We are now well into 2005. Most urologists have taken a significant hit in take-home pay, although it may not be as significant as projected. The big question is, how can you improve your income without working more hours?
The answer is that many options and strategies are available. In this article, I will not attempt to discuss all of them but will touch on a few and discuss one in detail.
Cut overhead The first action that is always considered when income decreases is to cut overhead. Any good business book will tell you that’s “good business.” However, there are many ways to cut overhead, which I will divide into two broad categories: the right way and the wrong way.
First, let’s discuss the wrong way. I have seen some absolute disasters in offices that have cut their overhead by decreasing the number, or the caliber, of employees. It’s OK to become lean and mean, but it’s counterproductive to drop below the workflow level needs. The first thing that suffers is billing and collection. Support, services, and productivity soon follow.
The right way is to become more efficient. Developing a more efficient charting and documentation system will not only save transcription cost and valuable physician time, but employee time as well. The electronic medical record will generate an even larger savings if you’re willing to commit the initial time and money.
Automating and streamlining your coding and billing gives you a double play. It will decrease your overhead and increase your income. The average urologist is leaving 10% to 20% of potential income for services provided on the table. At the lower end of the spectrum is the large office with coding and billing expertise; at the high end is the small group without the needed expertise.
There are several reasons for this, ranging from the low end (lack of information, automation, and expertise), to the high end (not having the payer-specific information needed and possibly too busy to work the accounts). All of these problems can be addressed with automation, shared data, and additional expertise.
Add office procedures Another key to improving your income revolves around performing more procedures in the office. The concept of adding new services and/or replacing current services with higher-paying procedures is one way to work smarter. One word of caution: Be sure the payment is greater than the cost of providing the service before implementing any new service. Keep in mind that we are not suggesting that you do unnecessary procedures. On the contrary, “medical necessity” should be the determining factor in the decision to provide a service and is an integral part of good patient care.
Also, if you provide a procedure that needs conscious sedation or other anesthesia, be sure to adhere to your state laws and standards of practice.
Here are three ways to increase the number of procedures provided in the office:
Shift procedures currently done in the hospital or ambulatory surgery center (ASC) to the office. The reason for considering a shift is quite simple. Medicare pays you better for providing some procedures in the office for those done in either the hospital or the ASC. This payment differential has been increasing over the past several years. Medicare has been improving the practice expense for office procedures. CMS was mandated by law to make the payments for expenses in the office more comparable to cost.
I will start with two examples—cystoscopy and vasectomy.
Take a look at your Medicare fee schedule, and you will see two payment schedules: facility fees (for procedures performed in the hospital, ASC, or any other location other than the office); and the non-facility fees for procedures performed in the office. For cystoscopy, the national rate for reimbursement for a facility is $110.28, while the non-facility reimbursement is $206.54 (your specific reimbursement will vary by state). The difference is to reimburse you for your rent, supplies, office assistant, etc.
For vasectomy, the rate for reimbursement for a facility is $218.29, versus $569.22 for a non-facility. The payment difference far exceeds the direct cost of providing the service. If you currently perform your cystoscopies and other procedures in the hospital, it’s time to reconsider.
Some procedures will show the same payment for both facility and non-facility fees. These will not reimburse you for your cost in the office and probably should not be done in the office. For example, TUR, small bladder tumor (code 52234), reimburses $250.50 for both facility and non-facility.
This year, you have a unique opportunity to improve your income by providing more services in the office. A non-facility fee has been added to a number of procedures.
52224: Cystourethroscopy with fulguration (including cryosurgery or laser) of minor (less than 0.5-cm) lesion(s) with or without biopsy. For this code, the non-facility fee is $1,508.70 and facility, $170.92.
52214: Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands. For this code, the non-facility fee is $1,593.97 and facility, $200.48.
Consider adding new procedures to the services you do not currently provide.
Space does not permit a complete discussion of this issue, but a few things to consider are urodynamics and some of the minimally invasive treatments for BPH.
Provide services that pay better for time spent.
Taking control of your patient mix is sound business. Proactively manage patient mix for increased revenue and office efficiency. The ultimate goal is to provide the best possible revenue-per-time spent, not to add more patients. Urologists can and should become familiar with any available, well-reimbursed elective procedures, such as vasectomy, and decide whether they can develop an improved revenue return for their time invested.
Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver and is also publisher of Urology Coding and Reimbursement Sourcebook
