Strategic plan helps retina practice move forward

Key Points

Editor's Note: Retina practices have experienced a transformation over the past several years, and our group practice was no different.

My partners-Bill Tasman, MD, Bill Benson, MD, Gary Brown, MD, Arch McNamara, MD, Jim Vander, MD, Carl Regillo, MD, Mitch Fineman, MD, Rick Kaiser, MD-and I increased our patient volume to accommodate new treatments such as frequent intravitreal injections of ranibizumab and bevacizumab, added new office locations, and also realized that we needed to update many of our practice systems and operations. Our "mom-and-pop" organization had grown to include 60 employees across two states, with seven office locations.

We started by calling a practice retreat where we could refine our practice mission and core values. Next we focused on the systems and tools that would allow us to provide the best patient care and provide the best working environment for our staff and physicians.

-Allen C. Ho, MD

Amid adding partners, opening new offices, and managing unprecedented growth, Mid Atlantic Retina turned to Advantage Administration Inc. to develop a strategic plan for the ensuing years.

After the strategic-planning retreat, Advantage implemented several of the identified opportunities: billing office redesign, information technology improvements, and a pay-for-performance program to increase staff productivity.

Billing office redesign

As a result of adding doctors and new locations throughout the preceding years, Mid Atlantic Retina's understaffed billing office was performing below industry benchmarks in the collection of insurance and patient receivables. The proper steps for billing of services rendered were not being adhered to on a regular and consistent basis, and significant accounts receivables were being written off due to untimely filing deadlines.

Because of space limitations, Advantage first made recommendations for space planning changes resulting in the ability to accommodate additional work stations. Once the business office was staffed properly according to national standards, Advantage trained each employee on newly reassigned job functions and improved the processes and procedures to ensure timely filing and collection of all claims.

Protocols were immediately set in place with a goal of ensuring that all claims were filed daily, that payments were posted within 48 hours, and that all rejected EOBs (explanations of benefits) were corrected and resubmitted with 72 hours. While working on process improvement to ensure timely filing of forthcoming claims, Advantage also reorganized the roles and responsibilities of collecting outstanding accounts receivable.

Information technology improvement

Due to an antiquated practice management system, each additional office location required its own database, meaning that any additional information had to be added to each of the five different databases as opposed to making a single entry. Additionally, an EOB could not be posted to one database, because there were payments for multiple locations on one check, which required the billing staff to locate each patient in one of the five databases to post the payments.