Practice Management - Requirements For Success

Many individuals are inspired to become entrepreneurs and control their own work destiny.  They are willing to put in the “sweat equity” to be their own ‘boss’.  Opening and running your own practice and or urgent care is a worthy goal but to be successful, the “devil is in the details”. 

Here are some suggestions on how to select a “value added” practice management program that allows one to run an efficient business.

1. Attractive interface that has “walk-up” usability
2. Designed for end-user not programmer
3. Easy, logical navigation
4. Scheduling module that can be customized 
5. Registration module with scanning of  identification and insurance cards capability
6. Instant eligibility notifications for insurance, deductibles, and co-pay
7. Instant access to past visits and  accounts receivable
8. Fully-integrated Electronic Health Record that interacts with the practice management system to capture all CPT codes, ICD-9-10 diagnosis to easily code and send an accurate bill.
9. Certified Electronic Health Record to be eligible for $44,000 meaningful use funds to defray initial costs.
10. Electronic Health Record that has a full database, scanning capabilities, E-prescribing, and is not “hated” by the end-user.
11. Coding support and billing functions that allow you to 1. Do your own billing 2. Outsource to a billing company 3. Any combination of the above.
12. Gives real-time feedback on AR to allow staff to resubmit claims for reimbursement in a timely manner
13. Management reports
14. 24 hours support
15. The cost of the software is offset in savings in the number of FTE’s (full-time equivalents) to run the practice.

Every practice is different, but being efficient and controlling costs goes a long way toward a positive ROI (return on investment).

Changing the Paradigm for Outpatient Care

The present model has the primary care physician as the provider and gatekeeper of patient care. They evaluate the patient, obtain consultation, admit to the hospital (the hospitalists have taken over this role), and are the general coordinators of care. However, this model in theory works well; it has proven to be ineffective. This is no criticism of the concept but the complexity of modern medicine has made this very difficult for the average family practice unit.

Current Model

The family physician is supposed be the “gatekeeper” of resources and keep people out of other venues like Emergency Departments and urgent cares.

The problem is that the general public has voted “with their feet” that they prefer the family doctor when they are well, but the Emergency Department when they perceive themselves to be quite ill and the urgent care for quick, convenient care.  Call any doctor’s office and the first non-human response is: “If this is an EMERGENCY call 911 or go to the nearest Emergency Department.”

At the present time Emergency Department Services comprise approximately 2% of the nation’s annual healthcare expenditures.

Almost every ED has the built-in infrastructure to accommodate large number of patients which could be expanded. These are centrally located in most communities and already are the de facto safety net of the United States.

Make the ED the central piece of an organized system of emergency department, urgent care, family physicians with an integrated use of consultants.

New Model

Advantages are:

• Lack of duplication of hard assets
• Patients already prefer the ED
• Coordination of care