Carving Out Financial Success: The Power of Insurance Carve-Outs in a Private Plastic Surgery Practice.

BACKGROUND: Since the Patient Protection and Affordable Care Act was signed into law, there has been a push away from fee-for-service payment models. The rise of bundled payments has drastically impacted plastic surgeons' incomes, especially nonsalaried surgeons in private practice. As a result, physicians must now attempt to optimize contractual reimbursement agreements (carve-outs) with insurance providers. The aim of this article is to explain the economics behind negotiating carve-outs and to offer a how-to guide for plastic surgeons to use in such negotiations. METHODS: Based on work relative value units, Medicare reimbursement, overhead expenses, physician workload, and desired income, the authors present an approach that allows surgeons to evaluate the reimbursement they receive for various procedures. The authors then review factors that influence whether a carve-out can be pursued. Finally, the authors consider relevant nuances of negotiating with insurance companies. RESULTS: Using tissue expander insertion (CPT 19357) as an example, the authors review the mathematics, thought process required, and necessary steps in determining whether a carve-out should be pursued. Strategies for negotiation with insurance companies were identified. The presented approach can be used to potentially negotiate a carve-out for any reconstructive procedure that meets appropriate financial criteria. CONCLUSIONS: Understanding practice costs will allow plastic surgeons to evaluate the true value of insurance reimbursements and determine whether a carve-out is worth pursuing. Plastic surgeons must be prepared to negotiate adequate reimbursement carve-outs whenever possible. Ultimately, by aligning the best quality patient care with insurance companies' financial motivations, plastic surgeons have the opportunity to improve reimbursement for some reconstructive procedures.

Increased Australian outpatient private practice psychiatric care during the COVID-19 pandemic: usage of new MBS-telehealth item and face-to-face psychiatrist office-based services in Quarter 3, 2020.

OBJECTIVE: The Australian federal government introduced new COVID-19 psychiatrist Medicare Benefits Schedule (MBS) telehealth items to assist with providing private specialist care. We investigate private psychiatrists' uptake of video and telephone telehealth, as well as total (telehealth and face-to-face) consultations for Quarter 3 (July-September), 2020. We compare these to the same quarter in 2019. METHOD: MBS-item service data were extracted for COVID-19-psychiatrist video and telephone telehealth item numbers and compared with Quarter 3 (July-September), 2019, of face-to-face consultations for the whole of Australia. RESULTS: The number of psychiatry consultations (telehealth and face-to-face) rose during the first wave of the pandemic in Quarter 3, 2020, by 14% compared to Quarter 3, 2019, with telehealth 43% of this total. Face-to-face consultations in Quarter 3, 2020 were only 64% of the comparative number of Quarter 3, 2019 consultations. Most telehealth involved short telephone consultations of ⩽15-30 min. Video consultations comprised 42% of total telehealth provision: these were for new patient assessments and longer consultations. These figures represent increased face-to-face consultation compared to Quarter 2, 2020, with substantial maintenance of telehealth consultations. CONCLUSIONS: Private psychiatrists continued using the new COVID-19 MBS telehealth items for Quarter 3, 2020 to increase the number of patient care contacts in the context of decreased face-to-face consultations compared to 2019, but increased face-to-face consultations compared to Quarter 2, 2020.

Australian private practice metropolitan telepsychiatry during the COVID-19 pandemic: analysis of Quarter-2, 2020 usage of new MBS-telehealth item psychiatrist services.

OBJECTIVE: The Australian Commonwealth Government introduced new psychiatrist Medicare-Benefits-Schedule (MBS)-telehealth items in the first wave of the COVID-19 pandemic to assist with previously office-based psychiatric practice. We investigate private psychiatrists' uptake of (1) video- and telephone-telehealth consultations for Quarter-2 (April-June) of 2020 and (2) total telehealth and face-to-face consultations in Quarter-2, 2020 in comparison to Quarter-2, 2019 for Australia. METHODS: MBS item service data were extracted for COVID-19-psychiatrist-video- and telephone-telehealth item numbers and compared with a baseline of the Quarter-2, 2019 (April-June 2019) of face-to-face consultations for the whole of Australia. RESULTS: Combined telehealth and face-to-face psychiatry consultations rose during the first wave of the pandemic in Quarter-2, 2020 by 14% compared to Quarter-2, 2019 and telehealth was approximately half of this total. Face-to-face consultations in 2020 comprised only 56% of the comparative Quarter-2, 2019 consultations. Most telehealth provision was by telephone for short consultations of ⩽15-30 min. Video consultations comprised 38% of the total telehealth provision (for new patient assessments and longer consultations). CONCLUSIONS: There has been a flexible, rapid response to patient demand by private psychiatrists using the new COVID-19-MBS-telehealth items for Quarter-2, 2020, and in the context of decreased face-to-face consultations, ongoing telehealth is essential.

Life in an Academic Practice Versus a Solo Private Practice: How Different Are They?

Facial plastic surgery has thrived in both academic and private settings. In this article, 3 surgeons comment on a variety of selected topics that are pertinent to their lives as academic and private practice surgeons.

Impact of the Current United States Health Care Environment on Practice: A Private Practice Viewpoint.

The evolving healthcare landscape creates unique challenges for private practitioners. They experience the same issues that face physicians in general - including increased regulatory/documentation burdens and downward financial pressures - but without the safety nets that exist in larger healthcare systems. Costs are born more directly, as there are fewer providers over which to spread expenditures. Financial reserves are less robust, making margins thinner to maintain profitability. Guaranteed referral streams are absent, requiring additional effort and creative solutions to maintain patient volume. As hospital systems expand, private practitioners must remain nimble, while maintaining excellent service and outcomes, in order to stay ahead.

[Relevancy and efficacy of advanced nursing practice in private practice to promote smoking cessation]. / Pertinence et efficacité d'une pratique infirmière avancée en libéral dans le sevrage tabagique.

Raising awareness of the harmful effects of smoking on health and supporting smokers who wish to quit are important public health challenges. The involvement of nurses in these specific healthcare actions targeting the motivation to change seems to be a promising approach as revealed by a study summarised in this article.

Factors Affecting Women's Success in Academic and Private Practice Plastic Surgery.

Because plastic surgery trainees generally spend the majority of their training in academic centers and may have minimal exposure to other practice models, it can be difficult to decide which is the best route to achieve satisfaction and success. Surgeons need to be aware of benefits and challenges associated with different practice models and with workplace factors in general that contribute to happiness at work. This article reviews common practice models and provide specific and practical advice for the female surgeon.

Investigating the dimensions of learning organizations questionnaire (DLOQ) in a Romanian private ophthalmology organization.

Private ophthalmology organizations are knowledge-based institutions that need to adapt to changes from both external and internal environments. To ease the organization's survival, a learning process is required at different levels: individual, team, group, and to the organization itself, triggering a learning organization (LO) transformation. The aim of this research was to assess the relevance and efficiency of the Dimensions of the Learning Organization Questionnaire (DLOQ) in a private ophthalmology organization from Bucharest, Romania. The DLOQ was translated from English into Romanian and administered to 113 nurses and physicians working in the private ophthalmology organization. The DLOQ includes the following dimensions: Continuous learning, Dialogue and inquiry, Team learning and collaboration, Embedded systems, Empowerment, Systems connections and Strategic Leadership. Data was analyzed using central tendency indicators, such as the mean and standard deviation for quantitative variables, as well as the frequency, for qualitative variables. To be able to determine the comparison between the DLOQ dimensions' scores and the professions of the respondents, several Mann-Whitney U tests were performed. The DLOQ's internal consistency and its measurement validity were assessed using the Cronbach's alpha coefficient values and the Confirmatory Factor Analysis, respectively. The findings of the DLOQ implementation revealed that it is generally suitable to be used in the ophthalmology context. However, among the DLOQ dimensions, the Strategic Leadership dimension had to be removed, due to cultural and socio-demographic factors. No significant variations across professions and dimensions were registered. Although the DLOQ was developed for company settings, this study demonstrated that it could be successfully applied in health care as well. The DLOQ dimensions may provide valuable insights and understanding regarding the objective where further efforts should be directed. Also, through appropriate care management strategies, this instrument may contribute to the strengthening of the health care system, and particularly to the implementation of LO orientation in other medical specialties.

Developing an Interventional Pulmonary Service in a Community-Based Private Practice: A Case Study.

Interventional pulmonology (IP) is a field that uses minimally invasive techniques to diagnose, treat, and palliate advanced lung disease. Technology, formal training, and reimbursement for IP procedures have been slow to catch up with other interventional subspecialty areas. A byproduct of this pattern has been limited IP integration in private practice settings. We describe the key aspects and programmatic challenges of building an IP program in a community-based setting. A philosophical and financial buy-in by stakeholders and a regionalization of services, within and external to a larger practice, are crucial to success. Our experience demonstrates that a successful launch of an IP program increases overall visits as well as procedural volume without cannibalizing existing practice volume. We hope this might encourage others to provide this valuable service to their own communities.

Impact of a comprehensive pharmacist medication-therapy management service.

OBJECTIVE: This proof of concept study aimed to determine whether a pharmacist-managed medication therapy management (MTM) program in a private endocrinologist physician's practice reduced healthcare services utilization and related costs 6 months after patients' discharge from an institution with a transition of care service. METHODS: Patients were included in the study if they were English-speaking, ages >18 years, had type 1 or 2 diabetes, and had a recent transition of care experience (inpatient hospital stay or emergency department/urgent care/paramedic or other acute care visit). The study had a non-randomized design where intervention patients, enrolled July 1, 2012-September 30, 2013, were administered MTM at four visits over 6 months and were compared to historical control patients with available electronic medical records from August 8, 2008 to March 15, 2012. The primary study end-point was the rate of 30-day hospital readmissions, as related to the reason for the index admission. Secondary end-points included the cumulative rate of all-cause hospitalizations, emergency department, paramedic and urgent care visits at 30, 60, 90, and 180 days post-discharge as well as imputed total costs, including prescription medication costs, at 180 days. Propensity score weights were constructed to balance covariate characteristics between the intervention and control groups. Weighted multivariate negative binomial and generalized linear regressions were used to model cumulative utilization rates and log-transformed costs, respectively. RESULTS: The intervention (n = 28) and control (n = 73) groups had 0% hospital readmissions at 30 days post-discharge. In propensity score weighted multivariate analyses, cumulative utilization rate was not different between the two groups (IRR = 1.61, p = 0.72 at 180 days) while costs in the intervention group were lower but not statistically different (cost ratio = 0.65, p = 0.13 at 180 days). CONCLUSIONS: Further studies should investigate whether the integration of pharmacists in transition of care models could reduce readmission and healthcare utilization rates post-discharge.