Toughest practice problems SOLVED

Our roundtable experts have the cure for what ails you, whether it's declining reimbursements, billing bottlenecks, long hours, or unhappy patients.

Doctors solve other people's health problems all day long. Meanwhile, they're often desperate for somebody to solve their practice management problems.

Health plan hassles, hectic schedules, coding rigmarole, efforts to grow the practice are familiar challenges of modern medicine. To find a cure for what's plaguing your practice, Medical Economics convened a roundtable panel of practice management experts at the 2007 annual meeting of the National Society of Certified Healthcare Business Consultants in Nashville. Each panelist presented a chief complaint he's heard from doctors, then offered a treatment plan. In the following roundtable presentations, you may see a plan of action that could work for your practice.

Ancillary services can give you the raise you're not getting from Medicare and third-party payers for office visits, and I regularly help doctors launch them.

A solo FP in Pennsylvania invested $2,500 in a spirometer a year ago. Spirometry now grosses roughly $1,000 a month, almost all of it profit. Likewise, a seven-doctor internal medicine group in the same state nets $50,000 a year-more than $7,000 per physician-from a refurbished bone densitometer purchased three years ago for $20,000. The numbers are bolstered by bone scan referrals from other practices.

However, you can lose money on ancillaries if you don't do your homework. You have to consider what's needed in your community, calculate the cost of offering the service, and estimate how much revenue the service will generate based on projected volume. Is it enough to break even? Remember, you may need to hire a specialized technician. There's also the hidden cost of lost productivity associated with staff and physician training. (To learn more, read our series, "Adding Ancillaries" at

Consult a healthcare attorney as well to ensure that an ancillary service will comply with federal antikickback and self-referral laws. Otherwise you could count on more revenue than you can reasonably expect to garner, and risk running afoul of the Feds. Some practices rent diagnostic imaging equipment and assume they can bill Medicare for both the technical and the professional fee, but that may not always be possible.

You can avoid some regulatory hassles by introducing ancillary services not covered by the Stark self-referral law-cosmetic procedures such as Botox, hair removal, and chemical peels, for instance. However, like any ancillary service, they may increase your malpractice premiums-another cost to factor in when you crunch the numbers.

Keep in mind, too, that ancillary services aren't the solution for a practice that's struggling financially due to poor management. If your office manager can't get scheduling or billing right, she won't get the ancillary service right, and you could lose money. So look before you leap.

ZETTER'S SUMMARY:To boost revenue, add an ancillary service

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