Category: Business

09 Apr 2016

More patients may not mean more collections


We live in a ‘more world’ where more of everything seems to indicate that we are doing better. The reality that this may not necessarily be true occurs to us in quiet moments. This applies to medical care too. More medicines cause more diseases instead of fixing problems. When doctors see more patients with the objective of increasing collections, it almost comes at a cost. When we examine data, we find that increasing patient volumes (just for the sake of doing so) may not translate to greater collections (or payments) from insurance companies.

Quality of patients and the care they get is more important than the volume in the long run. Let’s conduct a simple experiment. Select all the patients seen by a doctor for one week from two months ago (by this period, majority of the insurances should’ve reimbursed). Conduct a basic payer mix analysis (mix of insurances that patients have) and procedure mix analysis (consults/ procedures that physicians performed – from office visits to colonoscopies. Tracking payments for all these visits/ patients reveals that most of the money (upwards of 90% some times) comes from 5 or so insurance companies. From a business standpoint, could we stop adding patients for the purposes of making more money and focus on the ones we have – so that overall quality of care improves?

Freed up time may then be used to extend care to those who really need it, regardless of what insurance they carry or their ability to pay. It would be far more fulfilling to deliver care without expecting reimbursement than doing so by expecting high reimbursement and be frustrated later with the ‘system’ when insurances delay or deny pay.

09 Apr 2016

Focus and cut costs to thrive in Ambulatory Surgery Center market

Focus and cut costs

Since 2010, the ambulatory surgery center (ASCs) market has neither grown nor declined. ASCs start, shut-down and acquire other ASCs. There are over 5,400 surgery centers. Available physicians are limited and hospitals continue to pose a strong competition – sometimes partnering with ASCs. According to arecent Becker’s ASC article, ASCs will need to excel in a single specialty and run a very low cost center model to sustain in the future.


There are three dominant specialties in the ASC market: orthopedics, gastroenterology and ophthalmology. Let’s the example of ASC centers focused on gastroenterology. As medical science advances and a greater number of newer procedures become eligible for insurance reimbursement, gastroenterologists must develop deeper focus within the specialty. In 2014, there are 26 new codes for gastroenterology – suggesting newer ways to focus, get reimbursed and build expertise. A group must focus on EUS, another on EGD or esophagoscopy and so on. This method of divide and conquer would allow an ASC to be known as a leader in the field within their market and at the same time cover a wide range of procedures within the specialty.

ASCs can further add plans that involve diet and exercise, virtual follow-ups for a monthly fee. This creates additional revenue streams based on deeper understanding of patients and their conditions. It also engages patients and their families better and brings them back to the center on a regular basis.

Cut costs

Outsourcing activities or tasks in a controlled and methodical manner is clearly a way to bring costs of administrative tasks down. Identify tasks that are lower on the complexity scale and delegate and outsource them. When they aren’t core to the business model (i.e., treating patients), tasks such as billing, coding, denial management, patient collections, accounting, credentialing, pre-authorizations and so on will tend to be distractions from the core focus of the surgery center. Outsourcing companies centralize operations for a large number of providers, giving them benefits of scale – these cost savings are typically passed on to the center that could then pass them on to patients.

According to the ASC Value Driver Survey, 24% of ASCs experience stable volume, 27% reported growing volume and 27 percent declining volume. In the same survey, respondents cited competition from other ASCs and hospitals as one of their biggest challenges. Clearly, it’s a time to focus and cut costs to stay competitive.

09 Apr 2016

Digitally engage patients – your most under-utilized resources

Digitally engage patients

Medical practices continue to hesitate to share records freely with patients. There could be many reasons for such caution. Patients could use the information to sue doctors when something goes wrong. Doctors templatize information – and therefore, when someone reads it, it may not make much sense. But what if we trusted patients to do the right thing? We trust them to use the information to take better care of themselves? And we teach them to do so. Then we could get a lot back in return – not just clinical returns of healthier patients but patients could also engage better with ambulatory surgery centers and specialty groups to lower administrative costs.

Here are a few ideas where patients could help doctors lower administrative costs for the front desk and other staff members.

Patients could:

  • Update their demographics and insurance information through a web portal
  • Upload images of insurance cards, driver’s license and social security via a patient portal into the EHR
  • Read and sign consent forms
  • Pay past dues
  • Take clinical satisfaction surveys
  • Complete clinical questionnaires

Patients are the most under-utilized resources in a care setting – if we trust them enough and engage them, everyone would win.

09 Apr 2016

5 easy ways to increase patient volume significantly


Bonus: Get the Ultimate 13-Point Checklist To Increase Patient Volume. These 13 simple actionable steps will help your practice steadily increase patient volume.

There are several ways to attract and keep patients:

a) Publish online – It doesn’t have to be in a journal but could also simply be on your own website. It lets patients know how you think about different treatments. Patients would love to read case studies about other patients you might’ve seen. Several patients conduct at least basic online search before visiting a doctor or an ambulatory surgery center. What does your web presence (not just your website) reveal about you?

b) Bring a certain focus to your Center – e.g. a specialty differentiation. To attract higher quality patients, it’ll be good to focus on a specific area within your specialty. One ambulatory surgery center focuses on the highest volume of lower gastroenterology cases it does. Another focuses on EUS/ ERCP procedures. Yet another focuses on removing large polyps. It becomes easier to be known for 1 or 2 key things than be all things for all people.

c) Share your medical records with your patients just as you would with referring doctors – What if we trusted our patients more with medical information? Patients will appreciate what you did for them if they receive and see their own medical records. It also encourages 2-way communication.

d) Monitor health of patients using vitals that are out of range (e.g. very high BMI) and have your office give them a call to check on them. This reverses the scheduling process. You can also track when patients turn 50 and invite them for a colonoscopy (if you are GI-based center).

e) Use technology to standout. Encourage or give away remote monitoring equipment (e.g. to measure insulin, asthma, BP and so on) to select patients, capture their data regularly into their medical record and communicate proactively with them. Technology-enable your center from check-in to check-out and make the flow easy. They will talk to their families and friends about this.

All the above suggestions would make the ambulatory surgery center or medical practice standout amongst its patients – referrals usually follow.

A more interesting question however is to ask yourself if you simply want to increase patient volume for its own sake or increase it in a way that would increase reimbursements but not dramatically increase costs/ time spent. More on that topic in another post.

Bonus: Get the Ultimate 13-Point Checklist To Increase Patient Volume. These 13 simple actionable steps will help your practice steadily increase patient volume.

By Praveen Suthrum, President & Co-Founder, NextServices

09 Apr 2016

Lessons from Aravind Eye Hospital for Surgery Centers


Aravind Eye Hospital is a popular case study among business schools. After being encouraged by a friend, I saw this video of Pavi Mehta who studied the hospital’s model and wrote a book (called Infinite Vision). It reminded me of the MBA case study and made me think about how ambulatory surgery centers could use the ideas presented. Aravind performs the largest number of cataract operations at the lowest costs but at the highest levels of quality. Each doctor in the hospital performs on 2,000 cataracts/ year v/s an average of 200 cataracts/ year in the US. Here’s a summary of the book:

When a crippling disease shattered his lifelong ambition, Dr. Venkataswamy (better known as Dr. V) chose an impossible new dream: to cure the world of blindness. The tiny clinic he founded in India defied conventional business logic and is now the largest provider of eye care on the planet. At Aravind, patients choose whether to pay or not. Millions are treated for free, yet the organization remains stunningly self-reliant. Serving everyone from penniless farmers to the president, it delivers world-class outcomes at a hundredth of what similar services cost providers in advanced nations. Its model is emulated by organizations everywhere from Rwanda to San Francisco.

In several ways, it largely performs the largest number of outpatient surgeries by using 3 creative constraints set forth by its founder:

1) We can’t turn anyone away

2) We can’t compromise quality

3) We must be self-reliant

In an environment of universal coverage, increasing malpractice liability, and reimbursement cuts, all these three creative constraints  apply to ambulatory surgery centers (ASCs). How would a center run high volume operations, keep capacity utilization high, not build a business model that relies on getting paid by low or delayed or difficult insurance plans but yet standout in its quality? Unimaginable? Watch the video.

By Praveen Suthrum, President & Co-Founder, NextServices

09 Apr 2016

Growth happens exponentially, not linearly


I was at a University of Michigan alumni gathering last night. While catching up with fellow-entrepreneurs and their businesses, our conversation centered around growth of businesses and how it occurs. As kids, we are taught to count one by one in a linear fashion and that type of thinking continues into our work lives. But our minds don’t function linearly (neurons multiply), our bodies don’t grow linearly (cells multiply) and neither do businesses (customers multiply) – growth happens exponentially. One becomes two becomes four becomes eight becomes sixteen becomes sixty four becomes one hundred and twenty eight and so on. That’s how ideas propagate. That’s how even money grows – it compounds. When we build a system or a product, it has to assume this exponentiality in its development. As entrepreneurs, we must be capable of visualizing volumes based on exponential growth. We must actively shed linear thinking.

By Praveen Suthrum, President & Co-Founder, NextServices

09 Apr 2016

Handling the never-ending task list


There’s always so much to do. I wonder if this is a sign of contemporary work life or if it has always been the case. I suspect it’s a new age thing. There are more books on productivity now than there have ever been before. Deluge of technology at work and home somehow con us into thinking of ourselves as supermen and superwomen capable of doing everything. The reality is we simply can’t – even with the best of smart devices, we will not be able to do all that we think we can.

As business owners and administrators, we often find ourselves with a never-ending task list. I tend open a ‘note’ on Evernote and write lists under several buckets – operations, finance, sales, marketing, HR and so on. I tend to name this note amusingly as “Stuff in my head.” When I look back at my notes and lists over time, I find that I’ve done some and I’ve ignored some. I’ve been able to solve some problems and I painfully continue to leave some open. I find that some tasks become irrelevant. What works for me is the following – to clearly know what’s important to me and the business at this point in time. To rephrase, I ask myself the question: knowing everything I know, what is the most important thing I must do today. And I get around simply doing it. The task list becomes simply a channel to brainstorm and identify everything that needs thoughts and decisions. While at the task at hand, I have the itch to do other tasks to escape from the longer, important one but I ignore that craving. I remind myself that nothing else might matter if this is not addressed – because it’s important to me today.

But the small, seemingly unimportant items do add up. I tend to spread these out and complete them when I need a distraction or a change or a pause. However, when I give these tasks attention and focus, somehow they become interesting too. So may be it’s all in my mind.

The biggest thing I’ve learnt while completing anything to my satisfaction has been to do only one thing at a time. Not multi-tasking but single-tasking. It causes less stress because I’m not really worried about getting to the next task or handling 2-3 things at a time. Somehow the quality of my work improves because it gets the attention it deserves. I don’t worry about time – sometimes I give myself less time but I don’t particularly clock time around a task. I simply do it until it feels complete.

09 Apr 2016

Tackling ever growing ASC costs


The Healthcare reform is pushing healthcare organizations to follow a more quality based reimbursement model vs. quantity based. It’s imperative that being in the business of serving patients, the quality of care carries supreme importance. While every center wants to provide quality services, there are aspects by which quality may sometimes be compromised – increasing patient volume, lack of resources, the time spent behind each patient visit. It’s the need of the hour for centers to do things differently and here are some thoughts.

Build a lean organization. Go back to the drawing board and lay down your entire operations. Map the number of resources associated with each process and outline their responsibilities. This exercise will give you clarity on everyday resource utilization. You will get answers to questions such as – do we actually need four full time resources at the front-desk? Can the process be managed with just two?

Identify the gaps. The operations outline exercise will also help you identify process gaps within your surgery center. Say a patient comes to the surgery center for a particular visit, simulate the entire visit from the time patient registers an appointment to the time the claim is billed and note down the gaps in the process. The gaps can be pre-visit related like prior eligibility and authorizations, or during a visit like wait times, transfer from one room to the other, or can also be post-visit like same day claims submission, patient resources and medications. Fix the gaps to build an optimized operational flow.

Use technology where possible. The main advantage of using technology is it frees up time and resources which could have been used to do more meaningful tasks. Consider your billing for instance, how many resources have you allocated? Are they coding, proofreading, submitting your claims daily? Is simply submitting claims challenging enough for their capabilities? Ambulatory surgery centers should evaluate the possibilities of automating aspects of their revenue cycle management. Whether, collaborating with companies that provide automated services or building a software system in-house, technology can be used to remove redundancy.

Track and measure from every aspect. While there is a significant need for surgery centers to change the way they function, it is equally important to measure and track each aspect of the business. How has the center performed this quarter compared to previous quarters? How have the reimbursements changed? What contributed to the fluctuations in the reimbursement model? How effective is the inventory management? Surgery centers and business owners need to have a centralized way to measure progress across different metrics. They can invest in software systems that can crunch essential numbers automatically and provide executable insights.

Once you’ve built a lean organization, optimized your operations, have leveraged technology and start tracking every aspect, you have more time for your patients. The quality of focus on patients is to a greater degree with the operational bottlenecks out of the way. The process cannot be changed overnight, but once that is done it becomes a self sustaining model. Cost reduces, patients are happy and the center operates more seamlessly.

09 Apr 2016

How did the frog make it to the mountaintop?


My dad frequently forwards some amusing emails. Today I got an email about a group of frogs that were given the challenge of climbing a mountain. Once they started climbing, several of them started realizing how difficult the task was. Some got scared. Some complained. Some said this was stupid. Some fought with the others. Some kept saying that this was an impossible task and they shouldn’t have agreed to climb this daunting mountain in the first place.

Slowly, one by one all the frogs stopped hopping – except one. He made it to the mountaintop. After he got back, everyone pounced him and asked him how was he able to climb this challenging mountain when none of the others could. At first he didn’t respond. Then he saw that the other frogs were trying to talk to him, he indicated that they wait, took out his headphones and said, “Sorry, what did you say?”

The moral of the story is to ignore negative thoughts and focus on the positive. If we don’t hear about others’ complaints or fears or are oblivious to them, we simply may be more positive about everything we do. I could relate to this story – whether it’s about climbing mountains or running a business, what I think about a task seems to matter more than the task itself. Last month, I climbed Mount Kilimanjaro, the highest point in Africa and if there’s one thing that mattered more than the body or its capabilities – it was my state of mind.

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