Name: The NeuroMedical Center (NMC)
Location: Baton Rouge, Louisiana
Services provided: Our services include adult and pediatric neurosurgery and neurology, neuro-oncology, clinical and interventional neuroradiology, physiatry, clinical psychology and neuropsychology.
Number of doctors on staff: 26
Staff Structure
The Clinic is one of the few private practice, multidisciplinary, neuroscience groups of its size in the country. The Neurosurgical Department includes areas of general neurological surgery, as well as subspecialty areas of cerebrovascular surgery, complex spine surgery, radiosurgery and pain surgery. The members of the Neurology Department subspecialize in movement disorders, epilepsy and sleep disorders, in addition to providing general adult and pediatric neurology coverage. Neurophysiological testing and ultrasound are based within the Neurology Department and the Department of Physical Medicine and Rehabilitation.
The NMC employs 130 support personnel, in addition to medical staff. All processes, from appointment scheduling to billing, address the importance of efficiency and reimbursement for the services that the NMC provides. Additionally, the Clinic utilizes eight physician extenders, which allow for the most efficient utilization of our doctors’ time.
Back office management strategies
To accommodate the disparate earning capabilities of the various specialties within the Clinic and to control expenses, the NMC utilizes departmental cost accounting and functions day-to-day within the structure of an operating budget. Expenses and revenue are projected annually through a budgeting process, and the budget is reviewed quarterly to ascertain clinic profitability. Overall, this allows each department some autonomy in the budgeting process while controlling general and administrative expenses.
Within each department there also is a formula for calculating production-based revenue and shared revenue, thereby resulting in ample incentive to be productive, while encouraging participation in non-surgical patient care activity.
Biggest investment in recent years
Over the last year, the NMC established an in-house imaging center, requiring the largest capital commitment in recent years. It is successful because of a combination of quality service, competitive pricing and success in negotiating contracts with all of the MCO’s. Our in-house imaging services include magnetic resonance imaging, computed tomography, and fluoroscopic imaging. We perform myelography in-house, as well as a large number of ancillary procedures, such as epidural steroid injections and other fluoroscopic-guided invasive procedures.
We are currently in the process of designing specifications for an integrated business and electronic medical record data processing system that will record clinical information for studying outcomes, and other data bases essential for contract negotiation. This process is expected to culminate in a sizeable capital commitment.
Advice to young neurosurgeons
To provide excellent patient care and receive adequate compensation for doing so, we must recognize that there is an ongoing revolution in the manner in which physicians and specialty surgeons practice. The playing field changes annually, but several things are apparent. First, the pinnacle of patient acceptance of managed care has passed. Second, business and industry – the ultimate “payors” for the majority of medical services – are attempting to find a better way to ensure that employees are given better service more cost-effectively. In fact, many businesses are putting patient satisfaction above or equal to cost. The romance with managed care has chilled considerably.
Challenges of the future
Neurological surgeons will soon face significant reductions in reimbursement. We can’t continue to see more patients and do more surgery, while chasing the reimburrsement rainbow. One possible solution is to structure our practices to capture more revenue from services not related to direct patient care. This means closely assessing business opportunities that have traditionally been left to others and including in-house imaging into our practice. This will capture revenue and, at the same time, improve the quality of patient care. Group practices such as the NMC are well equipped to participate in this new paradigm.
Closing thoughts
The argument is frequently made that a multidisciplinary group practice, such as the NMC, carries with it a higher “overhead” than a single specialty group or solo practice. That is quite true. However, one must balance this against the staying power in today’s practice environment when engaging in this debate.
Thomas B. Flynn, MD, is President & Managing Partner of the NeuroMedical Center and an Active member of the AANS since 1971.