The Second Referral is Always Better than the First
by Julia Porterfield
It is said that the hardest referral to get from a practice is the first; but truth be told it really is the second. Marketing blogs and books can help determine which specialists, social media or outreach avenues are most likely to provide the referrals you seek. However, obtaining a consistent referral source rather than just a onetime patient pass is much harder.
One of the easiest ways to achieve the second referral is through timely communication to the practice following the referred patient's first visit. Within one to two days of the initial visit, it is important to reach out with a simple phone call, email or even voice mail to provide an update about the patient. This communication lets the practice know you are aware of their referral and that you appreciate the trust they have given you.
Additionally, it is also important to notify the practice in the event a patient does not show or cancels their first appointment. This front office tactic of providing no show and cancel feedback to the referring practice is also a great marketing tactic. Typically the practice will provide their own follow-up by ensuring the patient reschedules and attends their next appointment or they will send another referral to make up for the missed patient.
It is exciting to receive that first referral but good follow-up will strengthen your relationship with the referring practice in order to create a consistent referral pattern for you.
Friday, February 24, 2012
PAYER GUIDELINES
Have You Read Yours?
by Cheryl Nash
We are well into 2012 and the insurance companies are releasing their Medical Necessity guidelines for Varicose Veins. Some changes are minor, or nonexistent, and some changes are major, and will completely alter the way you need to document the rationale for treating your patients.
There are a number of changes that seem to be a theme. One change that is becoming increasingly common is conservative treatment needing to be documented by the treating physician. Most payers are no longer accepting the patient's word on wearing compression stockings as sufficient. They are also requiring more than hose, and want these items to be ordered by you, the treating physician. These items include elevating the legs, walking frequently and compression hose for a limited amount of time. During this trial the patient may need to be seen to assess their progress (or lack thereof) and ultimately track them until the trial timeframe is expired. These visits are billable with an established patient visit code 99212 or 99213. At the end of the trial, it may also be appropriate to order another duplex scan to assess the patient clinical condition prior to initiating an authorization. This is also a billable service with cpt code 93970 or 93971, depending on the legs to be treated.
Another trend is the requirement to document the impact of the patient's condition to their activities of daily living citing specific examples. As always, good documentation of the diameter of the veins, location of reflux, and venous filling index in the US reports is critical. Some payers are again requiring photographs and will ask for them upon review of your claims. Other payers are requiring that the patient be treated in only two sessions or that sclerotherapy being performed at the same time as an ablation is going to be considered inclusive.
Each payer is different, and the requirements can be drastically different. Please note that an authorization does not guarantee payment (as stated in every phone call to the insurance company) and all claims are subject to medical review after services have been provided. Know your payers requirements, and as these guidelines are also subject to review and revision without notifying you, the provider, we recommend re-checking these on a frequent basis to ensure compliance.
by Cheryl Nash
We are well into 2012 and the insurance companies are releasing their Medical Necessity guidelines for Varicose Veins. Some changes are minor, or nonexistent, and some changes are major, and will completely alter the way you need to document the rationale for treating your patients.
There are a number of changes that seem to be a theme. One change that is becoming increasingly common is conservative treatment needing to be documented by the treating physician. Most payers are no longer accepting the patient's word on wearing compression stockings as sufficient. They are also requiring more than hose, and want these items to be ordered by you, the treating physician. These items include elevating the legs, walking frequently and compression hose for a limited amount of time. During this trial the patient may need to be seen to assess their progress (or lack thereof) and ultimately track them until the trial timeframe is expired. These visits are billable with an established patient visit code 99212 or 99213. At the end of the trial, it may also be appropriate to order another duplex scan to assess the patient clinical condition prior to initiating an authorization. This is also a billable service with cpt code 93970 or 93971, depending on the legs to be treated.
Another trend is the requirement to document the impact of the patient's condition to their activities of daily living citing specific examples. As always, good documentation of the diameter of the veins, location of reflux, and venous filling index in the US reports is critical. Some payers are again requiring photographs and will ask for them upon review of your claims. Other payers are requiring that the patient be treated in only two sessions or that sclerotherapy being performed at the same time as an ablation is going to be considered inclusive.
Each payer is different, and the requirements can be drastically different. Please note that an authorization does not guarantee payment (as stated in every phone call to the insurance company) and all claims are subject to medical review after services have been provided. Know your payers requirements, and as these guidelines are also subject to review and revision without notifying you, the provider, we recommend re-checking these on a frequent basis to ensure compliance.
5010 TRANSITION
Some Interesting... and Disturbing... Results
by Cheryl Nash
As you may be aware, electronic claim formats have been switched from an older 4010 format to a newer 5010 format. The new format was to be implemented on January 1, 2012 to be ICD-10 compliant prior to mandatory use in October of 2013. Live sending commenced after the first of this year.
What this Means to You: This has caused many unforeseen electronic claim responses. We have seen and heard reports of multiple erroneous claim rejections in the past month, such as claims being rejected for no patient insurance identification number, no Tax ID number, and no referring provider just to name a couple. Of course all of this information has been on the claims, but the rejections are caused by clearinghouses not being able to read, or payers not able to receive, this data. The mistakes are random, and are seen nationwide, across all payers and clearinghouses, and are causing some delays in claim submission and processing. This ultimately causes delays in payment to the providers as well.
How to Correct: A timely response to the clearinghouse to report erroneous rejections as soon as they are seen is the best action. Most rejections are addressed by the clearinghouse, and the claim re-sent with no further action on your part. However, if no solution can be found quickly, we recommend contacting the payer to see about a desired alternative way to submit claims. Fax is the next best submission format after e-claims, as it generates a tangible proof of timely filing, and paper is a last resort, but of course there are some payers (like Medicare) who will not accept claims in fax or paper fashion. Check with the insurance payers to be sure the format will be accepted!
*** Update to ICD-10- CMS has released this update to the ICD-10 implementation date as a response to feedback from providers and agencies nationwide such as the AMA lobbying for a delay to the Oct. 2013 effective date.
Marilyn Tavenner, acting CMS administrator, told a conference of the American Medical Association today that CMS may "re-examine the pace at which we implement ICD-10," .
All HIPAA-covered healthcare providers must transition from ICD-9 to ICD-10 by Oct. 1, 2013. Although Ms. Tavenner did not say if there would be an actual delay, she said CMS would create new regulations over the coming days.
"There's concern that folks can't get their work done around [adoption of health information technology], their work done around ICD-10 implementation and be ready for [the health law's insurance] exchange," Ms. Tavenner said in the report. "So we're trying to listen to that and be responsive."
by Cheryl Nash
As you may be aware, electronic claim formats have been switched from an older 4010 format to a newer 5010 format. The new format was to be implemented on January 1, 2012 to be ICD-10 compliant prior to mandatory use in October of 2013. Live sending commenced after the first of this year.
What this Means to You: This has caused many unforeseen electronic claim responses. We have seen and heard reports of multiple erroneous claim rejections in the past month, such as claims being rejected for no patient insurance identification number, no Tax ID number, and no referring provider just to name a couple. Of course all of this information has been on the claims, but the rejections are caused by clearinghouses not being able to read, or payers not able to receive, this data. The mistakes are random, and are seen nationwide, across all payers and clearinghouses, and are causing some delays in claim submission and processing. This ultimately causes delays in payment to the providers as well.
How to Correct: A timely response to the clearinghouse to report erroneous rejections as soon as they are seen is the best action. Most rejections are addressed by the clearinghouse, and the claim re-sent with no further action on your part. However, if no solution can be found quickly, we recommend contacting the payer to see about a desired alternative way to submit claims. Fax is the next best submission format after e-claims, as it generates a tangible proof of timely filing, and paper is a last resort, but of course there are some payers (like Medicare) who will not accept claims in fax or paper fashion. Check with the insurance payers to be sure the format will be accepted!
*** Update to ICD-10- CMS has released this update to the ICD-10 implementation date as a response to feedback from providers and agencies nationwide such as the AMA lobbying for a delay to the Oct. 2013 effective date.
Marilyn Tavenner, acting CMS administrator, told a conference of the American Medical Association today that CMS may "re-examine the pace at which we implement ICD-10," .
All HIPAA-covered healthcare providers must transition from ICD-9 to ICD-10 by Oct. 1, 2013. Although Ms. Tavenner did not say if there would be an actual delay, she said CMS would create new regulations over the coming days.
"There's concern that folks can't get their work done around [adoption of health information technology], their work done around ICD-10 implementation and be ready for [the health law's insurance] exchange," Ms. Tavenner said in the report. "So we're trying to listen to that and be responsive."
Tuesday, November 29, 2011
DVT Outreach
Another Reason to Refer to You
by AJ Riviezzo
One 'campaign' that has been successful for a few of our clients is to provide same-day service on referrals for DVT scans. In many areas, the PCP has limited options for sending their patient out for an ultrasound on a suspected DVT. If you have a full time (or near enough) sonographer, you can offer out to the PCP community that you can provide this service.
There are a couple keys to really making this work. First, you need to be able to work that patient into your sonographer's schedule within a few hours. Second, you need to ensure a telephone call is placed back to the PCP confirming or denying the presence of a DVT. Third, you need to follow up the telephone call with a very good report to the PCP.
There are multiple benefits for having a program like this. For the PCP, this allows them to ensure their patient is seen in a rapid and friendly way rather than going to an urgent/emergent facility. It also allows the PCP to begin a treatment program perhaps more quickly than their current available options. For the practice, you are now being referred to for two different reasons... one of which, DVT, is very clearly understood by the PCP community. It does generate some revenue to offset the cost of your ultrasound technician. It is also not uncommon that what is a suspected DVT is frequently painful varicose veins. This program also allows a new reason for reaching back out to the PCP community . Overall, one of those rare win-win scenarios for everyone... including the patient.
by AJ Riviezzo
One 'campaign' that has been successful for a few of our clients is to provide same-day service on referrals for DVT scans. In many areas, the PCP has limited options for sending their patient out for an ultrasound on a suspected DVT. If you have a full time (or near enough) sonographer, you can offer out to the PCP community that you can provide this service.
There are a couple keys to really making this work. First, you need to be able to work that patient into your sonographer's schedule within a few hours. Second, you need to ensure a telephone call is placed back to the PCP confirming or denying the presence of a DVT. Third, you need to follow up the telephone call with a very good report to the PCP.
There are multiple benefits for having a program like this. For the PCP, this allows them to ensure their patient is seen in a rapid and friendly way rather than going to an urgent/emergent facility. It also allows the PCP to begin a treatment program perhaps more quickly than their current available options. For the practice, you are now being referred to for two different reasons... one of which, DVT, is very clearly understood by the PCP community. It does generate some revenue to offset the cost of your ultrasound technician. It is also not uncommon that what is a suspected DVT is frequently painful varicose veins. This program also allows a new reason for reaching back out to the PCP community . Overall, one of those rare win-win scenarios for everyone... including the patient.
Quick Marketing Thoughts
For Your Consideration
by Marcy Riviezzo
Health Fairs: For whatever reason, there tends to be a number of health fairs after the first of the year in most areas. Some practices have done very well at health fairs and some... not so well. If you do attend one, do not forget to market not only to the attendees of the fair but also to all of the other vendors. Frequently they can become a referral source or help lead you to a referral source.
Medicare: After the New Year, many commercial patients are going to be a bit more reticent to receive treatment for an elective procedure due to their deductible amounts starting over with the new year. Medicare patients have a very low deductible which is frequently covered by their secondary policy. One potential marketing outreach is to hold an educational seminar at a retirement community. Most of these seniors are still very active and concerned about their health. They also are very prone to attend any sort of meeting at their complex that has a physician giving a class. One tip: Bring an US machine (if you have one that is portable) and have one of the residents scanned for everyone to watch. Show and tell still works if you are eight or eighty!
Marketing Materials: With the new year fast coming upon us, you may want to take a little bit of the down time to review your marketing materials. All too often we just reproduce the same materials... frequently with the same results. Are the materials up to date with address, telephone, hours of operation and other pertinent details? Have you added other services such as Botox that should be listed? Try to really read all of your documents as if this is the first time you have seen them.
Internet Updates: Another consideration is updating your Social Living exposure. There are a number of programs like Facebook, Yahoo, and Yelp. You should also review your website to see if it is looking current. Is the material fresh or also a bit out of date. So many patients are now reviewing websites and social media that you need to ensure this is being refreshed regularly.
by Marcy Riviezzo
Health Fairs: For whatever reason, there tends to be a number of health fairs after the first of the year in most areas. Some practices have done very well at health fairs and some... not so well. If you do attend one, do not forget to market not only to the attendees of the fair but also to all of the other vendors. Frequently they can become a referral source or help lead you to a referral source.
Medicare: After the New Year, many commercial patients are going to be a bit more reticent to receive treatment for an elective procedure due to their deductible amounts starting over with the new year. Medicare patients have a very low deductible which is frequently covered by their secondary policy. One potential marketing outreach is to hold an educational seminar at a retirement community. Most of these seniors are still very active and concerned about their health. They also are very prone to attend any sort of meeting at their complex that has a physician giving a class. One tip: Bring an US machine (if you have one that is portable) and have one of the residents scanned for everyone to watch. Show and tell still works if you are eight or eighty!
Marketing Materials: With the new year fast coming upon us, you may want to take a little bit of the down time to review your marketing materials. All too often we just reproduce the same materials... frequently with the same results. Are the materials up to date with address, telephone, hours of operation and other pertinent details? Have you added other services such as Botox that should be listed? Try to really read all of your documents as if this is the first time you have seen them.
Internet Updates: Another consideration is updating your Social Living exposure. There are a number of programs like Facebook, Yahoo, and Yelp. You should also review your website to see if it is looking current. Is the material fresh or also a bit out of date. So many patients are now reviewing websites and social media that you need to ensure this is being refreshed regularly.
Sclerotherapy Billing
Sclero... One More Time
by AJ Riviezzo
My apologies to our regular readers but I received quite a number of questions regarding Medically Necessary Ultrasound Guided Sclerotherapy. Below is our answers to two very frequent questions posed at the this year's ACP Annual Congress:
Is Medically Necessary Sclerotherapy Paid for by Insurance Plans?
Medicare and almost all commercial insurance plans do pay for medically necessary sclerotherapy (MNS). There are a few keys to being reimbursed. First, you need to ensure the service is medically necessary based upon that payers medical criteria. Second, you typically need to authorize the service with the commercial plan in the same way you would authorize the ablation. Third, you need to ensure you have an operative note for the procedure as well as some notes showing why the patient requires this service.
How do You Bill for Medically Necessary Sclerotherapy?
Each payer is a bit different and there is even some difference in Medicare administrators. That being noted, our typical set of codes for MNS is a 93971 - single leg doppler US as you are usually re-scanning the leg before doing any injection, 76942 for the US guidance, and a 36471 if multiple veins are injected or a 36470 if only one vein is being injected. Even if the 76942 US guidance is rejected or excluded per the policy, we recommend still billing it as you are performing the service.
by AJ Riviezzo
My apologies to our regular readers but I received quite a number of questions regarding Medically Necessary Ultrasound Guided Sclerotherapy. Below is our answers to two very frequent questions posed at the this year's ACP Annual Congress:
Is Medically Necessary Sclerotherapy Paid for by Insurance Plans?
Medicare and almost all commercial insurance plans do pay for medically necessary sclerotherapy (MNS). There are a few keys to being reimbursed. First, you need to ensure the service is medically necessary based upon that payers medical criteria. Second, you typically need to authorize the service with the commercial plan in the same way you would authorize the ablation. Third, you need to ensure you have an operative note for the procedure as well as some notes showing why the patient requires this service.
How do You Bill for Medically Necessary Sclerotherapy?
Each payer is a bit different and there is even some difference in Medicare administrators. That being noted, our typical set of codes for MNS is a 93971 - single leg doppler US as you are usually re-scanning the leg before doing any injection, 76942 for the US guidance, and a 36471 if multiple veins are injected or a 36470 if only one vein is being injected. Even if the 76942 US guidance is rejected or excluded per the policy, we recommend still billing it as you are performing the service.
Tuesday, October 25, 2011
CAQH and the Physician
Something Else to Worry About
by Marcy Riviezzo
What is CAQH and why does this impact me and my practice?
The best way to describe CAQH comes directly quoted from their website:
"The Council for Affordable Quality Healthcare (CAQH) is a council of 25 of America's largest Health plans and insurers and three of the principal health plan associations working together to help improve the healthcare experience for consumers and physicians. CAQH member health plans have more than 110 million Americans and 600,000 providers in the networks."
It is the standard credentialing source for over two hundred healthcare plans. It maintains the UPD (Universal Provider Data Source). All information you provide to the Universal Data Source is maintained through encrypted technology.
If you are contracted personally or perhaps with a hospital or group, chances are someone in your administrative staff has created a profile for you on CAQH/UPD.
Here's WHY it matters:
ALL major insurance health plans access your profile regularly to keep your contracts and credentialing or recredentialing updated with information such as a copy of your current medical license, DEA License and Malpractice Insurance, just to mention a few requirements for you to practice medicine. The encrypted technology allows CAQH to streamline your data storage and manage it for distribution to all health plans and networks for easier contract applications and renewals. It is important that all physicians and mid level practitioners keep a current profile of their data for easy access.
Every six months CAQH emails a request prompting you to review and submit any new updates or renewals of information. Many of your contracts renew at the beginning of the new year and will want to access CAQH regarding your profile, so now is a great time to be proactive and contact or call CAQH to ensure you are current!
Annual updates to your profile include renewal of your Medical License, DEA license, malpractice insurance, BLS or ACLS, TB skin test, your current practice location and any hospital affiliations.
If you do not have a CAQH ID number and profile, I encourage you find someone to help you to create your CAQH/UPD as it can be frustrating and time consuming to complete it on your own. It is basically a process of gathering your professional profile but is usually an extra task that does not fall into a priority list of our day-to-day activities -- so often times this just doesn't get done. Once you get behind, it takes much longer to catch up.
If you have any questions regarding CAQH please do not hesitate to contact me directly to chat about helpful hints to keep CAQH on your priority list! I can be reached directly at 719.232.5566.
by Marcy Riviezzo
What is CAQH and why does this impact me and my practice?
The best way to describe CAQH comes directly quoted from their website:
"The Council for Affordable Quality Healthcare (CAQH) is a council of 25 of America's largest Health plans and insurers and three of the principal health plan associations working together to help improve the healthcare experience for consumers and physicians. CAQH member health plans have more than 110 million Americans and 600,000 providers in the networks."
It is the standard credentialing source for over two hundred healthcare plans. It maintains the UPD (Universal Provider Data Source). All information you provide to the Universal Data Source is maintained through encrypted technology.
If you are contracted personally or perhaps with a hospital or group, chances are someone in your administrative staff has created a profile for you on CAQH/UPD.
Here's WHY it matters:
ALL major insurance health plans access your profile regularly to keep your contracts and credentialing or recredentialing updated with information such as a copy of your current medical license, DEA License and Malpractice Insurance, just to mention a few requirements for you to practice medicine. The encrypted technology allows CAQH to streamline your data storage and manage it for distribution to all health plans and networks for easier contract applications and renewals. It is important that all physicians and mid level practitioners keep a current profile of their data for easy access.
Every six months CAQH emails a request prompting you to review and submit any new updates or renewals of information. Many of your contracts renew at the beginning of the new year and will want to access CAQH regarding your profile, so now is a great time to be proactive and contact or call CAQH to ensure you are current!
Annual updates to your profile include renewal of your Medical License, DEA license, malpractice insurance, BLS or ACLS, TB skin test, your current practice location and any hospital affiliations.
If you do not have a CAQH ID number and profile, I encourage you find someone to help you to create your CAQH/UPD as it can be frustrating and time consuming to complete it on your own. It is basically a process of gathering your professional profile but is usually an extra task that does not fall into a priority list of our day-to-day activities -- so often times this just doesn't get done. Once you get behind, it takes much longer to catch up.
If you have any questions regarding CAQH please do not hesitate to contact me directly to chat about helpful hints to keep CAQH on your priority list! I can be reached directly at 719.232.5566.
Quick Hits
Some Info for You
by AJ Riviezzo
E-Prescribe: The deadline for submitting a request for exemption from the E-prescribe program is November 1st. One way to be exempt is for the practice to be below a 10% threshold of specific codes. Most of these codes are essentially Evaluation and Management codes. Almost all phlebology practices should meet this exemption as the primary payments by Medicare are for surgery and ultrasound services. You need to file a letter with CMS to ensure you are exempt from any possible Medicare penalties.
Ultrasound Report Addition: On your ultrasound reports, we recommend adding a line to the body of the report that states: The permanent ultrasound recording is on file. This will help ensure you meet all legal requirements in your documentation.
Change in Code Use: Code 76942, ultrasound guidance, is receiving another short jab. Medicare and some other payers are now only allowing one 76942 to be billed per day. This means that if you are performing bilateral US guided sclerotherapy injections, you will not only be cut by 50% on the second sclero injection code you can also be cut back by the full amount for the US guidance as well. For Medicare patients we recommend against billing the second guidance code even to receive a denial. Our supposition is that fewer denials may hopefully mean fewer audit reasons.
by AJ Riviezzo
E-Prescribe: The deadline for submitting a request for exemption from the E-prescribe program is November 1st. One way to be exempt is for the practice to be below a 10% threshold of specific codes. Most of these codes are essentially Evaluation and Management codes. Almost all phlebology practices should meet this exemption as the primary payments by Medicare are for surgery and ultrasound services. You need to file a letter with CMS to ensure you are exempt from any possible Medicare penalties.
Ultrasound Report Addition: On your ultrasound reports, we recommend adding a line to the body of the report that states: The permanent ultrasound recording is on file. This will help ensure you meet all legal requirements in your documentation.
Change in Code Use: Code 76942, ultrasound guidance, is receiving another short jab. Medicare and some other payers are now only allowing one 76942 to be billed per day. This means that if you are performing bilateral US guided sclerotherapy injections, you will not only be cut by 50% on the second sclero injection code you can also be cut back by the full amount for the US guidance as well. For Medicare patients we recommend against billing the second guidance code even to receive a denial. Our supposition is that fewer denials may hopefully mean fewer audit reasons.
Administrative Law Judge
Follow Up Information on ZPIC Audit
by AJ Riviezzo
American Physician recently supported a practice that was involved in a ZPIC audit (essentially like a RAC audit except this was prospective and not retrospective). Eight of our ablation claims were denied at the first and second level appeal stages. This left using an Administrative Law Judge (ALJ) as our next recourse.
I have a more detailed article in the next Vein Therapy News but the findings in brief were:
Your documentation has to be viewed not as if another physician can understand and follow it but as if an attorney can understand it. Any, and I do mean any, variation in what is on one form to another was stringently questioned. For example, if your CEAP classification mentions swelling of the legs and your History and Physical does not specifically mention swelling of the legs, that is a problem.
It also became clear that any patient information that was not specifically noted as reviewed by the physician was discounted. Further, patient statements regarding previous attempts at conservative therapy (and thereby meeting the Medicare guidelines) were also discounted. We did argue that this was an unfair burden on both the patient and on the practice. It is normally standard to accept the patient's word when reviewing previous treatment, history, or compliance with something like conservative therapy management. That argument fell completely flat.
With the budget issues facing the Medicare program and recommendations that 'changes' be made to save money without impacting the actual entitlement, I can only assume that audits to find inappropriate or fraudulent treatment will be expanded. The primary weapon at your disposal for combating these audits is your well documented medical record.
by AJ Riviezzo
American Physician recently supported a practice that was involved in a ZPIC audit (essentially like a RAC audit except this was prospective and not retrospective). Eight of our ablation claims were denied at the first and second level appeal stages. This left using an Administrative Law Judge (ALJ) as our next recourse.
I have a more detailed article in the next Vein Therapy News but the findings in brief were:
Your documentation has to be viewed not as if another physician can understand and follow it but as if an attorney can understand it. Any, and I do mean any, variation in what is on one form to another was stringently questioned. For example, if your CEAP classification mentions swelling of the legs and your History and Physical does not specifically mention swelling of the legs, that is a problem.
It also became clear that any patient information that was not specifically noted as reviewed by the physician was discounted. Further, patient statements regarding previous attempts at conservative therapy (and thereby meeting the Medicare guidelines) were also discounted. We did argue that this was an unfair burden on both the patient and on the practice. It is normally standard to accept the patient's word when reviewing previous treatment, history, or compliance with something like conservative therapy management. That argument fell completely flat.
With the budget issues facing the Medicare program and recommendations that 'changes' be made to save money without impacting the actual entitlement, I can only assume that audits to find inappropriate or fraudulent treatment will be expanded. The primary weapon at your disposal for combating these audits is your well documented medical record.
Monday, August 22, 2011
Moving your Practice Forward
Free (or Close Enough) Support
by AJ Riviezzo
Phlebology is an interesting niche as it is becoming one of the few types of practice where there is a solo physician owner. This creates some unique opportunities and challenges as most of the physicians that start a phlebology practice have worked for a larger group, a group within the hospital system, or the hospital system itself. Being a good physician is only half the battle. The other half of the battle then begs the question: How do you gain the necessary information to be a successful business?
Trial and error is one very painful way of course. And, sad to say, it will indeed be part of your experience. Reviewing other practices that have been successful is another way to gain a bit of information (using someone else's trial and error). This has limited results as your market, your patient base, your referral network and even your payers may be different.
I recommend a multi-faceted approach. The first facet is to use your vendors. You as the physician/owner will be spending a fair amount of money on equipment, supplies and services. Many of the vendors for these services have a plethora of information, marketing materials, and other support available. For example, CoolTouch has a hotline to answer any billing questions along with a lot of materials both on line and in print. VNUS has an extensive collection of marketing materials available on line along with some recommendations for marketing efforts. Juzo, who has an excellent line of compression stockings, has marketing materials that are great for Lunch and Learns. My own small company provides a variety of support efforts to our physicians as well. All of this is free for the asking. In short, talk with your vendors and see what they can bring to the table for you besides an invoice.
The second facet is to develop a Board of Directors. As a physician/owner you are not likely well versed in banking, marketing, public relations, human resources and a number of other areas that are important to developing and maintaining a strong business. One way to have these types of people support you is to have them on a Board. You likely have friends or friends of friends with some of the skill sets. A retired banker, a semi-retired CPA, a stay at home mom who used to be the Director of Marketing for a company would all make excellent Board members. They have the time to attend a quarterly meeting. They have the energy to think about your needs. You can usually have these folks be part of your team for not much more than a small meeting stipend and a catered meal. The key here is to actually use these folks as a sounding board and do your best to actually implement some of their ideas (if no real authority they will quickly fade away).
The third facet is to reach out to your local Chamber of Commerce. The CoC's usually have programs and support geared specifically for small businesses. They have a network of relationships already built. They can recommend tried and true services available in your community. The cost to join the Chamber is usually very minimal but the offerings they have to help enhance your success is usually vast.
There are likely a number of other low cost to no cost options as well. The key is to find a bit of time out of your normal operations and focus on the practice as a business. While this can be neither easy nor comfortable it is important to do every so often.
by AJ Riviezzo
Phlebology is an interesting niche as it is becoming one of the few types of practice where there is a solo physician owner. This creates some unique opportunities and challenges as most of the physicians that start a phlebology practice have worked for a larger group, a group within the hospital system, or the hospital system itself. Being a good physician is only half the battle. The other half of the battle then begs the question: How do you gain the necessary information to be a successful business?
Trial and error is one very painful way of course. And, sad to say, it will indeed be part of your experience. Reviewing other practices that have been successful is another way to gain a bit of information (using someone else's trial and error). This has limited results as your market, your patient base, your referral network and even your payers may be different.
I recommend a multi-faceted approach. The first facet is to use your vendors. You as the physician/owner will be spending a fair amount of money on equipment, supplies and services. Many of the vendors for these services have a plethora of information, marketing materials, and other support available. For example, CoolTouch has a hotline to answer any billing questions along with a lot of materials both on line and in print. VNUS has an extensive collection of marketing materials available on line along with some recommendations for marketing efforts. Juzo, who has an excellent line of compression stockings, has marketing materials that are great for Lunch and Learns. My own small company provides a variety of support efforts to our physicians as well. All of this is free for the asking. In short, talk with your vendors and see what they can bring to the table for you besides an invoice.
The second facet is to develop a Board of Directors. As a physician/owner you are not likely well versed in banking, marketing, public relations, human resources and a number of other areas that are important to developing and maintaining a strong business. One way to have these types of people support you is to have them on a Board. You likely have friends or friends of friends with some of the skill sets. A retired banker, a semi-retired CPA, a stay at home mom who used to be the Director of Marketing for a company would all make excellent Board members. They have the time to attend a quarterly meeting. They have the energy to think about your needs. You can usually have these folks be part of your team for not much more than a small meeting stipend and a catered meal. The key here is to actually use these folks as a sounding board and do your best to actually implement some of their ideas (if no real authority they will quickly fade away).
The third facet is to reach out to your local Chamber of Commerce. The CoC's usually have programs and support geared specifically for small businesses. They have a network of relationships already built. They can recommend tried and true services available in your community. The cost to join the Chamber is usually very minimal but the offerings they have to help enhance your success is usually vast.
There are likely a number of other low cost to no cost options as well. The key is to find a bit of time out of your normal operations and focus on the practice as a business. While this can be neither easy nor comfortable it is important to do every so often.
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