Welcome! Improving Practice Finance is a difficult task that many internists feel ill-prepared to face. These key resources help improve your practice's finances so that you can improve the care you provide to your patients.
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Major Determinants of Practice Finance
Although there are many nuances, the financial health of a general internal medicine practice is heavily dependent on these factors:
- Payer Mix: proportion of services billed to commercial vs. government-sponsored payers.
- Productivity: Are providers billing the number of Relative Value Units (RVU) expected according to their time in clinical sessions (% full-time equivalent or FTE)?
- Population Health Contracting: What proportion of the patients seen are covered by a payer that has an ‘at-risk’ or ‘value-based’ contract with the practice. This means that the payment is not merely based on the care provided but at least partially based on the outcomes achieved for each patient (e.g. cancer screening, diabetes control). Finances are directly affected by the current [quality] performance metrics for that practice.
- Efficiency: How many resources does it take to provide care for each patient? This can be measured by the number of patients one clinician sees or how many FTE resources (nursing, front desk, other clinicians) it takes to support one FTE physician in his/her duties.
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Billing: Are clinicians billing visits according to the appropriate level of complexity? Are clinicians billing for care coordination, care planning, and transitions of care services? What is the proportion of bills not collected? What percentage of non-evaluation and management (E&M) reimbursement does the practice keep (e.g. revenue from lab or radiology)?
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Growth: Does the practice attract new patients? Does the practice retain the patients after their initial visit? What is the level of service and patient satisfaction of the practice?
MACRA and the Regulatory Landscape
MACRA (the Medicare Access and CHIP Reauthorization Act) is one recent change that is poised to significantly impact practice finances. This is both because of the percentage of reimbursement (up to 9% of Medicare ambulatory reimbursement by 2022) at risk and because of the practice resources that will be invested to try to retain as much of that reimbursement as possible. On the other hand, most practices have already existed over the last few years with the building blocks of MACRA (PQRS, Meaningful Use, the Value-based modifier and PCMH, for example) and investment in new technology, staffing, and performance data collection resources is likely to have already occurred.
Reimbursement for General Internal Medicine
Anyone interested in improving practice finances must first become well versed in billing codes. Most GIM visits are compensated based on evaluation and management (E&M) codes that are selected by the clinician based on the visit complexity. This complexity, in turn, depends on a somewhat arcane system of counting numbers of history and exam items and the number of problems addressed. More recently, CMS has introduced additional codes to compensate clinicians for care that is not problem-based but rather services provided such as wellness visits, care coordination, transitions of care, advance care planning. In certain practices, maximizing the appropriate use of these additional codes could make a significant impact on the bottom line. In all practices, maximizing the use of E&M codes of the appropriate level is key to the practice’s financial health.
Articles
If you are interested in contributing your favorite links and content to the SGIM Improving Practice Finances Resource Page please contact, Dr. Calie Santana, Editor, SGIM Improving Care Resource Pages, at csantana@westmedgroup.com