As a physician, becoming part of a physician referral network is one of the best things you can do for your medical practice. You’ll build relationships that will help ensure the success of your practice even as other sources of revenue evaporate due to changes in the economy and health care system. You can either join an existing referral network or, if you prefer, create one of your own by seeking out and cultivating relationships with other physicians.

If you join an existing network, you’ll have to evaluate it carefully to determine whether or not it meets your needs. To maximize referrals, be sure there are relatively few physicians in your specialty within the network. Make sure the network conforms to patient rules and laws and that the software or platform is easy for your staff to use.

Pill mills have been in the news quite a lot the past few years, and not in a good way. They dole out millions of narcotic prescriptions annually. Often times the line between doing what’s best for the patient and doing what’s best for the bottom line of the pill mill practice gets very shady at these businesses.

“Comprehensive pain centers are very different from "pill mills". Unfortunately the two practices get associated together in the minds of the public.” states David Greene MD, CEO of a pain management center in Phoenix, Arizona and consultant to National Medical Testing Supply (NMTS).  “With the US in the midst of a full onslaught pain medication epidemic, best practice pain centers are regularly being thought of as pill mills when in fact there are considerable differences.”

Although many patients will purposely seek out pill mills for the obvious reasons, as busy medical professionals we certainly don’t want to be referring patients to one or even thought of as one ourelves.  Here are the top 3 reasons pain management centers are different (in a good way) from your standard Pill Mill: 

Many practices are so hungry for patients that they sign up on patient contracts that are not as much of a benefit as they should be. One of the contract types is Workers Compensation. Most doctors will see a work comp patient if they come into their office, but many practices and specialties actually look for these types of patients. But should YOU look for these patients? Do you know if your state is directed or non-directed? Does your state have a state mandated fee schedule or not? If so, what is the fee schedule? After extensive research HNA put together a work comp grid specifically to assist our doctors in making this decision. Keep in mind that if you are in a directed state, this means that an employer tells the employee what doctor they must go see for an injury. Whereas a non- directed state the employee chooses what doctor to go see. Of course a state mandated fee schedule is a fee schedule the state has produced as to the charges you will be reimbursed for these services. This seems easy enough but what to do with this information? Well, if you are contracting with a private carrier your fee schedule may be a cpt code fee schedule or a percentage of a mandated fee schedule.

After a recent  e-survey we received many inquiries asking the definition of “enabled provider”.   By now, most of you have heard of and are somewhat familiar with Accountable Care Organizations (ACOs).  A less familiar term that is starting to be used in discussions pursuant to ACOs is Enabled Provider.  An Enabled Provider is simply a Provider (Physician and/or Facility) that is contracted with the ACO.  They are considered enabled due to the fact that they are integrated within the ACO from a contracting, systems and clinical perspective.  Please contact us with any additional ACO questions.

Attending to students at your local high school can bring business to your practice.

Are any of you promoting your practice to the High School sports teams in your community?

If so, what are you doing?

Please respond by posting your comments below.

**ALERT ** ALERT ** ALERT**

The office of Inspector General (OIG) has released its “2011 Workplan”. In other words, these areas of compliance are going to be targeted for audit (and fined accordingly, I’m sure).

The areas of specific focus for physicians / medical practices are:

The temporary course to freeze the scheduled 21% medicare reduction was blocked by Republican Sen. Jim Bunning of KY. Bunning claims the fix in the bill would add to the national debt.

Physicians and patients alike are outraged. This new cut will devastate the physician community and put disabled and elderly patients at risk of losing care.

So what is it going to be? Are you going to continue to accept medicare? Can you afford to accept a 21% pay cut?

Some or all information contained above compliments of Desiree Baylin at www.POMAA.net

It’s comparable to not participating in your company’s 401k to get the match. It is simply money left on the table. That’s how you need to look at point-of-service drug dispensing. It’s easy, with low investment, and your competitors just might be jumping on the bandwagon faster than you are.

The old is new again

A short history lesson is in order here: this is nothing new. Physician drug dispensing was the norm in days gone by, but somewhere along the way doctors gave up this income stream and cheerfully handed it to pharmacists. The time has come for you to reclaim your piece of the pie.

Patient Mix is a tricky road to navigate. Many practices just assume the more patients it sees, the more money it makes! Well, what if you could see different patients and make more? What is patient Mix? Patient Mix is the equation that leads to all the patients you see in your practice. Simply put: How many PPO patients, HMO patients, cash patients, and Medicare patients do I have? For example a typical General Practitioner runs about 85-90% on the large HMO patient mix structure. Meaning you are contracted with the top 5-10 HMO/PPO in your area because they control a large patient base. You contract with them and they fill your waiting room with patients. But are the reimbursements what you want? Usually not. You may think you make up for less money with more volume but this approach is a formula for disaster.

It’s reality folks: in the world of healthcare, going it alone is virtually impossible these days. As a stand-alone, multi-physician practice or sole practitioner, the myriad of requirements and obligations involved in healthcare have made being a small player a real challenge. Hospital chains, both for profit and nonprofit, have become negotiating powerhouses – and their clout guarantees preferential payer contracts.