MGMA's 'Successful Medical Groups'

Attention to the details of population health management, patient experience, and accounts receivable can a transform a troubled medical group into a high-performing one.

That's the experience of administrators from three medical practices designated as "successful medical groups" by the Medical Group Management Association (MGMA), who were part of a presentation at the organization's 2016 Annual Conference in San Francisco, Calif.

"If I can [solve problems], any of you can do [the same], because trust me, I have my challenges," said Alicia Vaughn, practice manager of Dawson Pediatrics in Dawsonville, Ga. Vaughn's practice struggles with low reimbursement provided by Medicaid, which covers 64 percent of its patients.

When Vaughn started as practice manager, Dawson was being audited by CMS for not complying with EHR requirements and other discrepancies. The person in charge of billing had no experience with billing. Vaughn paid for the billing person to attend coding school. And, she explored the alternatives to fee-for-service reimbursement that CMS was offering, finally settling on the Patient-Centered Medical Home (PCMH) model.

This approach fit into the work she did on improving the practice's EHR system; Vaughn found she could take some of the documentation burden off the practice's providers and also identify patients in need of more care.

The practice began to call patients in more frequently for wellness visits, identifying those whose chronic diseases were not under good control. For example, if a patient called to request an albuterol rescue inhaler this might suggest his asthma was not well managed, so the practice would schedule an appointment with the patient.

The practice also increased routine screening for conditions such as lead poisoning and tuberculosis. "We are projecting in one year a little over $200,000 increased revenue," Vaughn concluded.

For Jennifer Souders, practice administrator of Hilltop Family Physicians in Parker, Colo., the key to success has been improving the patient experience.

When she came to the practice 17 years ago, a patient who called in with a sore throat would be scheduled for an appointment later in the week. "That's not OK," she said. "If you're sick, you need to be seen that day." Hilltop now reserves half of every day for same-day appointments.

Next, Souders analyzed every step of the patient visit, from the front desk to checkout, making sure that the staff was on top of details such as collecting the right payer information.

The practice has streamlined its patient satisfaction surveys to just six questions, and is getting high marks on all of them. It keeps track of which payer is associated with the patient filling out the survey. "We can go to a payer with this, and maybe get our payments increased," Souders said.

Michael Shadley, practice administrator of Illinois Gastroenterology Institute, in Peoria, Ill., focused on making sure his practice gets properly reimbursed for each patient visit. The process starts with carefully tracking details about each patient's insurance coverage and details of each visit. Illinois Gastroenterology Institute collects copayments before the patient sees the doctor. "They pay a lot better on the front side than on the back side," Shadley said.

The practice will accept payment installments as small as $50, but only if patients agree to have the money automatically deducted from their bank accounts by a collection agency. "The people who aren't paying you are taking up spots from people who are willing," he said.