In order to retain or gain market share, there is a race among hospitals to acquire physician practices. More than half of physicians in the United States work for hospitals or other types of healthcare institutions. However, this creates a need for healthcare institutions as well as group practices to evaluate and monitor productivity and optimize charges and reimbursement. As a physician-led company, Qualitas Healthcare Solutions Inc. offers a unique insight as illustrated in the following case study.
Case Study # 3:
Physician Productivity, Charges and Reimbursement Analysis at a Children’s Hospital
Children’s National Medical Center (CNMC) in Washington DC is one of the nationally and internationally renowned hospitals providing state-of-the-art care to children, research and innovation and pediatric education. Nearly all physicians providing services at CNMC are employed by the hospital. In 2010 and 2011, the hospital and physician leadership was appropriately concerned about optimizing productivity, charges and reimbursement so that resources to support the institutional mission remain available. The institutional decision to perform internal and external benchmarking had been made but consensus about benchmarking parameters and data were not available. After a competitive search, CNMC selected Qualitas Healthcare Solutions, Inc. as a consultant.
Dr. Mankad engaged in a discussion with the physician and hospital leadership and management to develop a consensus around best practices in benchmarking and selection of parameters. RVU productivity per FTE, stratified for each subspecialty discipline was chosen as a measure of physician productivity with adjustments for specialties where that was not appropriate. Charges and reimbursement by commercial payers were chosen to benchmark financial performance. Extensive search for external benchmarks was conducted.
Qualitas was able to provide external RVU benchmarks for more than 85% of pediatric subspecialties. External data on charges and reimbursement were searched for 300 commonly used CPT codes. Dr. Mankad discussed the pros and cons of evaluating professional and financial performance based on measures chosen. Although external benchmarks are not always available for all specialties, especially in pediatric subspecialties where low volume makes it difficult to provide statistically valid data. However, CNMC had a starting point from which to develop further performance benchmarks.
“Dr. Vip Mankad was my colleague at Children’s Hospital & Research Center in Oakland California. Vip had an outstanding work ethic and was respected by his peers. As a physician Vip had a real expertise in Finance (which is somewhat rare for a physician), he & I had the opportunity to work together on many successful projects. I have now had the opportunity to work with him at his new company and I am very impressed by the skills he brings to the table. Above all else I consider Vip my friend & I consider it a privilege to recommend him”.
Doug Myers, MBA, CPA
Executive Vice President, COO and CFO
Children’s National Medical Center