In a perfect world, there should be a simple formula for neurology practice—see patients, get paid. But anyone who has spent a day on the job knows the real world formula is far more complex. Things like MACRA, MIPS, Meaningful Use, APMs and a slew of other acronyms are rightfully getting a lot of attention from neurologists who hope to maximize their pay.
These are rather recent developments in the world of medicine and it is right that they are attended to. Failure to do so could result in big losses.
But, in the midst of these modern concerns, old school practice management still has its place.
At the American Academy of Neurology annual meeting earlier this year, Brad Klein, MD, MBA, discussed some of these old school business practices that can make a big impact on your bottom line.
At the center of Klein’s recommendations is the timeless formula:
Net Income = Revenue – Expenses
You need to be intimately familiar with both variables in this equation. Where does your revenue come from? What are each of your expenses?
Klein suggests you comb through each line item of income and expenses to understand why it is there. An expense isn’t necessarily a bad thing. For example, it may represent supplies for a procedure you are doing more often. But you should know why it’s there, and it should serve a purpose.
The same is true for each source of income. You should not only know where your income comes from, but how much a dollar from each source costs you—in your time, staff time, and supplies.
It is helpful to think of income as one of two types. One type is income for work. See more patients, make more money. This is foundational in medical practice, but taking it to the extreme is a key contributor to burnout among neurologists. The second type of income earns money for you without increasing your workload much or at all. Focusing on this second type can help you maximize both your income and the quality of service your patients receive.
The Role of Advanced Practice Provider
One area where this second type of income can show up is in the work of an Advanced Practice Provider. If you have an APP in your practice, it is important that you are utilizing their complete skill set. If your APP is doing work a medical assistant is qualified to do, it’s costing you money and probably causing them to consider looking elsewhere for work.
In addition, you may wonder if you should add an APP, or even another physician, to your practice. Klein suggests using your third available appointment as a benchmark. If patients have to wait more than 30 days for that appointment, your practice can probably support an additional staff member. Alternatively, a long waiting list may give you enough buffer to feel confident asking for higher rates from plans that reimburse you at the lowest levels.
Know Where Your Patients Come From…
Klein also suggests looking at who your top referrers are. Make sure their patients are able to get appointments with you. If you are making them wait too long, those top referrers may soon start sending their patients elsewhere.
…And Take Care of Them
Speaking of those referrals, what happens when they call your office? Are they redirected multiple times? Do they have to leave a message? It should be easy for patients to call and set up an appointment. Klein suggests testing this yourself. You don’t want to lose business because it’s just too much of a hassle to schedule an appointment.
Another important point related to setting appointments is vetting patients for their insurance. It will cost you revenue if the patient shows up for an appointment and only then finds out you don’t take their insurance. Be sure your staff establishes this when the appointment is first scheduled.
Klein also mentioned that too many neurologists still do not have a website. We agree. In today’s world, it is unreasonable to go without a basic web presence. The numbers are compelling. As of 2016, 88 percent of U.S. adults are online. They use the internet to search for medical information and to find caregivers. And if you aren’t online, they won’t find you.
There are big ways to make and lose money in a medical practice. But remember the little things. They may not seem like much, but cumulatively they can make the difference between getting ahead or falling behind.