All specialties of the medical field are undergoing and experiencing a financial squeeze. This is chiefly due to increased regulations, shifting payment models by insurance payers, higher patient co-pays and deductibles, and low physician reimbursement, and claim denials/rejections for numerous reasons. Further, despite cutting other costs and improving on the billing and coding processes, it is getting increasingly difficult for the specialties, especially oncology (as cancer treatment costs’ are one of the highest) to ensure financial viability.
Oncology patients are all the more difficult to treat than in other specialties. Added to this, is the fact that per oncologist, the average staff (equal to 7 full time employees) costs much higher. Hence, it is becoming mandatory for cancer care providers to chalk out an effective revenue strategy. Apart from checking on claims filing regularly, taking control of billing and coding processes and their accuracy, checking and ensuring lesser denials and rejections on a regular basis, keeping a tab on accounts receivables, and ensuring that follow-ups are accurate, it is often seen that revenues dwindle. A few ways in which ROI can be enhanced, growth opportunities can be identified and worked upon, new services and technology can be added to the existing resources, and ultimately initiating an oncology ‘center of excellence’ are:
New patients are the mainstay of any practice. Hence, referrals from physicians makes it easier to increase patients and thereby revenues of the practice. Keeping the communication open, transparency in pricing etc. makes working with referring physicians much more beneficial.
With technology at its height and most people looking to the internet for information, it is absolutely mandatory to have a website from where a patient can gain all the required information and evaluate the care, pricing and value options (from oncologists of other independent community/healthcare facilities). A good design followed by robust information can assist the patient in choosing the facility, which includes oncologists, outcomes data (success rate of the oncologist) and clinical trial experience. Apart from websites, social media sites such as Facebook, Twitter and LinkedIn could be used to engage patients while educating them. Social media also assists in promoting word-of-mouth referrals for the concerned oncologist and the practice.
Communities can be made aware of the existing oncology practices through various actions by the oncologists’ facility such as sponsoring events, supporting other health initiatives etc. that can increase awareness thereby increasing patients, the reputation of providing health and wellness, and ultimately revenues.
Business Intelligence (BI):
It is also wise for oncologists to team with partners in the business intelligence field to identify resources which can further identify and improve their areas of operations, and assure expected reimbursement. Business coaches can help the facility to understand the accounts receivables and ensure issues are sorted.
Automatic delivery of messages before a patient is due for the next visit can go a long way in building a healthy patient relationship. Messages can be focused on each individual’s care program. This will give a boost to the practice as more patients will be satisfied with the care provided thereby augmenting revenues.
Evaluating and incorporating new services and technologies, enhancing the core business units, administering the referral chain, evaluating and implementing clinical programs (emerging) and ensuring participation of oncologists in these programs, evaluating and expanding in geographies and clinically to increase revenues and gain financial control can all assist in increasing the market share. Investments must be made in infrastructure to enhance patient care including a thorough evaluation of resource utilization and financial analysis.
Reimbursement counselors must work with patients to gain access to financial support. At the end of it, the benefits much reach the oncologist and the patient, while other resources can move towards optimal care.