Physicians To Receive 30% Less From Medicare: Are You Still In?

A couple of today’s news headlines …

“The Centers for Medicare and Medicaid Services has issued its proposed changes to the 2012 Medicare Physician Fee Schedule, including a long anticipated — and long-feared — plan to cut Medicare pay to physicians by 30%.” (MedPage Today, July 6, 2011)

“To curb rising Medicaid costs, about a dozen states are starting a new budget year by reducing payments to doctors, hospitals and other health care providers that treat the poor.” (USA Today, July 6, 2011)

Is it time for physicians to get out of Medicare? Time to resign from Medicaid?

Frustration may be mounting; there is an increasing Medicaid population in a number of states across the country, but a shortage of providers is already evident.  Will this shortage also be true for the significantly growing numbers of people joining Medicare in the next few years, based on the baby boomers aging into Medicare eligibility?

As a medical provider, the choice of not participating in government health plans is an option . . . if you can afford it.  There is quite surely a generation of physicians coming which will not know any different, and will be Medicare and Medicaid providers because they are still “hungry”.  And in the future, this trend may continue because that’s “where the patients are.”

It may not feel right, it may not feel just, and it certainly doesn’t feel fair.  For those providers who decide that being a healthcare provider means needing to adjust to a dramatically changing health care industry, here are four points to consider:

1. Accept the changes or get out of the Medicare and/or Medicaid programs.
2. Operate your medical practice in an efficient manner.  “Efficient” doesn’t mean “cheap”.  It means truly knowing what you need, spending wisely, and getting a return.
3. Finding new revenue is great … but realize that often times “new revenue” means capturing what you should have billed for and should have collected in the first place.
4. Keep looking for ways to do things “smarter, better and faster”.  Just like many other industries, healthcare has to learn “how to do it better with less”.

If physicians are going to continue to participate in Medicare and Medicaid . . . medical practice efficiency needs to become a science.

If you’re still in the game, great!  However, consider stepping up your ability to manage these needed changes …

• Consider a Comprehensive Practice Evaluation addressing “best practices”.  It’s sort of like giving your medical practice a complete “physical exam”.  When done right it will alert you to acute problems, give you a baseline upon which to build and measure progress, and lay out a treatment plan for immediate problems or areas of risk.
• Learn how to go past traditional medical practice benchmarking concepts.  Often times these only show that “we’re no worse than anybody else!”  Instead, learn to “optimize performance” … and out-perform everyone else.
• Establish easy methods of monitoring your medical practice performance.  Let’s face it, you’re busy.  But there are ways of getting your finger on the pulse of what’s going on.  And don’t just settle for knowing the results, but rather measure those results against attainable objectives.

Missed charges … the most common source of “new revenue” for medical practices.

In a recent medical group evaluation (6 physicians) we found over $400,000 of charges per year left on the table.  A revenue stream missed by not understanding proper medical documentation and coding.  That’s right, documentation and coding are your friend!  During our E&M documentation audits we don’t just find over-billings, but we almost just as often find many missed opportunities to adequately bill for services provided.  Right now, the chances are good that your medical billing is not optimized, meaning there are more collectible dollars on your books if you know how to go about it.

So why not embark on a state-of-the-art performance improvement system?  We’ve previously provided many suggested tools, check some of them out for better insights:

• 20 Ways To Improve Your Medical Practice Finances . . . Regardless Of What The Feds Do
• Using Best Practices In Medical Billing . . . Key To Surviving Economic Conditions
• Three Financial Strategies for your Medical Practice that are “Like Money in the Bank”
• Medical Accounts Receivable: Monitoring and Measuring Performance

The proposed changes to the physician Medicare fee schedule have been floated before.  With no change in the law, Centers for Medicare and Medicaid Services (CMS) has no choice but to publish proposed changes that comply with existing law, even if the resulting changes look catastrophic.  Congress has always “fixed” the problem – usually at the last minute – and may do so again.

Still, don’t you want to gain additional profit from your practice right now?   And don’t you want to be as prepared as possible if the worst would really happen?