ENHANCING PHYSICIAN PRODUCTIVITY

1. AAOS Practice Management Symposium San Francisco February 7, 2012 ADSoyerDO ENHANCING PHYSICIANPRODUCTIVITY

2. DISCLOSURES • AAOS Practice Management Committee

3. Goals • Definition of Productivity • Uses of Measuring Productivity • Areas to Improve Productivity in the Office -Patient Access to Practice -Office Operations/ Clinical Workflow - Management - Technology & Data • Ancillary Revenue • Investments

4. WHAT IS PRODUCTIVITY? • Measure of physician work

5. USES OF MEASURING PRODUCTIVITY • Determine Compensation reliable, consistent & objective To Be Effective: - must reflect the compensation environment or payer mix - must allow for improvement • Compare physicians • Determine staffing requirements / office resources More Productive Physicians spend more time in direct patient contact, generate more RVUs, consume more practice resources Therefore, Productivity generates more practice expense Resource Allocation can thus be adjusted by Physician Productivity

6. PRODUCTIVITY How do we Measure Physician Productivity? • # of office visits/ patient encounters -traditional measure of productivity limited by patient demographics -should include time as unit of measure • Collections -more accurate than charges in fee-for-service environment • RVUs -better measure in fee-for-service environment where multiple CPTs are generated • Ancillary output

7. ENHANCING PRODUCTIVITY • New Era of Patient Centered, Proactive Healthcare • New Models for Physician Productivity incorporate: evidence-based medicine, cost-effective practice and continued improvement of outcomes.

8. AREAS TO IMPROVE PRODUCTIVITY • Office Operations • Ancillary Sources

9. PATIENT ACCESS TO PRACTICE Increase Online Presence - Web 2.0 compliant website - Social Media Campaign Facebook, Twitter, Blog, YouTube - Marketing Google Ads (Adwords) AAOS Primer Social Media in Healthcare

10. OFFICE OPERATIONS • Front Office Patient Direct Access-alleviates burden on front desk at time of appointment -patient portal via website -online appt scheduling -demographic/ insurance forms email & downloadable Technology to enable efficient data entry - electronic signature capture - scanning documents

11. OFFICE OPERATIONS • Clinical Work Flow TIME IS MONEY! Efficient Time Management makes money Use technology -EMR (templates)/Scribe / Voice Recognition (macros) Efficient Time management saves money Reduces staff hours (less overtime)

12. OFFICE WORK FLOW • RVU value to your work • Low or ‘no value’ services should be delivered by non-physician extender - postop S/R, global fx f/u , etc… • High value services should be delivered by MD -US guided injections - In-office procedures

13. OFFICE COMMUNICATIONS • Internet phone -cost-effective upgrade with numerous options • Skype Business/ Teleconferencing -efficient time management for regular business meetings • Livestream -Orthopedic channel to live broadcast (e.g. lecture, community outreach) • Mobile - text -google chat

14. OFFICE OPERATIONS • Billing & Coding Code for everything you do Maximize every potential RVU EMR charge entry and PM software should be integrated Prepare for ICD 10 changes NOW!

15. OFFICE OPERATIONS • Management Understand Overhead in terms of Cost per month, day, hour Convert to RVU per month, day and hour Set realistic RVU goals for each physician Use Benchmarks for comparison

16. Management Six Step Approach Migliore 2002 • Develop a Budget compare actual results to expectations monthly • Monitor Practice Overhead compare to previous year and use benchmarks for FTEs • Monitor Cash Flow have reserve on hand • Monitor A/Rs should be monitored monthly, < 20% @ 90 days • Monitor Collection Rates should have high net collections • RVU Analysis of Practice provides data on higher reimbursing services to increase marketing, identifies unprofitable services, analyze contracts and negotiate higher reimbursement http://www.physiciansnews.com/business/502migliore.html

17. TECHNOLOGY & DATA • Use your Technology to your advantage • Website tools enable you to track & plot demographic data • Google adwords / Bing campaigns improve your web presence • Maximize your marketing potential to ePatients • Engage in social media

18. ANCILLARY REVENUE • Examine all ancillary revenue streams • Consider eliminating options that require continual investment with low ROI • Invest in services that compliment practice • Expand practice portfolio to include nonclinical revenue streams

19. OFFICE SPACE • Your Space Consider offering per diem lease when the space is not occupied Complementary services that will generate potential referrals such as Rheumatology/ Pain Management • Setup ancillary services to have daily production in your absence EMG/NCS, DME, Xray/ MRI, Urgent Care http://www3.aaos.org/member/prac_manag/enhancing_revenue_primer.pdf

20. CLINICAL INVESTMENTShttp://www.beckersorthopedicandspine.com/news-analysis/item/9027-private-equity-investing-in-healthcare-%E2%80%94-13-hot-and-4-cold-areas • 13 ‘Hot’ Areas in Healthcare Becker Aug 2011 • Hospitals & Health Systems • Hospital-based Specialists • ASC chains • HIT & mobile Health (mHealth) • Chronic Disease • Cancer & Hospice • Wound Care • Physical Therapy • Revenue Cycle Companies • Overseas Markets/ Addiction/ Rehabilitation/ Dental Practice Management

21. NON-CLINICAL INVESTMENT Latest Trends are in Social Media Companies & Internet Marketing Real Estate –buyers market

22. SUMMARY • Evaluate Individual & Practice Productivity • Benchmark with RVUs • Use Productivity to re-evaluate practice costs & resource allocation • Evaluate Clinical Workflow for Efficiency • Use Technology to improve Efficiency • Evaluate Ancillary Revenue Streams – eliminate low profit ancillaries and consider new investments (both clinical & nonclinical) • Determine Need for Practice Executive if anticipating growth/ expansion

23. Thank YouResources:www.beckersorthopedicandspine.comEmail: ADSBONES@gmail.comTwitter@ADSoyerDOAdamDSoyerDO @ Facebook