Add ancillaries to increase practice income, improve care and retain control

KOHALA COAST, Hawaii — With threatened reductions in reimbursements from the Centers for Medicare & Medicaid, orthopedists should look beyond their practice confines for areas that can improve both patient care and the business bottom line.

For some, looking at their practice as a business may seem unethical or at least undignified. However, Jack M. Bert, MD, practice management section chair at Orthopedics Today Hawaii 2009, here, said having this outlook will be necessary to retain control over the specialty of orthopedics.

“In today’s environment of insurers telling us what we can and cannot do, in my opinion, we must take back the control of medicine by controlling the care that our patients are rendered,” Bert said at the meeting. “This can be done by owning and managing the environments in which health care is delivered. This allows the treating physician to deliver, and the patient to receive, the best care possible.”

Bert, who is also the Orthopedics Today section editor for the Business of Orthopedics coverage, said, “The thought that administrators, politicians and insurers have a better understanding about the delivery of health care than physicians is the greatest myth ever perpetuated in health care.”

Bert’s suggestions for ancillary services that have been proven successful additions to orthopedic practices include: imaging services, ambulatory surgical centers, in-office pharmacies and durable medical equipment (DME).

“In-office MRI is the most profitable ancillary service that you can have,” Bert said. “Even with a standard scanner, you can do very well.”

During his talk, he referred to the certification issues raised by radiology groups and the American Hospital Association to require more expensive 1.5 tesla extremity scanners.

“I believe that it will be very hard for them to disallow extremity scanners,” Bert said, noting that is easy to obtain the current certification level required for these scanners. He also said the data confirm that the smaller scanners are just as accurate as the 1.5 tesla units.

“In-office surgery centers give you more control over your day-to-day activities, better patient care, greater productivity and greater patient satisfaction,” Bert said.

One challenge with establishing ambulatory surgery centers (ASCs) is if your location faces certificate-of-need issues. However, there are ways around these, Bert noted.

There is one advantage to creating an ASC in the next 3 years: CMS has added new codes that increase reimbursements for certain procedures, he added.

“So why wouldn’t you open a surgery center?” he said. “Well, data show that 33% of new ambulatory surgery centers fail.”

To ensure that your ASC has a better chance for success, you have to do market analyses, payer analyses and political analyses, he said.

In-office pharmacies are another option. With in-office pharmacies, orthopedic surgeons can earn the markup on the drugs plus the co-pays.

“In-office DME has been huge for us,” said Bert, whose group sells orthotics, braces, CPM therapy and cooling units.

Reference:
Bert JM. Ancillary Services for the benefit of the patient Imaging centers, ASCs, quick clinics, pharmacy and durable goods. Presented at Orthopedics Today Hawaii 2009. Jan. 11-14, 2009. Kohala Coast, Hawaii.