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3 Strategies to Combat Declining Reimbursement for Gastroenterologists

Posted by oiinfusion on Apr 4, 2019 9:01:00 AM

“Reimbursement across all medical specialties is declining.” said Dr. Timothy Miller, a gastroenterologist in Lubbock, Texas. Dr. Julie Servoss, MD, MPH, medical director, and EMA Gastroenterology volunteered “The best way for GI physicians to combat declining reimbursement is to not only think of your medical practice as a place you treat patients, but also as a business.”[1] It is through this lens, that things like declining reimbursements are heavy on the shoulders of physicians in private practice.

Gastroenterologist/hepatologist Rowen Zetterman, MD, Dean Emeritus of the Creighton School of Medicine in Omaha, Nebraska, points out that "everybody feels like they are running harder to stay where they are."[2] While this is true of change in any field, there are tangible modifications you can make to combat declining reimbursements and add additional time and income back into your practice. Here are 3 strategies to get you started.

1. Streamline your billing systems and ditch the paper.

If you have not already, one of the best ways to create significantly more efficiencies in your practice is to make the move to proper billing software. An article exploring challenges and opportunities in gastroenterology private practices asserts “Efficient practices that are able to negotiate attractive fee-for-service rates, have already implemented an EMR, have a clear strategic plan, and can manage value-based reimbursement will do very well”.[3] Within this topic is a small but important distinction. Should you go with an EMR (electronic medical record) or and EHR (electronic health record)?

Basically, the next step up from paper charts is an EMR. The National Coordinator for Health Information Technology (ONC), lays out this definition “EMRs are a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice.” The National Alliance for Health Information Technology stated that EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.” EHRs are more robust providing a holistic picture of patient care connecting all clinicians involved with the same information and background.

The management piece is a huge step to decreasing administrative burdens. The American Academy of Family Physicians has laid out a very comprehensive list of features and benefits of EHRs. Within that list, which can be found here, are several features that address billing hurdles specifically:

Rules-driven clinical coding assistance - Make available all pertinent patient information needed to support coding of diagnoses, procedures and outcomes.

Rules-driven financial and administrative coding assistance - Provide financial and administrative coding assistance based on the structured data and unstructured text available in the encounter documentation.

Service authorizations - Support interactions with other systems, applications, and modules to enable the creation of requests, responses and appeals related to service authorization, including prior authorizations, referrals, and pre-certification.

Support of service requests and claims - Support interactions with other systems, applications, and modules to support the creation of health care attachments for submitting additional clinical information in support of service requests and claims.

Claims and encounter reports for reimbursement - Support interactions with other systems, applications, and modules to enable the creation of claims and encounter reports for reimbursement.[4]

Technology has become incredibly powerful and utilizing these tools can help streamline your processes and relieve administrative overload.

2. Outsource what’s bogging you down

According to the Medscape Gastroenterologist Compensation Report for 2018, “bureaucratic tasks” are the primary cause of burnout among physicians, and more that three quarters of the gastroenterologists surveyed reported they spend 10 hours or more per week on paperwork and administrative tasks. [5] While updating and streamlining systems is a great start, another approach is to just outsource some of the administrative tasks outright.

You can outsource your medical billing, in fact physicians in private practice have been doing this for years. Companies who do this specialize in medical billing and have a ton of experience navigating insurance claims and other billing hurdles.

If you have an infusion suite that is run and managed internally, you can outsource that as well.

There are experienced infusion management companies that handle all the prior authorizations and insurance headaches and train and hire staff. There is an operations component as well, and a management company will take care of buying infusion equipment and supplies, setting up the infusion rooms, scheduling patients, buying the medication, and even managing pharmaceutical logistics. This route is a huge opportunity to pull the additional administrative work connected to an infusion suite out of the day-to-day practice management needs and allow the infusion piece to run a bit more autonomously in terms of the management side. Outsourcing these billing related pieces can help stabilize cash flow and give you more time to treat patients.

3. Renegotiate Your Fees

“Managed care payers, like commercial, Medicare Advantage, and managed Medicaid (which covers approximately 55 million enrollees across the United States) allow you the opportunity to collaborate and negotiate value-based contracts to receive the best terms possible for your organization and the communities you serve,”[6] says Donna Costanza, a Vice President of Strategic Solutions at Conifer Health Solutions in Frisco, TX.

Curtis Bernstein, CPA/ABV, ASA, CVA, MBA and managing director of valuation services for Sinaiko Healthcare Consulting, offers this advice: “The decision to actively approach an insurance company to renegotiate a contract should be based on the level of services performed under the contract, the current reimbursement under the contract as compared to the market and how the reimbursement has changed under the contract without negotiation.”[7] The trend is moving towards value-based contracts that seek to tie performance and outcomes to reimbursement. It’s important to approach this strategy through that lens, versus the past approach of focusing on fee for service contracts when approaching third party payors about renegotiation.

At the end of the day, there are several strategies you can adopt to avoid becoming overwhelmed. At OI Infusion, we specialize in outsourced infusion center management, allowing you to introduce a new profit center without the hassle. Interested? Click below to learn more.

Schedule a consultation for  in-office infusion management

[1] https://www.beckersasc.com/gastroenterology-and-endoscopy/fighting-the-decline-3-gastroenterologists-on-standing-up-to-reimbursement-pressure.html 

[2] https://www.medscape.com/viewarticle/819615_1

[3] https://www.gastrojournal.org/article/S0016-5085(12)00756-1/pdf

[4] https://www.aafp.org/practice-management/health-it/product/features-functions.html

[5] https://www.medscape.com/slideshow/2018-compensation-gastroenterologist-6009656#25

[6] https://www.coniferhealth.com/knowledge-center/5-considerations-for-success-with-risk-based-contracting/ 

[7] https://www.beckersasc.com/asc-coding-billing-and-collections/when-not-to-pursue-renegotiations-on-third-party-payor-contracts-qaa-with-curtis-bernstein-of-sinaiko-healthcare-consulting.html 

Topics: Gastroenterology, General Infusion Information