Real dollars and sense: Use of an OPA-C in a clinical practice
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Jason Mazza |
In my April column, I wrote about the value of an orthopedic physicians assistant in a surgical practice. Much of what I presented defined the qualitative value that an orthopedic physicians assistant can bring to a practice. In light of the continued changes we are experiencing in health care, and more specifically within our specialty of orthopedics, many practices are looking at restructuring and restrategizing hiring policies of clinical staff and allied health professionals.
Reducing costs of health care will remain one of the primary objectives going forward. Most agree that reimbursement will continue to decrease. There are concerns that we will need to see more patients who enter into the system during the next few years while, at the same time, use less resources. Our population is aging. Demographic trends show that the number of patients 65 years and older, which currently amount to one in every eight Americans, will nearly double within the next 15 years to 20 years. The population is not only getting older, but living longer. This will result in increasing trends in low bone mass and osteoporosis. Increased rates of certain fractures and more chronic musculoskeletal disease management will result in the practicing orthopedist needing more time to care for these patients. Orthopedists do and will need specialty trained assistants, not generalists to help manage the care of these patients clinically and surgically. Orthopedic practices will need to become more efficient than ever to serve our patients needs and to help their business models grow.
Changes in the way that medicine is practiced will challenge orthopedic surgeons in a number of areas including: refining the use electronic medical records, understanding meaningful use, ongoing procedural coding changes, ICD-10 implementation and proving clinically that some treatments are medically necessary. Developing streamlined workflow and staffing patterns will be a key component in creating an efficient orthopedic practice to overcome these new challenges.
There are many reasons to hire an orthopedic physicians assistant (OPA) in this regard. I have previously presented the OPA as an allied health professional who is specialty trained to assist in the complete care of the orthopedic patient. The primary role of the OPA in a clinical setting is to assist the surgeon with patient management from the beginning to the end of the encounter. Patients want access to their physician, and they want a quality experience. I think that most would agree, patients are happier when they see their own surgeon. Using a well-trained and motivated OPA can help balance the workload of the supervising surgeon while improving access to care, efficiency and offering effective patient care. This collaboration also keeps practice liability to a minimum and patient satisfaction high.
It should be clear that the role of an OPA is a supportive and delegatory one to the surgeon, and not one of autonomous practice. In a well-structured practice, the OPA is often the first person with whom the patient interacts. OPAs bring a level of knowledge that allows for a thorough establishment of the patients history and identification of potential risk factors. This information is communicated to the surgeon who then has a relatively good understanding of the patients problem prior to entering into the exam room. This can help expedite the surgeons medical decision making and allow for development of the treatment plan. Putting this information into a well-documented office note, coding the visit, arranging for ancillary services and making sure all of the patients concerns are covered can then be managed by the OPA. Having an assistant who works in all settings with his or her surgeon allows that person to be well-versed at providing in-depth patient education. This frees the supervising surgeon to allow for more time to be spent with complex cases.
Creating a quality experience
Our patients today demand a quality experience. Research has shown that many have reviewed information about a physician or practice online through websites, blogs and previous patients comments before setting foot in a surgeons office. Giving the patient easy access, communicating with them and providing them with a great customer service experience is necessary to gain further referrals from the patient and from primary care physicians.
Using an OPA to the fullest to have a well-structured clinical experience for the patient, in which there are not duplicate services performed between clinical staff members and the surgeon, is one key for building a efficient and effective practice. Appropriate patient follow-up is another. Who better to maintain frequent contact with surgical patients who have been discharged from the hospital or surgery setting until the arranged follow-up visit than the person who assisted with patients care preoperatively and in the operating room? This should be part of the OPAs routine role.
By providing this mechanism, the patient can discuss any concerns or problems via phone or email with the OPA, and many early postoperative issues can be addressed sooner to possibly prevent larger problems later. The OPA documents and reports all of this information back to the supervising surgeon in a timely manner to allow for potential changes in the treatment protocol. The surgeon is able to maintain control over the patients care, while at the same time, by reaching out to the patient, shows a greater degree of empathy and communication.
Potential benefits
These are just a few examples of how an OPA can fit into a clinical practice to help enhance the patient experience. In this age of foreseeable declining Medicare reimbursement, the biggest questions raised are how to justify the salary of an OPA and what are the financial implications to an orthopedic practice? To answer these, I have set up a real-world quantitative example to show the potential benefits of hiring an OPA.
Heres an example:
An orthopedic surgeon in group or solo practice who see patients 3 days per week with an 8-hour workday, sees approximately five patients per hour (40 patients per day) using medical assistants, nurses, orthopedic techs or X-ray techs to assist with patient care.
The addition of an experienced OPA can improve practice efficiency by 30% by eliminating the need for several other full-time employees (FTEs). The surgeon, OPA and X-ray tech can assist with patient care. Under this model, the surgeon will see an extra 1.5 patients per hour or 12 more patients per day.
Calculation of additional revenue to surgeon or practice:
Using 2011 Medicare E/M coding guidelines and reimbursement rates:
Addition of 12 patients per day seen stratified by visit type:
Three new patient visits (Comprehensive - 99204) x $157.99 allowable = $473.97
Three new patient visits (Detailed - 99203) x $101.28 = $303.84
Three established visits (Moderate - 99214) x $100.53 = $301.59
Three established visits (Expanded - 99213) x $67.20 = $201.60
Additional revenues per day: $1,281
Additional revenues per week: $3,843
Assuming 46 weeks per year of clinic: $176,778 in additional revenues (potential).
Taking into account liability insurance, professional association, continuing medical education and salary of the OPA, the potential net gain to a practice approaches $100,000 from direct patient visits. This may be a conservative estimate. This does not take into account additional revenue streams from collection of surgical assistant fees and reimbursement collected from a well-managed DME/bracing program that an OPA can administer.
There is great diversity from one orthopedic practice to the next. The common thread among all is that we are here to take care of the patient. An OPA is a well-trained allied health specialist who can help build and maintain a productive orthopedic practice using some of the concepts I have discussed. The example I have provided shows the potential revenues to a practice from adding an OPA. Some will argue that they do not wish to see more patients than they already do. As each practice differs in its needs and structure, an OPA may not be right for some. Practice restructuring is on the rise in response to changes we are beginning to feel. Redefining the role of key clinical personnel and the manner in which we provide care is a large part of this. Practices that become the most productive provide efficient and effective patient care at low cost and will be the ones who will come out on top as reimbursement continues to shrink. Restructuring, while painful, may be a necessary evil.
- Jason Mazza, MSc, OPA-C, CSA, SA-C, OTC, CCRC, is the immediate past president of the American Society of Orthopaedic Physician Assistants. Please direct all comments and questions to orthoopa@mindspring.com.