Physician Services

In the past few years we’ve seen that the increase in physician employment is driving the need to refine processes and systems within the practices and identify improvements for both stand-alone medical groups owned by hospitals and faculty practices that are part of university systems.

We find that physician practice leaders are faced with a daunting challenge: the need to identify opportunities for improvement versus the overwhelming complexities of:

• Professional billing changes
• Staffing and scheduling issues
• The right metrics to measure practice performance

Insight’s services include:

OPERATIONAL ASSESSMENT

Insight conducts Operational Assessments – from small physician groups to large faculty practice plans – to determine opportunities for improvement. Areas we would review include:

• Access and scheduling
• Centralized services
• Contracting for professional and purchased services
• Governance and organizational structure
• Information systems issues
• Operational expenses such as salaries, benefits, supplies, overhead, bad debt/indigent care
• Physician productivity/compensation plans
• Practice performance
• Patient throughput
• Performance metrics
• Service levels
• Space utilization
• Staffing model/non-physician staff productivity
• Standard reports issued to the physicians
• Supply utilization
• Use of mid-level providers

REVENUE CYCLE ASSESSMENT

Revenue Cycle is usually included as a component of an Operational Assessment. However, there are some instances when a client requests it as a standalone work product. In either case, our review of the professional revenue cycle includes:

• Management Skills Competency Review
• Staffing/Labor Management
• Accounts Receivable – Management Goals and Objectives
• Provider-Based versus Free-Standing
• Payer Mix/Indigent Care Strategy
• Registration Policies and Processes
• Authorization and Pre-certification Protocols
• Time of Service Payments
• Charge Capture and Write-offs
• Rejection Management
• Account Follow-up
• Remittance Processing and Control
• Insurance and Payment Collections
• Collection Agency Processes and Procedures
• Denial Management
• Information Systems – Modules and Interfaces
• Policies and Procedures
• Performance Metrics

FUNDS FLOW ASSESSMENT

A clear understanding of the sources and uses of funds for all service components is critical when establishing a collaborative practice between a hospital and physicians, or between a medical center, a medical school and a faculty practice plan.

The goal of a Funds Flow Assessment is to:

• Create an environment for disciplined business practices in the clinical enterprise
• Achieve the kind of sustainable operating margins that are required for future investments, appropriate bond ratings and the attainment of critical financial ratios

Our Funds Flow Assessments analyze time, effort, payment for services and strategic support by using mission-based allocation of funding and resource consumption as the guiding principle. Applicable to both hospital-owned physician groups and faculty practice plans, this approach:

• Provides a viable transition from “deal-oriented” funding to a business planning model
• Defines the amount and sources of revenue available for medical school departments and/or physician practices.

In a Funds Flow Assessment, the Insight team confirms the appropriate funding level (by mission) through reviewing all sources and uses of funds for:

• Clinical practice income
• Mission-critical strategic support
• Administrative time
• Teaching and research support

By working with numerous client organizations on Funds Flow projects we have developed standards and formulas for valuing resident teaching as well as benchmarks for appropriate strategic funding, administrative time and clinical practice income.