This week I want to spend a few minutes discussing some end-of the year practice analysis 'stuff'. I ran my practice numbers for 2013 and I would like to share a few things with you. I may devote several newsletters to this but here is some of the information.
Our practice consists of me (MD) and 2 nurse practitioners. We all work 4 days per week in the outpatient setting. I also see inpatient pediatrics. That being said, here are a few statistics for the entire practice:
80% of the profit generated was from office visits (99201-99215, 99381-99397) 20% of profit was from other things (procedures, immunizations, CLIA-waived labs, etc.) All 3 of us earned within about 8% of each other (total profit for the year)
But let me compare the top earner vs. the bottom earner with a couple interesting statistics:
Provider A saw 3787 office visits with an average profit of $81.70 per visit. Provider B saw 4797 office visits with an average profit of $72.16 per visit. Provider C saw 4282 office visits with an average profit of $74.41 per visit.
That means if Provider B could get their collections up to the level of provider A, that would net the practice an increase of $45,763 (additional $9.54 per visit multiplied by 4797 visits). If both provider B and C increased their billing to match that of provider A, without seeing any additional patients, that would provide the clinic an additional $76,979!
So where do the differences lie? I have to account for a difference of $9.54 between provider A and B. Where is it? The only way to know is through analyzing the codes for the last year. Let me show you what I found:
| Provider A | Provider B | |
|---|---|---|
| # office Visits: | 3202 | 3942 |
| Collections: | $204,701 | $223,581 |
| # Health Maint Visits: | 585 | 855 |
| Collections: | $47,362 | $64,476 |
| # immunizations: | 1284 | 1616 |
| Profit: | $29,512 | $27,920 |
| # lab: | 861 | 1318 |
| Profit: | $13,144 | $18,539 |
| # procedures: | 866 | 1028 |
| Profit: | $14,680 | $11,620 |
| Total visits: | 3787 | 4797 |
| Total profit/visit: | $81.70 | $72.16 |
First thing I look at is office visits (99201 to 99215). I did not provide the data to you but here is the summary. Their average reimbursement per office visit was $63.93 (A) vs. $56.72 (B). This is a difference of $7.21 or 75% of the discrepancy between the two providers. So this is very important to figure out!
Provider A billed for approximately 51% 99214s vs. Provider B was 49%. To me that is equivalent. So the difference is not related to the coding 'distribution curve.'
Provider A billed approximately 7.5% new patients. Provider B saw 3.9% new patients. Further analysis shows that Provider B saw a slightly higher percentage of Medicaid patients vs. Provider A seeing slightly more Insured patients. In my view, neither of these variables (# of new patients or type of insurance) are in any way under the control of the provider. Depending on how you look at it, this is a good thing. This means that 75% of what we considered 'lost money' is not lost at all. It is just simply reflective of the patterns of our practice. It means we have systems in place that are working and accurately capturing appropriate revenue.
Now let's take and divide out the remaining numbers to see what we get:
| Provider A | Provider B | |
|---|---|---|
| Total visits: | 3787 | 4797 |
| # immunizations/visit | 0.34 | 0.34 |
| Profit/visit | $7.79 | $5.82 |
| # lab/visit | 0.21 | 0.27 |
| Profit/visit | $3.47 | $3.86 |
| # procedures/visit | 0.22 | 0.21 |
| Profit/visit | $3.88 | $2.42 |
Here are some further interesting statistics: Over thousands of office visits, these two providers gave the exact same rate of immunizations. Wow. But interestingly the rate of reimbursement/profit was higher for Provider A by $1.97. This was found to be due entirely to payer type. Again, not the fault of the provider at all. Provider B actually had more CLIA waived labs done. On analysis it was found that A saw many more chronic/follow-up patients and B saw more sick visits so this made sense. Provider A and B also did about the same number of procedures and again had $1.46 discrepancy. Again this was found to be due to payer distribution.
So the takeaway message for my practice this year is the providers are doing an EXCELLENT job. But I will tell you that overall reimbursement is down compared to previous years. Insurance companies are paying less in our area. I don't have a good fix for that. It just makes it imperative to be sure you are coding as accurately as possible and keeping a close eye on your practice metrics.