never forget the scene. I was the lonely consultant in the dark and shag-carpeted basement “conference room” of a large pediatric practice and was giving them a stern lecture about their pricing. The practice hadn’t updated its prices in years and was undoubtedly losing money. Lots of it.

Chip Hart and Brandon Betancourt
Working really, really hard.

After my explanation of RVUs and why 105% of Medicare wouldn’t cut it, the senior partner – well, the loudest one, anyway – looked me in the eye and said, “OK, that sounds smart, let’s just raise our prices.” It was the response I was hoping to get.

The youngest and newest partner jumped in quickly, “What?! How can you listen to this guy?”

Uh oh, I thought. His voice cracked, “…I’ve been telling you this same information for almost two years and he just waltzes in here and says ‘Correct your pricing.’ and you do it just like that?”

I honestly thought he was going to cry in frustration and relief. 10-minutes of back-and-forth among them ensued. I just stayed out of it. At the end of the year, the additional $250,000 they collected erased the discomfort and awkward part of the memory for them.

I didn’t forget, however. I remember sitting there thinking, “This poor practice lost hundreds of thousands of dollars simply because they were unwilling or unable to listen to themselves. They had to hear it from someone else.”

HOW DOES THIS HAPPEN?

The answer is both obvious and convoluted. I have often said that the most important and difficult task for any small business is to find and hire good people. Unquestionably, this challenge extends to the hiring of practice management consultants.

Pediatric practices successfully hire consultants all the time without a tremendous amount of consideration – realtors, attorneys, I/T – but when it comes to getting help on the inner workings of the practice, the majority of pediatric offices too reluctant to ask for help.

And when they do ask for help, it’s often ineffective.

Every practice I visit codes imperfectly, yet some practices lose tens or even hundreds of thousands of dollars a year as a result of their inability to address the problem.

Most practices could use help negotiating with insurance companies, yet remarkably few of them do. Many practices need help with a compensation model or managing a challenging partnership, yet most of them just live with the problems and hope it will go away. And so forth.

Physicians, unfortunately, are uniquely susceptible to mis-using consultants, even if it is simply to not use them enough.

You expect most vendors and consultants to try to take advantage of you – all doctors are rich, right? – while having trouble admitting that you cannot solve all of your own problems.

Combine those aversions with the impecunious nature of most pediatricians, and there is no surprise that I meet practices every week who would rather lose another $15,000 this year due to a poorly designed superbill and bad pricing than pay a consultant half that amount to fix the problems.

HOW AND WHEN DO YOU KNOW YOU NEED A CONSULTANT?

There is no magic formula, but try these parameters on for size:

  • When there is an issue that your partnership cannot resolve, or when a neutral third party can facilitate a necessary change in your practice, consider a consultant.
  • When you are not an expert in the matters that affect your practice or if there is simply another party who might be more effective and efficient at addressing the matters, consider a consultant.
  • When your practice is losing more money on an issue than it would cost you to fix, consider a consultant.
  • When the amount of money you would pay a consultant is less than the amount of money you would generate seeing patients, consider a consultant.

Those last two examples are often conjoined in a death spiral of inaction. Many of you don’t want to pay a consultant $20,000 to renegotiate a contract increase of $50,000 annually because “you can do it yourselves.”

Yet, you don’t do it. Or you start the project and sink 10, 20, 40 hours into the task – often worth more to the practice than what you would pay the consultant – and then never complete the job.

Pediatricians, as business owners, are notoriously bad at examining the return on their potential investments and usually focus far too heavily on only the costs.

Pretending to be 100% self-sufficient serves no one except, perhaps, the insurance companies. Your patients don’t benefit, your lifestyle suffers, and you leave money on the table.

HOW THEN DO YOU HIRE A PRACTICE MANAGEMENT CONSULTANT?

First, hiring a consultant involves a lot of common sense. You want a written contract that spells out the terms of your obligation.

The terms should clearly outline your expectations, identify the fundamental goal, and determine conclusion of the contract. Ultimately, it involves a relationship of trust and confirmation. Some suggestions that go beyond the generic:

1 – Pediatric practices are different, don’t let a potential consultant tell you otherwise.

Most medical practice consultants live in the Medicare world and look for “alternative income sources” that just don’t exist in pediatrics.

More importantly, the attitude and (often unspoken) philosophies of pediatric practices differ from other medical specialties. Find someone who knows pediatrics.

2 – Work with a consultant on one or more smaller projects and build up to a strong relationship.

Before you leap into that full payer-mix and negotiation mission, see how well you work together on something smaller, like simply reviewing the state of your existing contracts. If you are not getting the kind of performance you expected, better to have not committed so heavily.

3 – Don’t be afraid to use different consultants for different needs.

Just as you may not be an expert on RBRVS or pediatric compensation models, your consultant may not know it all, either.

Although some consulting resources pride themselves on their breadth of experience, depth is usually more important. A good consultant might look at your practice and identify work that needs doing. A great consultant can identify work that needs doing, but suggests another resource.

4 – Even after you have chosen a consultant, keep an eye out for conflicts of interest.

Although they are impossible to avoid and sometimes even lead to efficient work (like one consultant recommending another), conflicts are often poorly revealed in the industry.

5 – Use your network of pediatric peers to help vet your consulting needs.

Surely, if your potential consultant expects to work with you, he or she can provide you with pediatric references whom they have helped with similar issues. SOAPM is an excellent place for a sanity check.

In the end, the practices who invest in themselves are, almost always, the top performers. You’ll see among best performing practices, that many have engaged – and continues to engage – consultants on matters that are outside their expertise.

Learn How To Create A Budget For Your Medical Practice

In medicine, the mention of the word profit is often viewed or interpreted as a dirty word. It is as if the word does not belong in the lexicon when health care is addressed.
 Broke doctor
I argue (in the context of the private medical practice setting) that profitability is a medical practice’s responsibility for one simple reason. If the medical practice (also known as a business) doesn’t deliver profits, health care providers are unable to provide for those in need.

Why Profits?

Profits pay for infrastructure, technology, education and human resources, all of which translate to superior pediatric care when employed correctly.
Another way I like to put it is by saying,

 

…a broke doctor does do anybody any good.

 

Calling vs Profits

Indeed, our medical businesses differ from other companies in that we care for children. And the notion of withholding medical services or restricting access to a sick child merely by the patient’s parents inability to pay for health care services is simply not in a pediatrician’s DNA.
However, it is important to accept the reality that without a way for a doctor or the practice’s income to outpace expenses, health care providers are unable to provide services of any kind. At least not for the long term.

Is there a solution?

How do we reconcile these two competing issues? On one hand, it is necessary for a medical practice to deliver profits if it wants to remain sustainable. On the other, we have an intrinsic motivation to put the patient’s needs first.
I am glad you asked.
These two dichotomies can co-exist – and even flourish – alongside each other. There is indeed numerous tools and principles rooted in business that can help medical practices manage what otherwise appears to be opposing forces.

A Resource You Don’t Want to Miss

Today, I want to tell you about a resource I’ve been working on to help your office obtain financial success, while simultaneously providing unsurpassed pediatric care to your patients.

To help you succeed in your financial success, I’ve written a comprehensive eBook on budgeting that walks you through the process of creating a budget for your medical practice. The materials also cover basic principles necessary to put the exercise into perspective.

Budgeting is a major component of financial success. Moreover, financial success is essential to the continuity of care.

To read more about this offering, click on the image below.

Medical Practice Budgeting
Click on the image

I do hope that you buy the book, but more important, that you find the eBook helpful, useful and valuable.

11 Straightforward And Practical Tips To Improve Your Practice’s Bottom Line

It is our responsibility as captains of our ships, however, to equip our practices and our staff members with the necessary tools and information if we want to have any chance of overcoming these real threats.

You do not have to be a marine captain to know that there are countless potential dangers navigating waters.

With a little imagination you know there are many risks. Some hidden, like currents, while others are painfully apparent (i.e. howling winds, waves and torrential storms).

 

Compass Direction GuideWe know there isn’t anything the captain can do to eliminate weather conditions or enforce her will on ocean currents.

However, we can all agree the captain has control over the vessel. We can also agree that the captain has the responsibility to equip the ship and its crew member to its maximum potential if they have any intention of overcoming environmental threats.

Running a “profitable” practice is indeed becoming more of a challenge. For many, it is uncharted territory. And while there are many extrinsic reasons – like decreasing insurance payments, high deductible plans, and the increased cost of providing care – that are contributing towards the “remaining profitable” challenge, the truth is, there is little – if anything – we can do to eliminate those threats.

It is our responsibility as captains of our ships, however, to equip our practices and our staff members with the necessary tools and information if we want to have any chance of overcoming these real threats.

Below are 11 STRAIGHTFORWARD and practical tips you can implement immediately to help you navigate these rough waters.

  1. Review fee schedules regularly to ensure your fees reflect market conditions in your region.
  2. Adjust fee schedules for certain procedures to improve providers’ competitiveness.
  3. Review all E&M charges by a certified coder before submitting claims.
  4. Hire coding consultants for annual chart reviews to ensure accurate coding.
  5. Monitor and report payments of your top insurance-payers.
  6. Run reports to understand payments by different networks or other contract types.
  7. Renegotiating (or consider dropping) contracts with payers who have low payments.
  8. Monitor how long it takes for charges to be entered and claims to be submitted to make sure claims are being filed timely.
  9. Consider provider training or implement random audits to ensure billing slips are completed clearly and accurately.
  10. Review your practice’s policies for routing super-bills to ensure claim submissions are sent as soon as possible.
  11. Implement processes so your billing staff works missing super-bills, claims, denials, consistently.

Imagine for a moment navigating open waters without navigation tools. Now, imagine what would happen if conditions were less than excellent?

If your boat ran off course or worse, capsized, would you blame the environmental conditions? Or would you take responsibility because you didn’t have the proper equipment and tools to navigate in challenging conditions?

21 Questions To Put You and Your Medical Practice Back On Track

Things have changed since the beginning. You are now so wrapped up in the day to day that you’ve lost your North, your purpose, your original destination.

It used not to be this way, but it seems like the practice has lost its focus.

Screen Shot 2015-01-09 at 6.02.01 PMLosing focus was not intentional. You started out with a clear vision, worked out the details and began. You remained disciplined and consistent. You were not distracted easily, you kept an eye on the ball and made sure things were addressed effectively and efficiently.

However, along came bumps on the road, mishaps, unforeseen circumstances, misunderstandings, performance issues, competition, reduction in payments and the vision, the original purpose, got buried.

Now, there is so much stuff going on, so many fires to put out, that you only have time to focus on the immediate, the urgent. No time to step back and re-assess. Not even enough time to align priorities or the important.

IS THIS YOU?

I do not know about you, but we’ve been there as a practice. We’ve felt before as if the practice has lost its north. My guess is that if you practice has been around for some time; you can relate. In fact, whether in the medical field or otherwise, many companies go through similar challenges.

Early in 2008, Howard Schultz, founder of Starbucks, is on record saying he felt the company had veered off its original path and as a result, he announced he was returning as CEO.

Steve Jobs’ return to Apple in 1995 was motivated by similar reasons. The company had spent the previous 10-years drifting and was on the brink of bankruptcy. The board brought Jobs back to realign the organization and restore it to its original innovated breakthrough company it once was.

HOW TO GET BACK ON TRACK?

Like Rocky Balboa returning to the old neighborhood after being defeated, we thought it was best to go back to the early days of the practice to get us back on track. We went back with the purpose to recall the essence of our practice.

However, merely remembering the old days was not enough. So we took the time to draft questions that would remind us of our north, but also is identify priorities and determine next best steps.

Below you will find 20 questions we wrote to help us gain the clarity and the insight that would lead us back on the correct path.

  1. In one sentence, what exactly is it that your practice provides (take care of patients is not a valid answer. Dig deeper to find the essence of what your practice offers)?
  2. Why do you/we come to work every day?
  3. In one sentence, why do parents bring their kids to the practice?
  4. If you closed your doors to the practice tomorrow, would anybody notice?
  5. Who would be most likely to miss you?
  6. What is one thing that is is preventing your practice to accommodate more patients?
  7. What is the one thing that is preventing the practice to have a full schedule?
  8. If you could ask a parent just one question about your practice, what would that question be?
  9. If your practice’s revenue stream suddenly stopped today, how many days would you have before you run out of money?
  10. If someone unexpectedly handed you $250,000 what would you do with it?
  11. If you were forced to hire someone today, who would you hire?
  12. What would you need to do, to ensure, the new hire contributes enough revenue to cover their expense?
  13. If you were forced to hire another person tomorrow, who would you hire?
  14. What was different about the person you had to hire immediately versus the person that you had to hire the next day? In other words, why was the first hire first and not the other way around?
  15. If you had no choice, which department in your practice would you outsource and why?
  16. Which employee would make your stomach sink if they gave you a 2-week notice.
  17. Alternatively, which employee would make you say “yes!” if they gave you their notice?
  18. If you have two columns on a piece of paper, one labeled urgent, and the other important, what would you write in each column?
  19. If you could get one solid hour with a guru you respect, what would you discuss?
  20. How would you define a great day in the office?
  21. What is it exactly that is preventing you from having a great day, every day, in the office?

ONWARD

I am sure there are many ways to jolt a company back on course, however in my experience, businesses that have lost their way, veered off their mission or forgot their purpose regain it by asking critical questions.

Asking the right questions lead organizations to put their current circumstances into perspective, prioritize issues and determine what is the next-best-step for the organization.

For us, the questions did not answer all of our problems. The questions did not immediately place us back on track. However, they led us to admit things we had been neglecting, brought awareness to the tough decisions we were avoiding and in several instances, helped us decide to abandon projects because they were not in alignment with our practice’s vision.


 

Can you think of another question that would fit with the list that I have? What would you add? Also, if you experienced something similar, I’d love to hear your story.

How Well Do Parents Know What You Do As a Pediatrician?

It’s hard to appreciate the value that pediatricians provide when one is not aware of exactly what it is that pediatricians do.

During the summer months, I posted on our practice’s Facebook page, a note encouraging parents, to schedule their children’s wellness visits.

Although the message was for our entire Facebook community, I wanted to catch the eye of parents with teenagers. Don’t know how well you manage teens in your office, but in our office, we have decent wellness visit numbers with younger patients. The teen population?

Not so much. Once the teen years kick in, we mostly see them when they are sick.Screen Shot 2016-02-26 at 11.48.51 AM

I wanted to encourage parents to make their wellness visits but also throw in a subtle nudge to parents with teens.To get their attention, I opened with this line: Did you know pediatricians are trained to treat children from birth to adolescence? Then I went on to talk about the importance of wellness visits etc.

Something interesting happened. The post outperformed other Facebook post. It received more likes that than the ordinary. But that the surprise me. What surprised me the most, were the comments from parents.

One mom said, “it’s good to know the pediatrician can see my teen.”

Another said, ” Timothy is going to be so happy when I tell him Dr. B can still see him.”

WHAT WAS THE LESSON?

It’s an age-old lesson. It’s a lesson on assumptions and what happens when we make them.

That simple, otherwise ordinary status update, got me thinking about how well (or not) we communicate what it is that we do as pediatricians. If so many people weren’t aware that pediatricians can treat teens and beyond (0-21), what else don’t they know? The irony is that our website is tagged with the line “Pediatric & Adolescent Medicine.”

OPPORTUNITY

We clearly have a communication problem. And I would argue that our lack of proper communication about what it is we do as pediatricians (more than runny noses and giving shots) is why many parents don’t see the distinction between a retail clinic and a pediatrician.


 

It’s hard to appreciate the value that pediatricians provide when one is not aware of exactly what it is that pediatricians do.

 


 

The good news is that there is a significant opportunity for pediatricians to cover a lot of ground. How so? By using social media channels to educate our community about all the great services we are trained to provide.

I also believe that leveraging this opportunity could aid your practice in differentiating itself from the competition.

WHAT IS YOUR COMMUNICATION STRATEGY?

Since I realized there was a chasm between our assumptions and the reality, I’ve been intentional about informing our community about the training, knowledge and expertise our pediatricians can address.

Some of it may seem too obvious for those of us that do this every day. Like explaining the importance of wellness visits.

But the truth is, some parents don’t know about yearly wellness visits. They assume that because the child no longer needs shots, they don’t need to go to the doctor.

Beyond promoting wellness visits, I use many of the things included in the Bright Futures guidelines as a way to highlight that a visit to the pediatricians is highly comprehensive.

And by educating our population, I’m also marketing our practice in a unique way. Instead of mentioning in a promotional piece that we accept most insurance plans, I may mention that how we can provide family support, safety and injury prevention, or mental health.

MARKETING STRATEGY

Not only is promoting and sharing this information relevant and valuable to parents, but I also think it is an excellent way to differentiate ourselves from the MinuteClinics or other medical services that overlap with pediatrics (i.e. Urgent Centers, Family Practice, Telemedicine).

YOUR CHALLENGE

Think about your medical practice’s communication strategy, or lack thereof. What is your practices unique selling proposition? What problems do you solve that others don’t? Then think about how best to communicate your message. Also, consider the channels you’ll be delivering your message. By channels I mean, traditional advertising, email campaigns, social media, etc.

Remember, each channel is unique, thus requires you to craft the message differently.

I’ll leave you with this… times are changing. That is certain. And we have two options, two paths to choose from. Disagree with how things are changing, or find ways to agree with the shifts in a way that benefits you and your practice.

Can Your Medical Practice Afford To Drop An Insurance Carrier?

I worked with a practice that was in a similar situation. The partners wanted to drop an insurance plan, but they had questions they wanted to answer before pulling the trigger, so to speak.

For example, one of the questions was how many patients would they potentially lose and how significant would be the financial impact if they dropped the insurance plan?

Screen Shot 2016-01-05 at 11.09.13 AMI received a letter from the University of Chicago Medical Center explaining that effective Jan 2016; they will no longer accept BCBS.

The announcement took me by surprise. Not because the hospital was dropping an insurance plan- but because they were dropping a major plan, BCBS.

BCBS has a significant market share in Chicago; which translates to a lot of patients having BCBS as their insurance carrier.

I can only imagine why the hospital decided to drop BCBS, but I think I can say with a fair amount of certainty that the decision must have been difficult for stakeholders of the hospital. Undoubtedly dropping such a large plan would affect a lot of patients, but also, shake up the hospital’s income.

CAN A PRACTICE AFFORD TO DROP A PLAN?

I worked with a practice that was in a similar situation. The partners wanted to drop an insurance plan, but they had questions they wanted to answer before pulling the trigger, so to speak.

For example, one of the questions was how many patients would they potentially lose and how significant would be the financial impact if they dropped the insurance plan?

INSURANCE DISTRIBUTION

To help them answer their questions, I worked with the practice manager to create a simple spreadsheet that I call an insurance distribution sheet. Below is a version of the spreadsheet already completed.

Screen Shot 2016-01-03 at 6.28.38 PM

To build the spreadsheet, we needed 3-data sets from the practice’s practice management system. Those three data sets were:

  1. Number of Patient Seen by Insurance Plan
  2. Gross Charges by Insurance Plan
  3. Net Receivables by Insurance Plan

The practice management system we were working with did not provide these data sets in one clean report. We had to run individual reports and enter the values into the spreadsheet.

Once the data was aggregated, we added a simple formula to translate the results into percentages. And the results is what the example above shows.


For those that are unfamiliar with Excel, click HERE to see a brief overview of how to calculate the percent of the total.


WHAT DO THE COLUMNS MEAN?

The first column is the insurance company patients had at the time of service. Percent of patients represents the ratio between all the patients seen, versus the patients seen with the corresponding insurance company. For example, let’s say the practice saw 1000 patients and of those, 300 had BCBS.

300 / 1000 = .3*

(*) BCBS represented 30% of the patients seen

Like percent of patients, percent of charges is the ratio of the practices gross charges divided by the gross charges corresponding to each insurance company. Example. Let’s say the practice billed $1,000,000. Of that million, BCBS represented $250,000.

250,000 / 1,000,000 = .25*

(*) Percent of charges for BCBS is 25%

The percent of receivables column follows the same math as percent of patient as well as percent of charges. And the cents/$ column calculates how many cents on the dollar the practice is collecting from the payor.

INTERPRETING THE GRAPH

Let’s look at BCBS and read across from left to right.

We see BCBS has 40% in the percent of patient column. Meaning, of all the patients seen, 40% had BCBS as their primary insurance. The next column is percent of charges. We see the BCBS represented 45%. This indicates that 45% of gross charges for the practice was billed to BCBS.

Percent of receivables is the next column over. It indicates that the revenue from BCBS accounted for 50% of the practice’s total income. And the revenue averaged 73 cents on the dollar. Another way to read it is, for every $1 billed to BCBS, the practice received 73 cents.

In contrast, let’s look at UHC. Only 8% of all the patients the practice saw for the period were UHC patients. UHC represented 9% of the practice’s revenue, and they averaged 60 cents on the dollar.

WHAT CAN WE GLEAN?

With an analysis like this, the practice can begin to find concrete answers to their pressing questions. For example, if UHC was the plan they were planning to drop, the sheet is able to show them what the impact would be from both a patient standpoint and financial standpoint.

UHC represents 10% of their patient panel. Which would have to leave the practice if they drop the plan, taking with them 9% of the practice’s revenue.

If the plan in question is BCBS, the numbers tell a different story. Fifty percent of the practice’s revenue would walk away with 40% of their patient panel.

Another observation is that Medicaid accounted for 37% of patients seen; but the State’s insurance plan accounted for 24% of the practice’s revenue. Something worth pondering.

HOW MUCH IS THE SHORTFALL?

For the sake of argument, let’s say UHC is the plan the practice was considering dropping. Doing so they would lose 9% of their revenue. This is not insignificant. If practice revenue is 1-million dollars, 9% represents $90,000. If practice revenue is 5-million, 9% is near $500,000. It’s less money no matter how you look at it.

PREPARING FOR THE SHORTFALL

When the doctors I was working with realized how much they’d lose, they got cold feet.

Here is what I explained to them…. the practice doesn’t have to see the same amount of patients to recuperate the 9% revenue shortfall. In fact, the practice can see fewer patients and still make up the revenue shortfall. How so?

Because of the cents on the dollar.

BCBS pays .73cents for every dollar billed. That’s 13cents more than UHC. By filling the schedule with better paying plans, like BCBS, Aetna or HFN, the practice will recuperate the 9% revenue loss faster because they are making more per patient than they would treating a UHC customer.

NOT ALWAYS SO CLEAR

Admittedly this graph does not give you a comprehensive picture. There are potentially other variables that a practice may consider. However, in the case of the practice that I worked with, this analysis was all they needed to answer their questions and move forward.

One last thing before you move one… don’t focus on the numbers you see on the graph and use them to compare with your practice numbers. Focus instead on the method, the process and the math with your numbers. Deal?


EDITORIAL UPDATE
The practice reached out to the payer to negotiate better rates. Armed with the data, they felt empowered (not at the mercy of the payor) and firmly request payment increases. The payer agreed. And they signed a contract that was competitive.

 

Simple Formula To Calculate How Much Of What You Can Collect, Do You Collect

Today’s post by guest blogger Mary Pat Whaley – Managemypractice.com. Mary clarifies a few misunderstandings managers often have regarding the term collection percentage. She also defines the term “funny money.” Read to find out what she is talking about.


 

COLLECTION PERCENTAGE

Screen Shot 2015-11-20 at 12.10.44 PMOne of the most talked about and least understood metrics is the collection %. There are two reasons it is misunderstood. One is because most people talk about a monthly collection percentage, as if the money you collect this month relates to the charges you billed this month.

Some of it does – the co-pays, deductibles, and co-insurance definitely applies to this month’s services, but the insurance payments most often do not.

This is how you can collect more than 100% in a month – by having lower charges and higher collections, you can achieve more than 100% collections! Not a real metric!

THE PROPER WAY TO MEASURE

Over the course of 12 months, it tends to even out, so you can use your annual collection % with a degree of confidence, but the very best way to know what you are collecting is to use a report that applies the payments (regardless of when they arrive) to the services in the month they were rendered. If your PM system doesn’t have this report, ask for it.

GROSS CHARGES, REAL OR NOT?

The second is because gross charges are not necessarily “real” numbers. Most practices set a retail fee schedule at a point to capture the most any payer will reimburse them. So, a practice could set its fees anywhere and never really expect to charge or to collect what I call “funny money.”

How to calculate:

Collection % = Net collections / Net charges.


Net Collections = Gross Collections – (Refunds).


Net Charges = Charges – (Contractually Obligated Write-offs).


 

Contractual write-offs are the difference between the practice fee schedule and the fee schedule you’ve agreed to accept.

PROPER COLLECTION RATE

A 98% or better collection rate is considered excellent, depending on what, if any, other write-offs you include with your contractual adjustments.

If you have only one category of write-offs (sometimes called adjustments) in your PM system, you are going to find it hard to calculate this percentage.

You may want to introduce new write-off categories and have your staff post-contractual adjustments to one category and other types of adjustments to several other new categories.

See my article here for in-depth information on creating write-off categories and managing write-offs.

If you have your contracted adjustments separated, follow the formula above to get your collection percentage.

Some practices will use a rolling 12-month figure for their collection percentage (i.e. ignoring the most recent month, use the last 12 month’s cumulative total net collections divided by the total net charges.)

 


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Also, Make sure to check out Mary Pat’s blog for a treasure trove of practice management related articles.

 

What Do Patient Lab Reports Have To Do With A Medical Practice’s Financial Statements?

An important aspect of managing a business is learning how to read financial statements.

It’s no secret, however, that most doctors don’t have formal business training. So reading financial statements to some is like reading in a language you don’t speak.

Screen Shot 2016-01-05 at 10.05.35 AMBut that is not an excuse for physicians that own or have a stake in their medical practices not to learn fundamental business principals such as reading financial statements.

Learning how to read just a few financial reports will give you a good idea of the financial health of your practice.

THEY’RE LAB RESULTS

If the financial report talk sounds complicated, think of them as a patient’s lab reports. Imagine your practice is a sensitive patient with an illness.

Just like labs results tell you want’s going on with a patient’s health, financials reports let you know what is going on with the medical practice’s financial condition.

And when you know what’s going on, you can instantly spot potential problems before they get out of control.

FINANCIAL STATEMENTS

Below are four financial reports. Familiarize yourself with them as well as get in the habit of checking/reading them each month.

Keep in mind that I’m not saying these are the only reports you should review. I am suggesting, however, that these are among the most significant and valuable reports for a business/private medical practice.

PROFIT & LOSS STATEMENT (P&L)

Also called the income statement, the P&L shows revenue minus expenses and either your practice’s net profits or loss.

The income statement gives you a snapshot of how different areas of the business is performing. For example, did the practice match revenue projections? Is the practice staying within budget?

BALANCE SHEET

The balance sheet is a simple document that shows what your business is worth. It list all of your assets and liabilities.

The report provides a quick and simple way to see what you own, who you owe, and revenues owed to you.

RECEIVABLES REPORT

This report – also referred to accounts receivables (AR) – shows you who owes you money, how much they owe, and the age of the debt.

In a perfect world, you would avoid extending credit to anyone. But in the business of private practice, we provide credit to virtually every single patron. Therefore, this report is critical to understand and review frequently.

CASH FLOW REPORT

If you’ve balanced your checkbook before, the cash flow report is a supped up version of that. The report shows you the number of checks you’ve written, your deposits, and your account balance.

This report is the best way to verify that your bank account balance is correct, and there are no unusual charged or errors.

GOOD HEALTH = STRONG PROFITS

 

You wouldn’t neglect to review a delicate patient’s lab results. So don’t neglect to familiarize yourself with these important financial reports and review them regularly.