There are many components to operating an independent Pediatric Medical Practice. The core function of Pediatric practices is managing patients effectively for their well being. Decades ago, the Healthcare market was a simpler design – a Medical practice developed a fee schedule and charged patients based on the fee schedule for procedures and/or time with the physician. Employers in the United States became the primary payer for Healthcare (partially due to US tax law that categorized payment for Health Insurance for employees as a business expense). In the 1950s, employers maintain wages while adding in Health insurance. The Health insurance originally paid a reasonable and customary reimbursement for physician offices (usually the patient paid and was reimbursed by the insurance company). As the population increased, the Healthcare treatments became more complex and costly and the employer was pushing back on the insurance company for their fees, Insurance companies created new products such as direct payment to medical offices, contracts and Health Maintenance Organizations (HMOs) with capitated fees. The insurance company tried to cover the new treatments while pushing to maintain or lower costs in other areas of their cost structure. Their organizations pay for lobbyist to change the policy and the law. This includes helping to create and expand the non-physician providers (Nurse Practitioners, Physician Assistants). Additionally, payers are continuing to implement value based payment models. With this continuous change in the market, what does the independent practice owner need to evaluate/benchmark related to their Pediatric Practice? Recommend reading our blog article titled “Is Your Pediatric Practice Making a Profit?” for a list of benchmarks as well as consider other factors.
No time to identify assemble the data, analyze the information and develop benchmarking reports? No worries…we will provide this to your practice leaders during an annual Business Review. Our goal with these annual business review is to review your practice performance from a revenue perspective versus industry benchmarks. We will provide a few suggestions ideas on how to enhance your Pediatric practice for your use. Additionally, during this annual review we will make suggestions to your current fee schedule (increases/changes) and discuss patient/insurance collection rate and policies.