Cath Lab Digest

As the healthcare landscape continues to change, it can be a challenge to survive in a managed care environment, let alone thrive. This author provides pearls for streamlining office management and offers insights on carve outs and selling OTC products in the office.

   Over the past 12 years of working in private practice, I have had the unique opportunity to work in a practice that includes managed care patients. There have been many changes in the makeup of these health maintenance organizations (HMOs) since I started in practice and we have made many adjustments to the office management of these patients.

   In 1996, there were more than 10 different independent practice associations (IPAs) managing more than 200,000 HMO patients in our region of southern California. Since that time, many of these IPAs have consolidated or gone out of business. There are now only four different IPAs in the region. This does not include Kaiser Permanente (a closed managed care organization).

   This consolidation has occurred for many reasons, which include a desire to cut costs, improve patient outcomes and become more efficient. It is interesting that the IPAs that have been successful and have survived over the past decade are not the ones that cut corners with reimbursing physicians or approving authorizations. Rather, the survivors are those that have strived for a higher quality of care.

   Typically these organizations are performing internal reviews of the doctor’s quality of care, patient outcomes and patient satisfaction with the use of numerous surveys and data reports. Organizations share these reports with the physicians in an effort to create awareness of patient perception and satisfaction with the care provided.

   As physicians and surgeons, we do not always realize what a patient sees or perceives about the care we provide. However, we can learn from our mistakes and continue to improve as a private practice. Sometimes a patient has a great outcome from surgery but is disappointed with the way a staff member interacted with him or her or with the manner in which a billing service spoke to the patient. These reports and surveys have helped us improve.

Insights On Streamlining Office Management

   The greatest challenge for a busy practice is how to include HMO patients but not let the practice be overwhelmed by the additional paperwork and increased patient volume. The use of authorization request forms will help improve communication between the doctor and the staff. This will eliminate wasted time looking for diagnosis or procedure codes, and assist the staff in expediting the authorization.

   The IPAs in our community are able to authorize all requests via the computer. Unlike with most PPOs and workers’ compensation patients, obtaining authorizations in the IPA setting does not require numerous phone calls or waiting on the phone for 15 or more minutes. Office staff do not need to be redirected to a supervisor or leave messages for a claims adjuster. Computerized authorizations are much more efficient and we are able to obtain authorizations within 24 to 48 hours.

   One of the keys to treating a large volume of HMO patients in one’s practice is to resolve the clinical problem as quickly as possible and resolve it permanently. This may require a change in treatment protocols for the foot and ankle specialist.

   For example, many doctors prefer to perform a partial nail avulsion for a new ingrown toenail. In our experience, most ingrown toenails, particularly those in children, recur more than 50 percent of the time. It is our preference to perform a partial nail matrixectomy on the initial visit to help resolve the problem permanently and prevent the need for numerous follow-ups in the future.