Jennifer Dunaway, COO and Practice Administrator at Seven Hills Women's Health Centers talks about how the recession has affected her business.
-How has the recession affected your practice and they way you do business?
Specialists in OBG have long understood the implications of shifts in household income irrespective of the broader economy. Adults of child-bearing age have, generally speaking, not yet hit peak earning strides. This reality, coupled with the cost of child care and other expenses associated with child rearing and/or lost income due to one or both parents scaling back to be home with children, has long impacted the business practices of the specialty.
These static realities are re-framed within the context of the recent recession and the proliferation of high deductible health plans. Seven Hills Women's Health Centers is spending more time and resources educating patients regarding their individual healthcare benefits (with increased OOP for patients) and explaining the patient financial responsibility.
With respect to internal business operations, the challenge of the economy and the complexity of the industry have precipitated the need to automate as many processes as possible. This has resulted in technological upgrades and some outsourcing, which includes electronic benefits verification, automated telephone reminder systems, third party billing as an interim measure that falls between practice-generated statements and collection agencies.
All of these measures have been installed in an attempt to capture real time data and communicate the information necessary to facilitate collections from patients. While financial policies remain unchanged, they are becoming more difficult to enforce. Our industry, and particularly this specialty, is one that is relationship-centered. Financial transactions have historically been, and continue to be perceived as, secondary (rather than coincidental) to the patient/physician relationship. Furthermore, risk management issues abound. Even in the instance of absolute financial non-compliance it is often imprudent (even unthinkable) for an obstetrician to terminate or discontinue obstetric care. Therefore, some services continue to be delivered when the prospects of being compensated for care have been grossly diminished.
On the healthcare consumer side of the equation, patients are postponing having children and elective procedures due to, presumably, both the recession and the higher expenses patients are required to absorb for their own healthcare. Therefore, patient volume has decreased. Additionally many women who are or become pregnant and who were once insured in the private sector have migrated to state Medicaid coverage due to income loss. While these patients are retained, Medicaid provides the lowest level of reimbursement in the payer market.
To assist our patients with out-of-pocket expenses, we are redirecting some minimally invasive procedures back to our offices.
-What financial action did you take?
Work force has been realigned to practice needs. Many vendor contracts have been renegotiated. Payroll is being maintained at budget neutral for non-physician personnel and all physician compensation has been decreased.
-What kinds of difficulties do you expect to face in 2010/2011?
All multiples of the same as outlined above, including telescopic projection of AR due to higher deductibles and lower levels of household income.
-With regard to financial incentives for EHR use, do you have meaningful use requirements on your radar?
Seven Hills Women's Health Centers has operated in a fully implemented EHR environment for years. It will be difficult to qualify for the ARRA funding with our patient demographic mix.
-What are your next steps?
We will run analytics and determine whether there is expense offset opportunity.