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From the May 2003 Issue |
All-Around Efficiency Massachusetts OB/GYN practice improves its financial and administrative health with practice management software. Almost every day, an OB/GYN practice is in the local news, closing its doors due to skyrocketing malpractice premiums, the impact of financial risk and slow or incorrect payer reimbursements. More than ever, having the right technology behind it is critical for a practice’s fiscal and administrative longevity. PROBLEM Hampshire OB/GYN has six doctors, four nurse midwives and three nurse practitioners who practice in two office locations and one hospital in Northampton, Mass. The practice also has another 40 support employees, and all employees use the practice management system (PMS). Hampshire OB/GYN is a 31-year-old practice that sees about 36,000 patients a year. The practice’s profitability depends on efficient statement processing, complete collection of insurance data, eligibility and coverage verification checks, timely statement delivery, accurate charge entry and proper insurance claim filing. Like many OB/GYN practices today, we have experienced slim profit margins due to the increased influence of managed care and the high cost of malpractice coverage for obstetric (OB) doctors. Our malpractice premiums increased 50 percent last year. Our previous system, a DOS-based PMS, could not transport data quickly enough between our two office locations. We needed much greater efficiency in the daily collection, entry and processing of data. Our practice was growing, and we planned on adding two full-time schedulers in each office. We didn’t want to waste these staff hours with slow automation. OB/GYN practices have insurance tracking and reporting challenges that other specialty practices don’t have. For this reason, many OB/GYN practices maintain a variety of different reports using different search criteria to track all patient visits correctly. For example, many insurance providers use a global billing system for their OB claimants. This system reserves all billing until the end of the pregnancy. In the meantime, the OB/GYN practice must be able to exactly track all visits and procedures for all patients. There are approximately 13 visits per OB patient, and the system must track the visit, all treatments and treatment codes, the clinician(s) who rendered services, all charges and all payments per patient for the duration of the pregnancy. Verification of insurance eligibility and coverage levels is critical to ensure the patient’s insurance covers our service and that each procedure is coded correctly. So are ad hoc reports that enable us—at any point in the patient’s treatment cycle—to review specifics services rendered and charges assessed thus far. Once the patient has delivered, we need reports that can display the final status on all visits and charges and any follow-up needed from our billing office. We didn’t have full functionality for these capabilities with our old system. SOLUTION In August 2002, we began investigating new information technology. We knew it was crucial to understand the specific needs of all end-users in the practice, so we first formed a committee consisting of two representatives from the billing and claims department, two nurses who also did scheduling, the practice administrator and two physicians. Each committee member created a list of criteria for evaluating each system. We researched practice management systems at various trade shows and selected seven systems to investigate. Then we narrowed the finalists down to four and invited each vendor to present in-depth demonstrations to the committee. The committee unanimously selected Greenway’s PrimeSuite system primarily for its intuitiveness, user-friendliness, an ability to integrate an electronic medical record (EMR) with the administrative and financial component, and its ability to meet our requirements for HIPAA compliance. IMPLEMENTATION We implemented the new PMS in March 2002; the move to it was relatively seamless. Our administrative and financial information conversion took four days, two of which fell on a weekend. We manually keyed all future appointments, because there was no way to electronically convert them from the old system into Greenway’s system. The conversion did not affect the day-to-day activities of the practice, and our patient schedules were uninterrupted. Staff training was a critical part of implementation. The billing, nursing, scheduling and practice administration staff all received in-depth training on the system at a week-long program held on the Greenway campus in Carrollton, Ga. These employees then helped train the rest of the staff. During the week of go-live, Greenway provided on-site representatives to work individually with employees and provide hands-on training where needed. RESULTS We saw quick improvements in our overall practice organization, workflow, scheduling and billing. Claims. The amount of time spent by staff processing charges and claims has been reduced by 50 percent. On the legacy system, we averaged 30 minutes a day processing the claims. We now spend 15 minutes a day on the task. The claims processing reports are much easier to work, allowing for much faster detection and correction of errors. The practice spent approximately 45 staff hours per year correcting errors during claims filing. Scheduling. Our staff costs for scheduling appointments have decreased substantially. At our remote site, our scheduling time dropped from an average of six minutes per appointment to two minutes per appointment, with savings of about $5,000 annually. Similarly, as patient volume increased at our second location, the front-desk registration staff were able to register patients more efficiently with PrimeSuite. This generated about $10,000 savings in staff expenses. Without our new system, the patient volume increases that we experienced would have required additional staffing hours and, therefore, overtime costs for labor. Instead, we have been able to process all incoming patient data efficiently without adding new staff or extending current staff hours. Our scheduling functionality improved, too. As a group practice that shares its patient load and wants to provide patients with a choice of providers, we needed more flexible scheduling functionality. Some patients wanted to see only certain doctors in one location, while others would be happy with a doctor or midwife at either location. Our computerized scheduler needed to be able to return the next available appointment or appointments within a requested time frame for any user-defined parameters. With our previous system, we needed to make multiple searches to find appointment choices of this type, but with PrimeSuite, this functionality was both available and extremely user-friendly. Financials. We have lowered our billing expenses because we now collect good data on the front-end. We have decreased accounts receivable (A/R) days from 62 days to 41 days, which we feel is notable since the industry standard for A/R days for OB/GYN practices is under 60 days. Custom Reports. We can now generate the custom reports we require to better track contracts and fee schedules of our 25 different payers, as well as to ensure that each code is being paid correctly. Previously with our DOS system, 32 percent of codes were underbilled, 15 percent of codes were overbilled and only 53 percent of codes were billed correctly. If all codes had been billed correctly with the old system, the practice would have increased revenue by 9.5 percent. One of the most important reports we run on the Greenway system is a report that compares billable care providers to rendering care providers. When doctors contract with a payer, they are assigned an identification number. Because midwives and nurse practitioners are not always assigned individual numbers, they often bill under their physician’s number. Previously, when we would run reports based on what we billed, we would identify charges provided by a nurse midwife, but listed under a doctor’s name. This impeded our ability to determine the productivity of our nurse midwives or nurse practitioners. Now we can run these reports based on the rendering care provider. We are installing the EMR portion of PrimeSuite in late spring and anticipate a significant ROI. We look forward to the results of its implementation and integration with the PMS, and to even more improved financial results for the practice as the result of data collection and capture. For more information about PrimeSuite from Greenway, www.rsleads.com/305ht-205 SOURCE Gina Tucker PRODUCT/COMPANY
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