When Brault first approached this sizable independent emergency physician group in the mid-western U.S., they were achieving relative financial success using their own coding and billing staff. The billing office manager had created a finely tuned operation, and had no reason to hand the reins over to a third-party biller like Brault. Then one day, disaster struck. The manager around whom their entire billing system was built suddenly decided to retire, and the question for practice leaders suddenly became whether to remain in the billing business or outsource to somebody else.
One of the partners remembered Brault from a Chart Study and Revenue Projection we conducted for his previous company. And, based on this previous experience, he invited to complete a detailed review of the practice’s charts. The additional income we uncovered amounted to $2.2M – revenue they could have been collecting all along, which made a very compelling business case for partnering Brault rather than continuing to do billing in-house. Excited at such a sizeable improvement, we double- and triple-checked the figures, then presented the findings to the leadership team. But to our surprise, not everyone was thrilled with the result.
Instead of reveling in what was clearly good news (which was based on an analysis of a statistically significant sample size) one partner was incredulous. In his mind, two million dollars in new income was neither achievable nor believable. Noting his concerns, the other partners overruled this doctor’s objections and Brault was allowed to become the practice’s billing partner.
Intelligent Practice Solutions
To help the independent emergency physicians group address its business challenge, Brault provided the following assistance from its full suite of Intelligent Practice Solutions over a period of 12-16 months:
Initial Financial Analysis. Obviously, unveiling millions in found money requires a chart study based on sophisticated statistical analysis–a deep dive into metrics that few companies ever check. We call them the seven intrinsic medical practice revenue drivers, none of which is related directly to the billing process.
These drivers are:
1. Clinical acuity. How sick are your patients? Clinical acuity will vary considerably as reflected in admission rates. For example, an ED with a 20% admit rate will typically have sicker patients than one with a 10% admit rate. Details like these can help us better understand specific acuity levels across different practice sites.
2. Practice Style. This metric looks at doctors’ propensity to perform extensive workups on patients who are discharged. Style will vary among physicians, based on factors like how cautious they are about the presence of comorbidities or significant differentials, and the extent to which history, physical, and labs are performed. Therefore, understanding this nuance and variance plays a significant role in our analysis.
3. Documentation Style. Certainly, better documentation results in higher levels of care reported to the payers. But documentation style can vary significantly from one emergency physician to another. Details like these are accounted for in our chart study process and documented for future one-on-one or group training opportunities.
4. Payer Mix. The payer mix revealed through our chart study is also an important data point, which we compare against the group’s historical payer mix. This offers a checks-and-balances methodology that can reveal errors in the study, such as chart-selection bias. Inversely though, if the payer mixes align, then we can be confident that our results are achievable.
5. Patient volume. This is another indicator of whether the selected charts reflect the actual practice of the physician group. For example, if the patient volume extrapolated over 365 days reveals a significantly different volume than the forecasted volume in our study, then we can revisit the data points to enhance our degree of confidence in the results.
6. Payer Contracts. Knowing payer rates for the visit levels is also an important factor in our revenue analysis. By going through each individual payer category and determining a revenue projection for each health plan, we can reveal an exceptionally accurate view of expected cash-per-visit.
7. Fee Schedule. Fee schedules vary among emergency departments, even in the same economic region. So, as part of our analysis, we do a deep dive into each practice’s reimbursement potential – to uncover areas of opportunity for future payer contract negotiations.
Outcome and Results
The biggest result was that, we not only found additional revenue, we actually beat the $2.2M annual projection and collected $2.5M in additional revenue that year. And because of Brault’s personalized training platform, the group’s performance also became more strategically focused, resulting in better metrics overall, but specifically more revenue for the practice and for each individual provider.
Our ability to correct previous problems and deliver the results we promised led to several new-business referrals from the client, including two from the ‘doubting’ partner, who subsequently became our advocate among his colleagues.
Case Study Part II: Fast Forward One Year
About a year after we got the group’s billing and cash flow back on track, their hospital challenged practice leaders to improve their patient satisfaction scores. Uncertain about what to do or where to begin, group leaders once again turned to Brault. It didn’t take long for us to identify the problem: despite decades of collective ED experience, the group didn’t really understand how the satisfaction scoring system worked, or how to positively impact patients’ scoring of their performance.
Intelligent Practice Solution: Physician Education
The simple act of conversing with patients can improve satisfaction scores, which the practice accomplished with flying colors. Practice leaders also reported other benefits, including better provider performance and increased cash-per-billable visit. The best part: results were delivered, as projected and promised, without any shifts to the client’s payer mix, fee schedule, or patient volumes.