the smart unwind

www.bluepearlconsulting.com

ABOUT BLUE PEARL CONSULTING

ABOUT THIS WEBINAR

Blue Pearl Consulting is a boutique management and operations consulting firm serving clients throughout the Midwest and beyond. Blue Pearl's

Medical Management Services division specializes in assisting hospitals, private practices, assisted living facilities, and other medical service providers reach maximum operational efficiency, allowing you to serve your patients as

you envision.

Facing increasing costs and volatility in the industry, many doctors have joined large healthcare associations only to find that they are tasked with administrative

work, no longer control their own schedule, and work much better in a private practice environment. However, returning to private practice can be overwhelming and, if you don’t do it right, you could find yourself in the same position that forced

you to become a hospital or association employee in the past.


SPEAKERSSince 2011, Joel has grown Chicago-based Blue Pearl Consulting from a small startup into a cutting-edge firm widely known for its innovative approach, genuine interest in its clients, and truly effective solutions. Before founding Blue Pearl, Joel spent a number of years overseas working as a currency trader and equities analyst. Upon returning to the United States, he furthered his career with one of the largest asset managers in the world.

Joel has been quoted or contributed to articles in the Washington Post, ABC News.com, Motley Fool, Daily Finance.com, First Business News, and many more. Joel also speaks at numerous trade shows, symposiums, and panels—most recently at MD&M East, the largest Medical Design & Manufacturing event on the East Coast. Joel received a J.D. degree from Loyola University of Chicago Law School and a BA in Economics and Math from Emory University. He lives in Chicago with his wife Jill and their daughter Zoe.

As a Partner at Blue Pearl Consulting, Stacy Braack is a leader in client services. She develops productive relationships with potential clients, identifies and defines projects, and prepares proposals that effectively address client issues. Prior to Blue Pearl, Stacy spent the majority of her career in operations management for both industrial and consumer products manufacturing companies, as well as financial institutions and government entities.

At Blue Pearl, she applies her operational expertise to medical services companies to maximize efficiencies and drive significant bottom line improvements. Stacy earned an MBA from the Kellogg Graduate School of Management at Northwestern University and a BS in Industrial Engineering from Stanford University.

Joel FreimuthPresident & CEO

Stacy BraackPartner

There have been several episodes in recent history where doctors have left private practice to join healthcare associations, often stemming from regulatory changes and rising insurance premiums.

In the late 1980s and early 1990s, healthcare system changes appeared to be gaining ground.

There was a growth of managed care plans:

Health insurers coordinated the use of health care for enrollees by directly arranging for services through affiliated physicians, hospitals, and other providers.

Many physicians sold their private practice because managed care plans were able to pressure providers to accept more risk for patient care and take lower payment rates.

However, there was a backlash:

Customers protested the restrictions on services by managed care plans. Meanwhile, hospitals and physician management firms found they had overpaid for some physician practices.

As a result:

Managed care plans loosened their controlsand a number of mergers and acquisitions were dissolved.

While consolidation has continued, there were many doctors who returned to private practice successfully.

THIS IS NOT THE FIRST TIME THIS HAS HAPPENED...

Source: AMA 1998/1999


...HISTORY REPEATS ITSELF.

WHY IT’S HAPPENING AGAIN:

· Requirements to add expensive electronic record systems· The Affordable Care Act· Uncertainty of regulations· Dramatic increase in student debt· Stagnant reimbursement rates· Longer revenue cycle· Rising insurance premiums

Doctors have real and grounded fears about:

Source: Accenture 2012



Source: AAMC 2012

“HOSPITALS DID IT BRILLIANTLY. THEY CAME IN AND SAID,

‘WHATEVER YOU’RE MAKING NOW, WE’RE GOING TO MATCH THAT. WE’RE GOING TO GIVE YOU A LITTLE RAISE. WE’RE GOING TO TAKE ALL THIS STUFF OFF YOUR PLATE.’

OF COURSE, THERE’S A FLIP-SIDE TO THAT.”

- JOEL FREIMUTH


They no longer have total control over patient care. There are protocols and regulations within the organization that drive how they treat a patient.

Unfortunately, you can’t be House. You can’t just cut through the regulations and restrictions to provide the care that you want.

WHY DOCTORS NOW WANT TO UNWIND

They have a million different bosses.

The burdens of running a practice weren’t taken away, they were shifted.

The doctor’s contract is up. This gives them the opportunity to consider unwinding again.


Initial Setup

Revenue Cycle Management

Employee Accountability

KEYS TO SUCCESS

INITIAL SETUP

There are numerous questions you need to answer before you open your

doors. Each question has logistical and financial

ramifications.

What kind of relationship do you want to have with your patients?

How long do you want to spend with each patient?

How do we dispense services?

How are you going to generate new patient contact? Direct Marketing? Referrals?

Do you have a website? What is its Purpose?

If you take insurance, are you going to take Medicare/Medicaid? What does that mean if you do?

If you take Medicare, how do you forecast your cash flow?

If you have a high volume practice, how many billers do you need?

Do you outsource billing or do you do it in-house?

There is not necessarily a right answer to these questions, you just need to have an answer


There are times when you’re physician and there are times when you're a business owner, and you need to be able to wear both hats.

Don’t gloss over questions. Every famous military leader, coach, business leader says that planning is the key to success.

YOU HAVE TO TAKE OFF THE FANCY LABEL OF “I RUN A MEDICAL FIRM” AND

SIMPLIFY IT TO “I RUN A BUSINESS”

THIS IS YOUR PLANNING STAGE

REVENUE CYCLE

WHAT IS THE REVENUE CYCLE?

It starts when the patient contacts the office to make an appointment. It ends when the doctor gets paid for the service provided to that patient.

THERE ARE FIVE KEY PORTIONS OF YOUR REVENUE CYCLE:

· Client intake & timing of client intake· Insurance verification · Communication between the biller and the medical staff· Claim submission· Appeals You have to start thinking about the cycle before they walk in the door.

GET THE MONEY YOU’RE ENTITLED TO

Communication between you, your biller, and your staff is crucial.

Basically, you need to make sure:

· You get the right information and that it is correctly imported· The people who are submitting the claims have access to the people who are performing the service· The codes are matching up (especially when ICD10 rolls out)· Anything that goes wrong gets dealt with quickly, accurately, and appropriately

For a more in-depth look at mastering the revenue cycle, view our previous UBM

webinar at bluepearlconsulting.com/ubm1

If you’re not on top of the revenue cycle, you’re not in a position to anticipate and prepare for changes.

EMPLOYEE ACCOUNTABILITY

As a CEO of your practice, you have to hold your employees accountable.


Your vision for the way you deliver care needs to be communicated to every member of staff, not just

nurses and doctors.

YOUR VISION

The first person your patients see

The people in charge of receiving the money

your practice is entitled to

They should understand how the money they collect will be used to fulfill your vision.

FRONT DESK STAFF BILLING STAFF

Mistakes often occur when employees aren't truly invested in the vision for your practice. While you must hold your employees accountable, you also must hold yourself accountable for communicating your vision.

THEFT, FRAUD, & MISTAKES

Based on the staggering amount of theft and fraud, you need controls and audits.

Doing background checks and asking the right interview questions will not be enough.

Source: ACFE 2014

Source: ACFE 2014

Source: ACFE 2014


Your internal controls and audits have to be the thing that stops theft and fraud from happening.

Sometimes employees can be lazy or lack training, which results in mistakes.

Here are just a few problems that can come up with your staff:

· Uncashed checks· Unverified insurance· Sloppy note taking· Mismanagement of schedules

Whether it’s fraud or simply a mistake, the implications are the same—You lose the money you’re entitled to.

MISTAKES

DASHBOARD METRICS

REGULAR MEETINGS/CHECK-INS WITH STAFF

& How do you avoid mistakes?

You need interim reports that show how much money you’re taking in, how many patients you’re seeing, your average billings, collections, etc.

You need to be able to see trends and track progress

For example:

· Are you getting better at collecting receivables?· Are you seeing more patients?· Are you seeing the right types of patients?· How has your practice performed over time?

These are the kinds of dashboard metrics that are the foundation for any business.

This puts you in a position to make decisions—Can we afford this new piece of equipment or technology?

Can we hire another nurse? Should we hire a doctor as a partner or as a junior?

All of these questions are answered in an open book exam, if you understand the financials of your company.


While working with a client on their revenue cycle, we discovered a drawer filled with over $70,000 in uncashed checks.

This wasn’t fraud or theft. The employee wasn’t a bad person. There was simply a lack of processes, training, and communication.

Don’t give away money through mistakes.

A TRUE CLIENT STORY

THEFT, FRAUD, & MISTAKES

Theft doesn't always mean getting robbed at gunpoint.

THE #1 EMPLOYEE

You can unwind successfully. You can start up your private practice. And you can have success for years to come.

It means you have to be smart. You need to set up your practice like a business.

You can do it by mastering these three factors:

You have control of everything that can make you successful:

As long as you prepare and anticipate, you’ll be ready for any business obstacles, leaving you to

focus on what you truly do best.

It starts and ends with you

· You· Your business plan· Training & employee accountability· Controls & audit procedures· Patient care· The patients you see· Marketing· Location

· Initial Setup· Revenue Cycle Management· Employee Accountability

the smart unwind

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