Billing patterns for in-office computerized tomography scans of the face/sinus by otolaryngologists.

PURPOSE: To evaluate billing trends, Medicare reimbursement, and practice setting for Medicare-billing otolaryngologists (ORLs) performing in-office face computerized tomography (CT) scans. METHODS: This retrospective study included data on Medicare-billing ORLs from Medicare Part B: Provider Utilization and Payment Datafiles (2012-2018). Number of Medicare-billing ORLs performing in-office CT scans, and total sums and medians for Medicare reimbursements, services performed, and number of patients were gathered along with geographic and practice-type distributions. RESULTS: In 2018, roughly 1 in 7 Medicare-billing ORLs was performing in-office CT scans, an increase from 1 in 10 in 2012 (48.2% growth). From 2012 to 2018, there has been near-linear growth in number of in-office CT scans performed (58.2% growth), and number of Medicare fee-for-service (FFS) patients receiving an in-office CT scan (64.8% growth). However, at the median, the number of in-office CT scans performed and number of Medicare FFS patients receiving an in-office CT, per physician, has remained constant, despite a decline of 42.3% (2012: $227.67; 2018: $131.26) in median Medicare reimbursements. CONCLUSION: Though sharp declines have been seen in Medicare reimbursement, a greater proportion of Medicare-billing ORLs have been performing in-office face CT scans, while median number of in-office CT scans per ORL has remained constant. Although further investigation is certainly warranted, this analysis suggests that ORLs, at least in the case of the Medicare FFS population, are utilizing in-office CT imaging for preoperative planning, pathologic diagnosis, and patient convenience, rather than increased revenue streams. Future studies should focus on observing these billing trends among private insurers.

Managing a pessary business.

In this final article in a series of three, components of pessary fitting, provision, and follow up are reviewed from a business perspective related to supplies, patient flow, billing, and coding.

Disability insurance and the physician practice: a primer for physicians and office managers.

While your office may be familiar with all of the ins and outs of health insurance, disability insurance claims are complex and difficult to navigate, often deliberately so. When the unthinkable occurs and a claim must be filed, physicians are all too frequently stymied by the response of the insurance company to their claim. This article will provide fundamental information for the physician who needs to file a claim as well the practitioner who comes across a long-term disability insurance claim in his or her practice.

Basic bookkeeping and avoiding theft.

Bookkeeping practices in dental offices may be relatively simple, but care must be taken to prevent employee theft. Well-chosen accounting software and routine office practices may facilitate smooth operations. Systems of internal control should be established to safeguard the practice's finances. The dental practitioner should be very involved in their practice's accounting to maintain order, prevent theft, and keep costs under control.

What Is a Value Management Office? An Implementation Experience in Latin America.

Value-based health care has been touted as the "strategy that will fix healthcare," yet putting this value agenda to work in the real world is not an easy task. Robert Kaplan and colleagues first introduced the concept of a value management office (VMO) that may help to accelerate the dissemination and adoption of this value agenda. In this article, we describe the first known experience of the implementation of a VMO in a Latin American hospital and the main steps we have already taken to accelerate this value agenda at Hospital Israelita Albert Einstein. We faced a number of challenges in implementing the VMO at Einstein, including integration with existing clinical and financial information areas, transition to a standardized outcomes model, adaptation to our "open medical staff" model by connecting the VMO with the Medical Practice Division, and involvement with our physician-led multidisciplinary groups.

Caring for patients with limited English proficiency: the perspectives of small group practitioners.

BACKGROUND: Language barriers in medical care are a large and growing problem in the United States. Most research has focused on how language barriers affect patients. Less is known of the physician perspective and the efforts they are making to overcome these barriers. OBJECTIVE: To learn about current approaches to communicating with limited English-proficient (LEP) patients and the associated financial and nonfinancial constraints that private practice physicians and managers perceive in providing these services. DESIGN: Computer-assisted telephone focus groups with open-ended discussion guide. SETTING: Small private practices in geographic areas that have experienced recent dramatic increases in LEP populations. PARTICIPANTS: Primary care physicians, specialists, and practice managers. APPROACH: Focus group transcripts were systematically coded using grounded theory analysis. The research team then identified common themes that arose across the groups. RESULTS: Citing the cost, inaccessibility, and inconvenience of using professional interpreters, physicians commonly used family and friends as interpreters. Few recalled any actual experience with professional interpreters or were well-informed about the cost of their services. Physicians and office managers voiced uniform concern about how language barriers impede quality and safety of patient care and increased malpractice risk. CONCLUSIONS: Health care providers in private practice recognize the importance of overcoming language barriers. However, perceived barriers to implementing cost-effective strategies to these barriers are high. Physicians in private practice would benefit from information about how to best overcome language barriers in their practices efficiently and affordably.

Electronic health records: just around the corner? Or over the cliff?

We recently implemented a full-featured electronic health record in our independent, 4-internist, community-based practice of general internal medicine. We encountered various challenges, some unexpected, in moving from paper to computer. This article describes the effects that use of electronic health records has had on our finances, work flow, and office environment. Its financial impact is not clearly positive; work flows were substantially disrupted; and the quality of the office environment initially deteriorated greatly for staff, physicians, and patients. That said, none of us would go back to paper health records, and all of us find that the technology helps us to better meet patient expectations, expedites many tedious work processes (such as prescription writing and creation of chart notes), and creates new ways in which we can improve the health of our patients. Five broad issues must be addressed to promote successful implementation of electronic health records in a small office: financing; interoperability, standardization, and connectivity of clinical information systems; help with redesign of work flow; technical support and training; and help with change management. We hope that sharing our experience can better prepare others who plan to implement electronic health records and inform policymakers on the strategies needed for success in the small practice environment.

A cost-benefit analysis of electronic medical records in primary care.

Electronic medical record systems improve the quality of patient care and decrease medical errors, but their financial effects have not been as well documented. The purpose of this study was to estimate the net financial benefit or cost of implementing electronic medical record systems in primary care. We performed a cost-benefit study to analyze the financial effects of electronic medical record systems in ambulatory primary care settings from the perspective of the health care organization. Data were obtained from studies at our institution and from the published literature. The reference strategy for comparisons was the traditional paper-based medical record. The primary outcome measure was the net financial benefit or cost per primary care physician for a 5-year period. The estimated net benefit from using an electronic medical record for a 5-year period was 86,400 US dollars per provider. Benefits accrue primarily from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. In one-way sensitivity analyses, the model was most sensitive to the proportion of patients whose care was capitated; the net benefit varied from a low of 8400 US dollars to a high of 140,100 US dollars . A five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a 2300 US dollars net cost to a 330,900 US dollars net benefit. Implementation of an electronic medical record system in primary care can result in a positive financial return on investment to the health care organization. The magnitude of the return is sensitive to several key factors.

Physician opportunity costs in physician practice cost functions.

Estimation of cost functions for physician firms is problematic because many physicians are self-employed, and the marginal opportunity cost of physician labor is not observed. In this paper, we show how to recover marginal costs and conventional measures of economies of scale from cost functions that condition on the amount of physician labor input. In addition, we introduce the new concepts of marginal nonphysician input costs and 'behavioral' economies of scale, which reflect the structure of costs when physician labor input moves along a utility-maximizing expansion path. Our results could be useful in the design of resource-based physician fee schedules.

Efficiency and administrative costs in primary care.

We use a formal model to examine the implications of endogenous managerial effort for the interpretation and estimation of efficiency in health care organisations. The model is applied to investigate the doubling of the cost of administering primary care in England in real terms between 1989/1990 and 1994/1995. The main cost determinant was the number of general practitioners (GPs), and there were economies of scale but not of scope. Fund-holding had a positive but small effect on administrative costs, so that the recent abolition of fund-holding may do little to reduce primary care administrative costs. After allowing for changes in the numbers of primary care practitioners, the quality of primary care and the extent of fund-holding, most of the increase in costs was unexplained, and may reflect additional but unmeasured increases in the administrative burden associated with the 1990 reforms. There was little variation in relative efficiency across areas.

Economic and management considerations of a computer.

The extent to which a computer can be effectively employed in a veterinary practice depends to a large extent upon the size of the practice. Estimating defensible money investment in hardware and software prior to purchase is typically problematic because of the assumptions entailed in gauging potential return on capital. Successful software decisions flow principally from careful prepurchase planning and rigorous adherence to high standards of postpurchase support from the vendor selected. Staff involvement in the planning phase should be encouraged. The period of installation and implementation will probably be a stressful time in the practice.

Evaluating computer systems for the veterinary practice.

Evaluating the computer systems available to veterinarians involves examining the practice itself and its needs; the veterinarian and staff and their willingness to integrate different system types into the practice; and the systems and the vendors of those systems. This article gives guidelines to follow in all of these areas.

Allocating physicians' overhead costs to services: an econometric/accounting-activity based-approach.

Using the optimizing properties of econometric analysis, this study analyzes how physician overhead costs (OC) can be allocated to multiple activities to maximize precision in reimbursing the costs of services. Drawing on work by Leibenstein and Friedman, the analysis also shows that allocating OC to multiple activities unbiased by revenue requires controlling for revenue when making the estimates. Further econometric analysis shows that it is possible to save about 10 percent of OC by paying only for those that are necessary.

An approach to locating a family practice office in a metropolitan area.

A simple, economically feasible approach to locating a family practice office within a metropolitan area is presented. The Grand Rapids area serves as the population base for this investigation. An Office Location-Population Profile is determined from census tract population data and known physician office distrubution. Based on this information, a subsegment of the total area is delineated as a possible neighborhood for an office location and a physician-opulation ratio for this subsegment is determined. This is compared with recommended ratios. A statistical profile of the population, within the area considered as a possible site location, is developed using information available through census bureau statistics. Finally, a direct survey of a random sample of households within the selected area is performed. This format provides an objective approach to facilitate rational decision making in locating a family practice office in a metropolitan area.

Addressing multiple problems in the family practice office visit.

OBJECTIVES: The purpose of the study was to describe the number of problems addressed during family practice outpatient visits, the nature of additional problems raised, how they affect the duration of the visit, and how well they are reflected in the billing record. STUDY DESIGN: Cross-sectional. POPULATION: We studied a total 266 randomly selected adult patient encounters representing 37 physicians. OUTCOMES MEASURED: A problem was defined as an issue requiring physician action in the form of a decision, diagnosis, treatment, or monitoring. Visit duration and the number of billing diagnoses were also assessed. RESULTS: On average, 2.7 problems and 8 physician actions were observed during an encounter. More than one problem was addressed during 73% of the encounters; 36% of these additional problems were raised by the physician and 58% by the patient. On average, each additional problem increased the length of the visit by 2.5 minutes (P<.001). The concordance between the number of problems observed and the number of problems on the billing sheet indicated a trend toward underbilling the number of problems addressed. CONCLUSIONS: Multiple problems are commonly addressed during family practice outpatient visits and are raised by both the physicians and the patients. Our findings suggest that current views of physician productivity and the billing record are poor indicators of the reality of providing primary care.