1. Form a relationship with referring physicians to drive patient volume. Marketing is an essential tool to a surgery center’s success, and when it comes to interventional pain management, education is an essential part of marketing. Mike Heifferon, Ph.D, MBA, chief operating officer, and Marie Masztak, RN, BEd, vice president of nursing, of Deca Health, suggest that ASCs should devote one full-time equivalent position (ideally, two part-time staffers) to marketing efforts.
Meeting with referring physicians is an important part of this step, according to Mr. Heifferon and Ms. Masztak. Representatives from the ASC should provide physicians with information regarding customer and physician satisfaction at the center as well as educational material on pain management and how it can enhance their patient’s care.
“It is important to demonstrate to new physicians that performing pain management procedures in the ASC allows them to collect a facility fee while providing high quality and safe services to their pain patients,” Mr. Heifferon says.
2. Figure out where your cases will be most profitable. Pain management physicians who aren’t employed at a hospital need to analyze their cases to see where they will be most beneficial. “Not all cases are great cases for ambulatory surgery centers,” says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions. “Some cases are better for hospitals or clinics. The way to determine where your cases will be most profitable is to understand your case contracts and know what the yield is for each case.” Don’t schedule cases that aren’t yielding enough in the ASC if you are able to perform them elsewhere.
3. Steer away from money-losing pain implants. Some pain implants cost too much to use in an ambulatory surgery center without losing money. For example, a percutaneous discectomy implant with a probe costs between $900 and $1,500, but the reimbursement for the procedure is around $1,000. “Every time we use this implant, we lose money,” says Urfan Dar, MD, manager and medical director of Theda Oaks Surgery Center in San Antonio. “In some cases I have had to pay $300-$400 out of my own pocket.” Try to persuade the insurer to pay more and if that doesn’t work out, perform this procedure in the hospital going forward.
4. Have expert coders for pain management. Pain management, especially for orthopedic and spine pain patients, has a lot of innovation and some new procedures might not be covered by all payors. Physicians should be aware of which procedures an insurance company considers experimental to avoid denied claims and loss of revenue. However, practices can bill an unlisted procedure code for some new technologies. Coders must be familiar with the technology and procedure to fully utilize unlisted procedure codes. “You need to know how to bill for experimental procedures, and be able to say ‘Here’s why we used the code for this patient’ to the payor,” says Mr. Voithofer.
5. Consider adopting new procedures. Clinton Mallari, MD, a pain management specialist with the Center for Pain Care in Boise, Idaho, saw a segment of his patient population that didn’t respond to conventional treatment and wanted to find a way to help them. He decided to incorporate low intensity laser therapy into his practice, which was only approved by the FDA in 2004. “I started using the technology as a non-invasive way to treat patients with failed back surgery, headaches, etc.,” he says. “It doesn’t take up much room in my practice and it’s easy to use one member of our medical staff to do the treatment. Last year, we generated more than $60,000 in our practice by employing laser technology. These are patients who I would have otherwise referred out to physical therapy.”
However, receiving coverage approval from payors can sometimes be a headache. Dr. Mallari’s staff spends half a day each week trying to get authorizations to do these procedures by speaking with insurance companies.
6. Incorporate an EMR. There are several things pain centers should know about implementing an electronic medical record. APMR Spinal & Skeletal Pain Medicine, an eight-physician practice based in Upstate New York and in Northern Virginia, installed an electronic medical records system three years ago. Even though APMR’s practice sites are more than 300 miles apart from each other, physicians and staff can call up a patient’s chart and other information at any location through the Internet-based EMR system. “Access to a medical record anywhere is a huge advantage,” says Nameer R. Haider, MD, a partner in the practice, who travels frequently between the two locations.
However, it may take awhile to implement the technology before the benefits are realized. “It was chaotic when the system was introduced,” Dr. Haider recalls. “It is a steep learning curve.” Physicians and staff had to learn the software and get used to having computer-based systems many previously paper functions. But after three years, “I’d never want to go back,” he says.
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Dr. Scott Glaser: The Need for Interconnected Prescription Monitoring Programs
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