Name of practice: Neurosurgical Associates
Location: Lexington, Kentucky, with off-site clinics in 14 locations throughout Eastern and Central Kentucky
Number of neurosurgeons: Five
Total number of employees: 19 Full-time; six part-time
Number of medical centers served: Four
Approximate number of patients cared for in your practice per week: 400-450
Practice philosophy:
Our practice strives to provide a fullrange of neurosurgical services, with minimal subspecializations; build strong relationships based on responsiveness and accessibility with our referring physicians; and promote team work among our physicians and employees. Our reputation is built on invariable competence, ethical motivation, prompt responsiveness, compassionate concern and unquestioned reliability.
Most innovative back office management solution:
Recently, our back office has improved its efficiency and work flow, and our employees have been instrumental in many of these changes. For example, we assigned a person at the check-in-desk to record all demographic and billing information, saving later calls and delayed billing; we have hired a full-time telephone operator, rather than expecting all employees to interrupt work for incoming calls; and we have assigned two full-time surgery scheduling clerks to handle all requirements for prior authorizations.
Most innovative approach to managing external relationships:
Our most innovative solutions revolve around developing our outside clinics and becoming intimately involved in several local managed care plans,
Currently, we operate 14 rural outreach clinics throughout eastern and central Kentucky. We Add, and occasionally drop clinics as opportunity arises or success dictates. The local contact, goodwill, additional referrals, and convenience for local physicians and patients have given the strategy a perennial place in our practice.
We also have developed a shared savings plan with a regional HMO. Faced with deeper discounting, we are challenged with the option of dropping participation or negotiating an alternative added reimbursement benefiting both parties. Because the health plan wants cost savings, we are negotiating benchmarks, or targets, for overall costs for common conditions treated by neurosurgeons ( or orthopedic spinal surgeons). and comparing the profile of the practice against the regional average costs.
Another way we have addressed managed care is by participating in the organization and governance of a large multi-specialty IPA since 1994, and a Medicaid regional sole source provider-govered HMO product since 1996, and a Medicaid regional sole source provider-governed HMO product since 1996. The intent has been to take a lead in organizing physicians to negotiate with and oversee management of care by large regional managed care organizations
Biggest investment you have made in your practice in recent years:
This year we spent about $80,000 upgrading our office administrative computer software. It will allow us to track referrals, codes, levels of service, charges, receipts, and more. Adding to, or upgrading our computer information system has been, and will continue to be, the largest capital expense component we face.
Future of neurosurgical private practice:
Private practice neurosurgery in a single-specialty group has the advantage of flexibility, adaptability and freedom of action. Solo surgeons cannot share fixed overhead or services, share call, patient care or experience, access expert assistance, or arrange free time as easily. Large multi-specialty groups use specialty revenues to subsidize primary care, general care, general overhead and business expansions; subordinate practice decisions and financing to whole group budget constraints; and take daily management decisions away from those if affects the most. Academic practices face growing future problems of reduced residency and research funding, reduced Medicare payments, exclusive contracting restrictions, and deeper competitive fee discounts, all of which means money taken out of clinical revenues and income. Private single-specialty practice has its own financial challenges, but it is the best arrangement for adapting to rapid environmental change.
Closing thoughts:
Your neurosurgical practice should reflect your beliefs, ambitions, talents, ethics, and personality. It should provide the security, opportunity, and support you need to achieve your personal goals and meet your public responsibilities.
Each member of this practice is afforded the opportunity to achieve any and every personal and professional goal desired, and those goals vary widely. Within the practice we have examples of success in academic medical research, medical organization leadership, cutting-edge neurosurgical innovation, public policy influence, regional and national medical politics, and personal publications. The culture, design, flexibility, and management of the practice permit and encourage both practice success and personal fulfillment.
This is the second in a series of profiles that highlight an AANS member and his or her innovative practice-building techniques.