Group Medical Practice
Logan Primary Care, a group medical practice in Southern Illinois, is an example of how healthcare delivery in the United States is evolving.
The practice started out in 1994 with four doctors and a staff of eight, including one physician assistant, nurses and two administrators. Today the family practice is a full-service health center with nine doctors, four physician assistants, the Logan Park Med Station immediate care area and a laboratory along with a clinical and operational staff of 85.
As Logan Primary Care expanded to more effectively serve the growing population of Herrin, Ill., however, its business operations took a turn for the worse. When representatives from the George S. May International Company approached Tara Deaton, administrator for Logan Primary Care, about a Survey Analysis of Logan's business operations she agreed to meet with them -- although somewhat reluctantly.
"I thought it was just going to be another appointment where I would listen to a proposal and then kindly thank the people for stopping by," says Deaton. "To my surprise the ideas presented caused us to sign on May International immediately."
After a few intensive weeks of working side-by-side with May International management consultants, Logan Primary Care was on the road to recovery with improved morale, increased cash flow, better employee accountability and a solid management team.
"We knew some things needed to be fixed, but without any formal management training we were unsure of how to fix them ourselves," said Deaton. "The practice is now operating more smoothly and we're amazed at how much money we're saving."
Panning For Growth
When Logan Primary Care opened its doors in 1994 it was the only building in the immediate area. But with an eye to the future and a vision of growing the location into a hub for patient-oriented healthcare, the founding physicians laid claim to land adjacent to the clinic. The land now houses a pharmacy with drive-through service and several specialty physician offices. In addition, Logan Primary Care leases office space to a radiology practice so patients don't have to travel for routine x-rays. Additional specialists on staff at the nearby Herrin Hospital also lease space in the building. A satellite office opened in nearby West Frankfort, Ill., to expand medical care in the Franklin County area.
With its comprehensive healthcare offerings, Logan Primary Care is a busy practice. Including patients seen at the satellite office, Logan sees about 300 patients per day. Saturdays are equally as busy, averaging about 55 office visits from 10:00 a.m. to 5:00 p.m. Sunday office hours, introduced in 2004, bring in an additional 35 patients on the weekend.
The majority of office visits are scheduled but Logan also treats walk-ins at its Med Station. "The station gives people an alternative to the emergency room for routine ailments like sore throats, flu symptoms and minor injuries. It's convenient for patients and helps hold down healthcare costs for everyone."
Keeping Up With Change
As Logan Primary Care grew, demands from insurers, payors and regulators were changing the way providers are paid. Collecting payment for services moved beyond the scope of a billing clerk who collects payment from patients and forwards claims to payors. Maintaining a positive cash flow now takes the work of specially trained coders, credit and collections experts, accountants and more.
Unfortunately, Logan's billing operations didn't keep up with the changes. "Our billing was a mess," said Deaton, "but I didn't have the expertise or the time to fix it, and I couldn't be pulled away from my primary responsibilities to learn how."
To help get Logan Primary Care's billing operations under control, one of the first things that May International consultants addressed was the department's procedure for collecting co-payments, out-of-pocket charges and past-due balances. A more timely collection of these payments had the potential to add $87,000 to the bottom line through reduced write-offs for non-collectible balances. Collecting payment at the time of service also reduced paperwork and increased efficiency in the billing department.
As the consultants pointed out, expecting payment at the time of service is no different than preventing customers from walking out of a store with unpaid merchandise or stopping "drive-offs" at a fuel station. "Our primary responsibility is to provide healthcare services," said Deaton, "but we have to make a profit to do so."
To ease the sometimes sensitive practice of demanding payment upfront, May International consultants recommended that patients be reminded of their financial obligation even before stepping foot in the office.
The newly defined process begins when the receptionist or appointment clerk confirms insurance coverage and co-pays at the time an appointment is made. The credit eligibility clerk, a position created expressly for this purpose, verifies insurance coverage before the patient arrives. At the office the receptionist photocopies the insurance card and collects payment before the patient sees the doctor. Any questions or concerns about billing are directed to the credit manager in an area separate from the waiting room. "Patients have been very positive about this process," said Deaton. "They can leave right after their appointments instead of waiting around to take care of paperwork."
May International consultants also worked with Logan to establish job descriptions for each position in the billing department. The new descriptions clearly define responsibilities for each position and eliminate overlapping authority. Logan also established performance measurements to more accurately gauge employee performance. "The billing department is operating more efficiently, and with a greater sense of control and accountability. The changes have been a real boost to morale," said Deaton.
Saving Money, Saving Time
Reconstructing Logan Primary Care's billing practices was a major step in improving cash flow, but the simple logistical change of eliminating multiple entrances, each with separate receptionists and cashiers, saved the practice over $43,000 in labor costs.
Improved operating efficiencies at Logan Primary Care brought about positive changes to the bottom line, but perhaps even more importantly, the changes provided the added benefit of extra time.
May International consultants recommended streamlining the practice's operating committees, each managed by a staff doctor, from nine to two. A weekly "Vital Signs" report, with succinct, targeted information, replaced the daily multi-page documents the doctors had been receiving for years.
"We had a lot to learn when we started working with the May International consultants," said Deaton, "but they were well-organized and experienced in this field and together we have made a lot of positive changes that will enable us to provide even better care for our patients."
