MGMA Better Performers: Investing in convenience and community

Located on the southern banks of the Ohio River, in western Kentucky, Owensboro is the state’s fourth-largest city. In June 2020, the city’s unemployment rate was just 4.2%, well below the national average of 11% and slightly lower than the previous June (4.4%), prior to the pandemic.1 The area’s strong economy centers around such industries as bourbon and tobacco, personal protective equipment (PPE), and healthcare, including the city’s largest employer, Owensboro Health.

Situated between the major cities of Chicago, St. Louis, Cincinnati and Nashville, Owensboro is also a central distribution hub. And it has a vibrant downtown and riverfront, which has attracted many hotels, restaurants and boutiques, thanks in part to a $40 million grant from the U.S. government during the last recession.

All these factors make Owensboro an appealing place to live and return to, especially for the providers and staff at Owensboro Pediatrics. Finding doctors is no trouble for Practice Administrator Ross Scott, MBA. “Since 1996, we’ve never had to recruit anyone [to the practice],” Scott said. “All our physicians are from this area and want to come back to this area.”

Owensboro Pediatrics was founded in 1996 by Drs. Michael F. Yeiser and David E. Danhauer. Scott, who has been with the practice since 2010, noted that all seven of the practice’s physicians are partner-owners, including Yeiser, who is still practicing. The practice has four nurse practitioners (NPs), two physician assistants (PAs) and 34 staff. The payer mix is 64% commercial, 35% Medicaid and 1% self-pay.

Among the services Owensboro Pediatrics offers are well-child exams, school physicals, sports physicals, walk-in and evening sick clinics, and walk-in immunizations.

Productivity*

As a Better Performer in productivity, Owensboro Pediatrics surpassed MGMA’s criteria in the following areas:

• Greater than the median for total medical revenue per FTE physician (Owensboro Pediatrics: $997,784.58; Pediatrics — physician owned: $908,610.00).
• Greater than the median for total medical revenue per staff.
• Greater than the median for wRVUs per staff.
• Greater than the median for provider wRVUs for at least 66% of providers.

Patient access

Convenience is a key element of Owensboro Pediatrics’ care delivery goals. “The main thing we want to do for our patients is to be accessible. … We want to be here for our patients when they get sick, because that can be nerve-racking,” said Scott. This is reflected in the practice’s extended hours:

• The practice is open from 8 a.m. to 8 p.m., Monday through Thursday.
• Evening hours are reserved for sick visits only.
• The practice also has Saturday hours and an all-day walk-in clinic, five days a week, from 8 a.m. to 11 a.m. and 1 p.m. to 4 p.m.

Owensboro Pediatrics did not offer telehealth before the pandemic. Although the practice performed many ADHD rechecks via telehealth, most patients and providers made it clear that they preferred in-person visits. “We did do some [telehealth], but it’s not a large percentage at all,” noted Scott about the low demand. “It’s gotten less over time; especially with little kids, it’s just tough to see what a baby’s eardrum looks like over telehealth.” As of August, out of roughly 350 visits per day, the practice was only doing a couple telehealth visits.

The practice actively assesses staffing levels relative to patient access to reduce time to third-next-available appointment. “We are bringing in a new doctor who is starting in September, and we also have a new NP to bring on,” said Scott. “We are always trying to make sure that we’re staying ahead on our physician staffing to anticipate our needs.”

Patient engagement bolstered by marketing

While Owensboro Pediatrics does not pay for advertising, it has a strong presence on social media by sharing insights on salient and seasonal topics, such as school physicals or guidance on mask-wearing for students. The practice is also well connected to the community, donating to many child-centric organizations such as Wendell Foster, a center for children and adults with various disabilities; GRADSA (Green River Area Down Syndrome Association); Puzzle Pieces, a day facility for individuals with intellectual disabilities; and Dream Riders of Kentucky, a horseback riding facility for those with mental and physical disabilities.  

“We want to donate to organizations that have to do with children, normally toward kids of need,” stated Scott. “We want to make sure that we’re spending our resources to advance the kids that really need it.”

Minimizing no-shows

Despite the pandemic, during July and August 2021, Owensboro Pediatrics was busier than it’s been during those months in years past. As such, the practice rarely has open appointments. That said, to minimize no-shows, the practice has a text reminder system to continue to contact patients until they respond.

“Recently, even if they’ve responded ‘yes, they’ll be here,’ we still send a follow-up text the day before the appointment,” noted Scott about how many distractions there can be over a long holiday weekend, for example. “Especially around the holidays, we were getting a lot of no-shows when we opened back up … it’s easy to forget when you have four kids you’re chasing around.”

In addition, the practice tracks open appointments through a scoreboard in its EHR. As mentioned, however, Owensboro Pediatrics is currently booked six weeks out. “When we did [have open appointments], we could reference our scoreboard and that’s when we were working those reports to get in people that hadn’t been in in a while,” said Scott.

Reviewing payer contracts and auditing payer reimbursements

Owensboro Pediatrics reviews payer contracts annually and formally audits payer reimbursements quarterly by running reports to compare to their fee schedules. As Scott expressed, the billing staff does a great job of catching one-offs when payments come in, which are promptly addressed. “In pediatrics, our vaccine reimbursements really just have to be watched closely to make sure that those costs are being covered,” said Scott. “Obviously, you don’t want to go a whole quarter and wait to your formal time when you look at everything.”

Chart audits and updates to E/M codes

Although Owensboro Pediatrics doesn’t have a peer-to-peer chart audit process, the billing staff randomly pulls information for review daily. In addressing the recent E/M code updates, the practice set up individual and group webinars for their providers to watch and discuss. To reinforce what they learned, the billing manager conducted direct training with the providers.

“Once we got in it after we saw a few weeks of how things were going, we had a meeting with all the providers and our billing staff so they could … brainstorm ideas of how we could improve things and the trends the billing staff were seeing that needed to be corrected,” noted Scott about getting everyone in the same room to pose and answer questions. Scott added that for the first three to four months the practice’s coders reviewed every 99213 and 99214 to ensure accurate billing.

Leadership and staff engagement

Scott meets with Owensboro Pediatrics’ seven physician-owners weekly. In addition to Scott, the practice has a management staff composed of a clinical supervisor and a billing manager, whom Scott meets with weekly as well. Scott emphasized that the lines of communication are always open as leadership “talks constantly, all day, every day.” To that end, while the physician-owners have final say in organizational decisions, Scott’s meetings with the other managers have become crucial in terms of taking the pulse of the staff and addressing day-to-day issues.

As for staff engagement, the practice prioritizes transparency and wants staff to feel comfortable voicing concerns and offering suggestions during general staff meetings. Moreover, the physicians show appreciation for staff and providers by throwing parties every few months and providing treats to staff on a regular basis.

Profitability*

As a Better Performer in profitability, Owensboro Pediatrics surpassed MGMA’s criteria in the following areas:

• Less than the median for total operating cost per wRVU (Owensboro Pediatrics: $51.50; Pediatrics — physician owned: $92.43).
• Less than the median for total cost per total RVU (Owensboro Pediatrics: $45.71; Pediatrics — physician owned: $76.67).
• Less than the median for total operating cost as a percent of total medical revenue (Owensboro Pediatrics: 55.38%; Pediatrics — physician owned: 64.23%).
• Greater than the median for total medical revenue after operating cost per FTE physician (Owensboro Pediatrics: $445,254; Pediatrics — physician owned: $368,697).

*Data from 2021 MGMA DataDive Cost and Revenue, based on 2020 data.

Managing costs

Owensboro Pediatrics focuses on three main areas to keep costs down:

• Staffing: Scott noted that the practice cross-trains as many employees as possible. “As any gaps pop up in our schedule, people calling in different areas, or just for any reason we need to move somebody, we can switch them around and then keep our full-time equivalents down,” he said.
• Supplies: The practice is part of MGMA BestPrice. In addition to group purchasing, the practice continually compares suppliers and their costs, and is not committed to one vendor.
• Vaccines: The group’s physicians have had their own physician buying group (PBG) since 2009, with offices in Kentucky and West Virginia. According to Scott, this provides significant savings on the purchase of vaccines.

Additional ways the practice keeps costs down:

• Benchmarking provider and staff salaries — A local CPA firm provides some benchmarking data for Owensboro Pediatrics, but Scott says his primary resource is MGMA DataDive. “When I started submitting to that four years ago … I found it to be one of the best tools,” stated Scott. 
• Cost containment — Scott worked with managers across the organization to limit staff overtime in the past year. “We have the managers of each area watching their employees’ time worked to make sure we do not have excessive OT,” he said. “We try to spread the hours around, increasing hours of those well below the OT threshold, while decreasing those employees nearer the threshold.” 
• Outsourcing — The practice realized savings by outsourcing IT needs several years ago after previously using an in-house IT professional. Outsourcing afforded new services and expertise. “One of the main things was gaining the group knowledge of all the IT professionals,” said Scott of the partnership with a local firm. “They also increased our security across the board. Our monthly IT package consists of dark web monitoring, a higher level of spam protection, etc.,” he added.

On top of these factors, Scott puts his bachelor’s degree in accounting to good use by reviewing basic in-house accounting items for the practice, but its CPA firm is responsible for reviewing the books and all accounts each month.

Note:

1. Alcorn C. “This is the only city in America where unemployment is actually down.” CNN Business. July 30, 2020. Available from: cnn.it/3n4DEzx