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.

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.

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.

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.

Significant clinical practice cost savings through downsizing office supply inventory and just in time ordering.

PURPOSE: Cost containment in the office is becoming more important secondary to increasing overhead costs and lower reimbursement. In an attempt to limit these particular expenditures we analyzed and restructured our methods of ordering, storing and distributing office supply inventory. MATERIALS AND METHODS: In a large academic practice with 11 urologists and approximately 20,000 annual patient visits an attempt was made to decrease overhead costs using the principle of just in time inventory popularized by large manufacturing companies. We initially issued a return of excess and/or unused supplies from our office inventory stock room. Our main supply room was then centralized to contain office supplies for up to 4 weeks. The 12 individual clinic rooms were stocked with appropriate supplies to last 1 week. Limited access to the main supply room was established and a supply manager was established to log all input and output. RESULTS: The initial credit for the return of unused/overstocked supplies was $10,107 in January 2004. Annual office supply charges in calendar year 2004 were $87,444 compared to charges in calendar year 2003 of $175,340. No stock outs occurred during year 2004 and all standing delivery orders were terminated. The total number of patient visits in calendar year 2004 was 20,170 compared to 19,455 in calendar year 2003. CONCLUSIONS: Decreasing overall inventory through accurate demand forecasting, judicious accounting, office supply centralization and just in time ordering is a potential area for significant overhead cost savings in a clinical practice.

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.