aaham hfma presentation march 2011

7/31/2019 AAHAM HFMA Presentation March 2011

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Proprietary & Confidential

Copyright Intermedix Corporation 2010


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HITECH

Privacy &

Security

RAC Audits

ICD-10

EHR

Limited time

offer

5010

Economic

Challenges

HealthCare


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Local Delivery

Local AccountabilityPhysician Leadership

Coordinated,

accountable care across

the continuum of care

Performance Measures

(transparency)

Financial rewards tied to

quality more than

volume or cost

Improve health

outcomes, slow cost

growth


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Why do physicians want to becomeemployees?

1. Improved work-life balance

2. Competitive benefits & retirement package

3. Job satisfaction

4. Increased annual income

5. Consistent income

Source: PricewaterhouseCoopers 2010 Report


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Does physician integration makesense to your facility?

Your business model will change


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e Physician fee schedules are often structured using

the RBRVS, assigning relative values (RVU) to each

CPT code for services on the basis of the resourcesrelated to the procedure rather than simply on the

basis of historical trends.

Physician work component (55%)

Practice expense component (42%)

Professional liability insurance component (3%)


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Average Salary is $160.00/hr for an ED provider

$1,401,600.00 in physician salaries annually for a

single coverage ED ($116,800 a month)

Add Malpractice expenses

Add Benefits

Add Medical Director stipend ($5,000-$20,000/month)


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18,000 annual visit emergency department

Single coverage ED

730 hours a month

730/120 (full time ED provider hours) = 6 FTEs required

2 patients per hour

$60 - $130 per patient collections:

$1,080,00000 - $2,340,000.00


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Cumulative costs for provider: $1,401,600.00 (Salary)

$ 120,000.00 (Malpractice) (Plus tail coverage)

$ 400,000.00 (Benefits) $ 10,000.00 (Medical Director Stipend)

Total physician cost $1,971,600

Possible revenue: $1,890,000.00 ($105.00 per patient)


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Length of visit increases

More legal exposure

Employee liability is direct to the hospital, groupkeeps liability if separate entities

Difficulty implementing production based models

Eventually employee physicians always wantdetailed financial information and profit sharing


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Problems with scheduling and recruitment arenow hospital issues

Disciplining the doctor(s) becomes a hospitalissue

Total risk of bad collections falls on thehospital

Liability for coding problems falls on thehospital


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Hospital may feel they have more control

Implement a benchmarking tool to increaseproductivity and tie directly to incentiveprogram.


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High volume, low dollars

ED Physician coding is complex

Understanding E/M levels

Ongoing physician documentation training

Identify, track, report and improve documentation

deficiencies

Monitoring contracts for underpayment/working denials PQRS (Physician Quality Reporting System)

System changes required for optimal reporting


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Handling physician credentialing

Experienced with the nuances of ED coding

Attending ACEP coding courses?

Monitoring contracts and allowances

Negotiating payer contracts

Generating ED specific reports


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Monitoring/reporting PQRS statistics

Discussing with ED physicians regarding

documentation deficiencies and providing

ongoing training

Calculating RVUs

Consistently following up on ED accounts

Working denials and appeals


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Control of Staff

Control of Costs

Bundled payments

One patient statement for global charges


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Strain on current staff

HR issues, vacations, medical leave, etc.

Limited hiring pool Space limitations

Lack of clinical knowledge

Physician documentation training


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Keeping up with current coding regulations,

state rules and regulations, changes with

the payer rules, etc.

ICD-10 challenges

RACs, etc.

HIS limitations


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EMRs!!

Compliance Concerns:

Cloning (reference handout)

Templates

Over documentation

Automated coding


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Financial Impact

Certified Coders arent cheap

2009 AAPC estimates $53,700 (loaded)

Revenue decrease with no lobbying efforts

by provider organizations (HBMA,EDPMA)

Revenue decrease with inadequate

provider managed care negotiations


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Reduced liability

No HR issues, ongoing training, certifications,

space management, etc.

No management of other services:

Physician credentialing

Billing statements

Postage, return mail

RACs, etc.


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Fees based on revenue collected

No claims clearinghouse cost

Coding and billing expertise in the

specialty

Peer to peer physician documentation

training


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Lack of control

Cost of collection


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DONT SHOOT THE MESSENGER!


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Taxes

Vacation pay

Sick pay

Paid holidays

Medical Insurance

Work Comp

Unemployment

Personnel Turnover/Training Costs

Non-labor costs (furniture, equipment, space, utilities, etc.)

average nationwide expense of employing someone, depending on the benefits package-

35-40% over the annual salary amount


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Management of Staff $60,278 $ 15,069

Salary for Certified Coder (CPC) $53,352 $ 53,352

Salary for Biller $47,736 $ 37,000

Claims Clearinghouse Cost $ 4,500

Mailing Costs ($1.25 per statement) $ 33,750

1.5 statements per account

Salary for Payment Poster $42,120 $ 13,500

Salary Patient Call Center $47,028 $ 13,500

(in-bound calls, self pay)

Salary for Patient Acct. Rep $47,028 $ 27,000

(outbound calls, insurance, denials) Physician Credentialing Cost

More turnover in the ED $ 4,500

Total:


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$931,829 $1,738,800

$105 avg. patient collection

lost reimbursement due

to inaccurate documentation &

inexperienced coders

lost revenue for A/R

holding costs and inconsistent f/u

$105 avg. patient collection

8% contingency fee (Range 7-9%)

All inclusive fee

NET REVENUE


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Cumulative costs for provider: $1,401,600.00 (Salary)

$ 120,000.00 (Malpractice) (Plus tail coverage)

$ 400,000.00 (Benefits) $ 10,000.00 (Medical Director Stipend)

Total physician cost $1,971,600

Possible revenue: $1,890,000.00 ($105.00 per patient)


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RVU/Pt

increase

@ 18,000 visits @ $30/RVU

collection rate

@ $35/RVU

collection rate

@ $40/RVU

collection rate

0.10

RVU/pt

1800 RVU

increase/year

$54,400

increase/year

$63,300

increase/year

$72,200

increase/year

0.33RVU/pt

5940 RVUincrease/year

$178200increase/year



0.50

RVU/pt

9000 RVU

increase/year

$270000

increase/year

$315000

increase/year

$360000

increase/year


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Do they handle specialized coding and billing?

Can they provide onsite physician documentation training

specific to the specialty?

Can they manage contracts and payer negotiations?

Do they patient accounts?

What are the fees and any additional costs?

Do they understand compliance and acuity levels!


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ED has always been considered the

red-headed stepchild

There is not a one size fits all answer

Depends on your facility, your

resources and your overall strategies tofulfill your hospitals mission.


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Judy Griffith

Director of Business Development

Intermedix

303-656-8790

[email protected]
mailto:[email protected]:[email protected]

aaham hfma presentation march 2011

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