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1. Looks for appropriate expansion opportunities. The most successful programs look for effective ways to expand their patient base. “Consider expanding your practice into cancer pain and palliative medicine,” Amy Mowles, president and CEO of Mowles Medical Practice Management. “Recognize that this may significantly increase demands for availability. It can be very rewarding work, but you need to know your community resources: detox programs; inpatient pain programs —don’t be afraid to refer the very difficult patient; and make sure you have access to a variety of excellent specialists and primary care doctors.”
2. Bring on new physicians. Growth can come through expansion of services, but it can also come through recruiting new physicians. Top centers carefully seek out the best providers and then ensure these physicians are a good fit for the organization, Ms. Mowles says. “They obtain mandatory peer references, and use primary and secondary verification sources,” she says. “They’re not shy about looking over [the recruited] physicians work, watching for warning signs of poor care that include not returning calls or answering pages, frequent complaints and mishaps that could be avoided with precautions.”
3. Hire a physician liaison. Once a practice establishes what primary care physicians want and works toward providing that, someone has to tell the primary care physicians that the services are available. Hiring a physician liaison is an effective way to do this, says Mr. Anderson.
“This person should be out in the field five days a week, buying lunches for and interacting with the primary care physician community,” says Scott Anderson, COO, Prairie Spine and Pain Institute in Peoria, Ill.
A well trained and highly motivated physician liaison should be able to add 50-75 referrals to your practice (or ASC) every month. The ideal person for the job holds a four-year degree in an allied health field such as functional or behavioral health. They should have an outgoing personality and be very comfortable meeting and speaking with people. Mr. Anderson says to stay away from people with nursing degrees or experience as a pharmaceutical representative.
4. Incorporate cutting-edge treatments. Part of creating a unique story for referring physicians is being able to perform all pain management procedures such as spinal cord stimulator implants and radiofrequency ablation. Robert Saenz, CEO of Tulsa Pain Consultants and president of VIP Medical Consulting, says the returns for physicians are favorable for both of these procedures.
Francis Riegler, MD, co-founder of Universal Pain Management, says that because there are only three medical device manufacturers of spinal cord stimulator devices, the market is highly competitive. He recommends practices check with other vendors in their area to make sure they are getting the best price. There are also rebate programs for these devices.
5. Form a relationship with primary care physicians. Mr. Saenz says pain management has evolved over the last five years from a “last resort” treatment option to a more feasible first step for chronic pain. “It used to be that neurosurgeons or back surgeons would refer patients with back or neck pain to pain physicians, and that is evolving,” Mr. Saenz says. “At this point, pain management doctors are more of a hub than a last stop.” To this end, pain management physicians are forming relationships with primary care providers to create a channel of direct patient referrals.
Mr. Saenz says the referral of patients from primary care physicians to pain management specialists can help in providing more options for treatment. “The patients come directly to the pain management physician, who does an assessment to determine whether they need medication, physical therapy or surgery,” he says. “It’s a smarter way to do it than to jump right from primary care to a surgical consultation.” He says many patients will never need surgery to treat their pain — the issue can simply be “managed” over time with a combination of different non-surgical treatments.
6. Keep implants in mind when negotiating payor contracts. Some pain procedures require expensive implants and if payor contracts don’t reflect a competitive rate, you won’t make money on those procedures. This might include carving out these procedures or implant rates within the contract, says Bill Gilbert, vice president of marketing for AdvantEdge Healthcare Solutions. “Make sure that expensive items like implants are appropriately reflected in the rate that is being paid by the payor,” he says.
For example, you might have a contract for $10,000 with a payor for a particular procedure, but they don’t carve out an implant that costs $7,000, which means your actual revenue is much less than the amount reimbursed. A contract with another payor that does carve out $8,000 for implants might be more attractive.
7. Train staff in patient collections. Pain management physicians must have a staff trained in the best methods for collecting from your patients. The scheduler should know whether patients have an outstanding balance when they call for a follow-up visit, and if they do, ask them to send the payment in prior to the visit. “The front desk staff needs to be trained in collection procedures because most people naturally aren’t very comfortable asking for money,” says Mr. Gilbert. “Have a script written up for the front desk staff so that when they ask for patient payments, they begin with the assumption that patients are going to pay.” This might mean asking the patient which type of credit card they’d like to pay with instead of asking how they would like to pay.
8. If a case isn’t profitable in the ASC, take it to the hospital. 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.
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