Practice Efficiencies

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Practice Efficiencies

• By Ricky Newton, CPA
• Practice Administrator/Consultant
• Peninsula Cancer Institute T/A Cancer Specialists
  of Tidewater
• [phone]
• Rnewton_at_tidewatercancer.com

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Cancer Specialists of Tidewater

• Actual Collections Rate per year Actual
  Receipts / Actual Charges
• 2003 50.96
• 2004 48.32
• 2005 43.76
• 2006 43.76
• 2007 42.51

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Annual Conversion Factors
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2007
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Lobbying Educating Insurers

• Become involved in supporting (including
  financially) all organizations that lobby on your
  behalf such as Community Oncology Alliance (COA),
  American Society of Clinical Oncology (ASCO),
  Association of Community Cancer Centers (ACCC)
  and your local regional and state societies
• We need to educate Congress, Medicare (CMS), and
  third party payers using data and real examples
  of changes to patient care that have occurred due
  to current reimbursement rates
• We need to fight for payment for what we do and
  not for drugs but we do need to fight to get paid
  for drugs so that our costs are covered on them.
  We lose on too many of them at ASP 6.
• Get your Congressmen and women to support H.R.
  1190 and your senators to support S. 1750. These
  bills push for a fix on early payment discount
  being taken out of the ASP formula since that
  occurs between the distributor and manufacturer
  and not our practices and the distributor. It
  also asks for the creation of treatment planning
  and pharmacy facility fees. We need to get paid
  for what we do like other physicians do and stop
  hoping that third party payers are going to
  supplement our Medicare population.

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Managing Drugs

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Distributors GPOs

• OTN/Onmark
• McKesson/NOA
• Curascripts formerly Priority/Matrix
• Florida Infusion
• Oncology Supply/ION
• OneOncology
• Bellwether Oncology Alliance/Metro
• US Oncology
• Others

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Other Pharmaceutical Contracts Issues

• Sanofi Aventis (Oxaliplatin)
• Abraxis BioScience (Abraxane)
• Ortho Biotech (Procrit)
• Amgen (Aranesp and Neulasta)
• Prefilled syringes discount (Aloxi, Procrit,
  Neupogen)
• Early payment discounts

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Medical Supplies

• Do you shop your supplies?
• Take advantage of early payment discounts as many
  have 1 to 2 discounts
• Have several suppliers such as the following
  come into your practice and see all of your
  supplies and get back to your nurses with samples
  and with quotes back to you
• All the drug distributors already noted
  previously
• Physician Sales Services
• Hospira
• Pilot Medical
• Cardinal
• Besse Medical
• Advanced Medical

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Managing Insurance Receivables Provider Office
Visit Coding
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Account Receivable Aging 1 year after merger
Patient Balances Remaining from July 2007 59,625
Actual Current Patient A/R Balance 99,046
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Medicaid patient that is being denied payment for
all CBCs due to it being inclusive in
dialysis Patient is not even being treated for
dialysis and we have spent over 6 months getting
this corrected
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Why do I have a denial on Bevacizumab?
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Medicare denied because her name did not match up
with her benefits. We had to rebill with her
middle initial included to get paid on this.
We right off every time for this patient and
doctor knows about it
Non Payment for off label use for Metastatic
Renal Cell Carcinoma which we appealed and were
eventually paid
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Managing Other Practice Expenses
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Technology

• Hardware agreements Have you gone through the
  agreement and pulled out equipment that you no
  longer have?
• Servers and printers usually are the most
  important pieces of hardware to cover as you can
  pay for 4 year maintenance agreements on
  workstations purchases through Dell or another
  provider
• If you have a software agreement with your
  practice management company then having them
  control the hardware agreement on your server and
  printers saves you money in the long run
• Buying verses leasing a copy machine Many times
  leasing is a lot better deal but make sure that
  the maintenance fee per copy each year stays low
  in the long term lease.

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Fixed Assets

• Go through and identify your specific assets on
  your fixed asset schedule that goes to your
  accountant who prepares your corporate tax return
  each year (Dont note as a description Furniture
  or Equipment or group furniture together and call
  it nurses office furniture)
• At the end of each year go through this list and
  make sure tell the accountant to dispose of any
  assets that you no longer have
• If you pay personal property taxes in your state
  then doing what I asked above will cut down on
  how much tax you pay each year on each asset
  Also, many states dont have you pay tax on
  software and leasehold improvements.
• When you do add leasehold improvements or do any
  construction then ask for Cost Segregation to
  be done with your accountant (This may be very
  beneficial financially for your practice and your
  accountant will be able to tell you this)

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Storage Units

• Are you keeping a storage unit open to house
  items from your office that you are actually
  using?
• Check into storage units that charge by the box
  They also can keep every box marked with bar
  codes along with everything in each box which
  saves time from having to find files as every
  chart is bar-coded unless it is in your EMR

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Sanitary Linens

• Do you actually use everything that is noted on
  the bill?
• Is the quantity correct for each of the items
  that you are utilizing from the linens company?
• Should they be coming weekly, every other week
  etc.

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Chemotherapy Waste

• Where do you buy the containers and are you
  making the best use of the containers as you
  possibly can?

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Meals Expense

• Deduction of 100 of Meals under Internal Revenue
  Code Subsection 274(n)(2) if
• 1. Meals that qualify as a de minimis fringe
  benefit provided on the employers premises for
  employers convenience if more than 50 of the
  employees who are furnished meals for employers
  convenience.
• The following are some IRS-approved ways to meet
  the employers convenience rules (Reg Section
  1.119-1(a)(2)
• Meals are provided so employees are available for
  emergency calls during the meal period, and such
  calls actually occur or can reasonably be
  expected to occur
• Meal periods must be short (30 to 45 minutes)
  because of the nature of the employers business
  and the employee does not have time to eat
  elsewhere.
• Because of a lack of eating facilities near the
  business (or other similar circumstances),
  employees cannot be expected to secure proper
  meals within a reasonable meal period.
• Meals are furnished immediately after working
  hours that would have been provided during
  business hours, but, because of work duties, were
  not eaten during working hours.
• 2. Companies picnics or holiday parties.

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Other Miscellaneous Items

• Retirement plans and built in fees
• Cell Dyne maintenance fees and buying new
  equipment
• Can your state society buy books
• No bank charges and low credit card fees
• Before you recruit and advertise in the paper
  check with all employees, hospitals and local
  organizations
• Negotiate with answering service- Pay per
  occurrence
• Negotiate Rent on a long term lease if you have
  no opportunity to own your own building to rent
  back to yourself. Make sure that in lease
  agreements that the rate it increases each year
  like the consumer price index does not cause your
  lease to exceed your fair market value of rent in
  similar properties over the course of that long
  term lease.
• How do you buy magazines for your patient and
  chemo room? Do you rotate them through your
  offices? Do you purchase them in bulk to get the
  best deal by buying several subscriptions at
  once?

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