Is your practice experiencing a decline in net income?
Do daily operations feel chaotic with complaints from patients about wait times, billing, etc.?
Perhaps your practice is running smoothly enough, but you feel that things could be better.
If you can relate to any of these situations, a medical practice assessment can help take your practice where it needs to go. In a constantly evolving healthcare environment, the assessment of operations and monitoring of performance that a medical practice assessment provides could contribute greatly to your practice’s success and profitability.
A practice assessment is a diagnostic service that includes a comprehensive review and provides input on all operational aspects of the practice. Depending on the practice size, specialty and issues, the assessment might include any or all of the following:
- practice operations
- organizational flow
- revenue cycle
- financial operations and management
- internal controls
- policies and procedures
If your practice has already identified a specific area of weakness, a limited review may be more appropriate than a full practice assessment. For example, if your practice has recently noticed a decline in the gross collection percentage or an increase in denials, a limited review of billing and collections might be sufficient. Practice assessments are not one-size-fits-all; we strive to tailor our assessments to meet each client’s specific needs and objectives.
Once the goal and scope of the engagement have been defined, the consultant gathers certain data to build the foundation of the assessment. Data commonly analyzed in a practice assessment includes billing reports, financial reports and benchmarking data.
Although practice data is a critical part of the assessment, it alone does not allow us to develop assumptions and recommendations. Performing interviews, in addition to gathering data, is integral to the practice assessment. As with a golf scorecard, the numbers will tell you how many strokes it took to get to the hole, but not how to improve your swing. Practice data is the golf scorecard, and interviews provide the operational insight to assist in improving your game.
Interviews provide an opportunity to interact with staff, comparing processes with reality and deep diving into operational issues behind the numbers. Interviewees typically include management and rank-and-file employees from each department along with a representative employee from every function of the practice (both clinical and business office functions). As in a physician-patient relationship, in order for the consultant to diagnose properly and recommend treatment, data gathering and interviews must occur and are essential for an appropriate analysis of the practice.
Based on information obtained, the consultant will then analyze certain areas of concern. The most common problem areas uncovered in medical practice assessments are:
- charge data (capture and compliance)
- collection data and cash controls
- insurance (filing and follow-up)
- practice overhead
- human resources
Each item listed above contributes to the financial and operational success of a practice.
As one of the last phases of the medical practice assessment, the consultant analyzes numerous aspects of each category for inefficiencies and/or compares findings to benchmarking data to determine if the practice is underperforming or needs improvement in certain areas. For example, charge data would be analyzed to determine if all services provided were billed and coded accurately, posted timely, and in compliance with federal regulations. Additionally, overhead expenses would be compared against benchmarking data for your practice’s specialty to identify potential areas of excessive cost. Furthermore, a review of workflow and organization structure might be conducted to determine structural issues that may impact operational efficiency.
After the practice assessment is complete, we issue a report outlining our observations, findings and recommendations. This report is one of the vehicles we use to communicate the results and benefits of the engagement. The purpose of a practice assessment is to effect positive change in the practice, and the success of the engagement, therefore, lies in the practice’s ability to implement recommendations. Obviously, if you hire a consultant to conduct a practice assessment and present a report, but nothing changes, the practice receives little to no benefit.
A practice assessment involves cooperation and communication by both the consultant and the practice, but the benefits awaiting your organization can be invaluable. If you think your practice is due for a check-up, tell us “where it hurts.” A practice assessment could lead to the cure.