Cost per RVU (that’s relative value unit) can be determined by dividing total practice expenses by total RVUs, yielding a number that can be compared annually as an indicator of a practice’s performance. If you didn’t know that, you are not alone. Neurosurgical residency programs do a great job of teaching how to diagnose and operate, but they typically do a poor job of preparing residents for the practical aspects of managing a neurosurgical practice, which in reality is a small business. This article offers some basics of practice management for the new-to-practice neurosurgeon, with focus on four primary areas: compliance, billing, office management, and patient relations.
With the passage of the Health Insurance Portability and Accountability Act, ensuring compliance is one of the most important functions of an office manager. In addition to HIPAA, there are federal, state, and local regulations regarding the flow of information between patients and doctors, doctors and doctors, and doctors and the insurance carriers (including government payers). Medicare regulations generally are followed by most insurance plans, but specifics for a particular region can be found by accessing the Web site of the regional Medicare intermediary. For example, Trailblazers is the intermediary responsible for handling all Medicare claims in Baltimore.
The most visible aspect of HIPAA in an office setting relates to patient privacy. In general, relating more than one unique piece of identifying information should be avoided. For example, patients may be identified by name, but not also with their doctor’s name or diagnosis. Release of patient information is allowed to referring physicians only; all others must have patient consent. Use of patient information for research must also be approved; one strategy is to have patients sign a consent form at initial consultation that allows their information to be used for research purposes.
Knowing how to code a surgical procedure properly is important for every neurosurgeon because even when someone else handles coding, the neurosurgeon is responsible for the accuracy of submitted bills. All residents should attend a billing course such as those offered by the AANS before starting practice. The most common Current Procedural Terminology codes, which describe the operation, and ICD-9 codes, which provide the diagnosis or the symptoms, should be learned. Medicare publishes quarterly updates that detail which codes may be added on (for more reimbursement) and when “unbundling” — breaking down a procedure into smaller parts for greater reimbursement — is disallowed. An average practice of five neurosurgeons performing 1,400 cases and seeing patients in 6,000 office visits per year will need two coders and two collectors. At least one of the coders should be certified, a process that requires at least two years’ experience and annual recertification.
A medium-to-large practice will need a practice manager. A bachelor’s degree is a minimum requirement, and often this person will have an MBA or other master’s degree, or other appropriate credentials such as a CPA. A practice manager’s responsibilities include hiring and evaluating staff, promotions, preparing the budget and payroll, cash management, and maintaining supplies. The practice manager as well as coders and collectors should be included in a practice’s incentive program to reward them for going the extra mile.
Patient satisfaction is the ultimate goal of a neurosurgical practice. An office management axiom is “A happy patient tells one person, but a dissatisfied patient tells 13 people.” Find out what the patients think; send out surveys, and make sure that the practice’s phones are answered by a live person. Listen to patients’ concerns and respond to them quickly.
Probably the best advice is to avoid micromanaging the practice. Let the practice manager handle the details, but know what he or she is doing because ultimately the neurosurgeon is responsible.
Resources for the Real World
In acknowledgement of the complex practice environment faced by today’s neurosurgical residents, resources that better prepare residents for the transition are under development. At least one training program, the Medical College of Georgia in Augusta, requires a Web-based course that acquaints its residents with basics of practice management. The AANS recently offered the course Neurosurgery in the Real World, which covered coding and reimbursement, government regulations, contract negotiations, practice development and professional liability. In addition, print resources such as Starting a Medical Practice and Managing the Medical Practice are available from the AANS Online Marketplace, www.AANS.org.
Perhaps the greatest resource for neurosurgeons entering practice is the AANS Young Neurosurgeons Committee. The YNC provides information at www.AANS.org Young Neurosurgeons and develops programs like the Real World course that respond to the needs of early career neurosurgeons while opening the door to involvement in the AANS.
Lawrence S. Chin, MD, is chair of the Department of Neurosurgery at Boston University School of Medicine and chair of the AANS Young Neurosurgeons Committee. Gloria Jones, office manager at University of Maryland Neurosurgical Associates, contributed to this article.