Focused Physicians targets independent practices

By Sandy Clark
Springfield Business Journal Contributor
http://www.sbj.net

For Donald M. Tucker, president and CEO of Focused Physicians LLC, success is tied directly to the viability of his clients’ practices.

Tucker’s company provides back-office services to doctors such as accounts receivable, accounts payable, human resources, contract negotiations and new practice setup and evaluations.

“We do cost controlling, revenue capturing and ensure coding accuracy and compliance for the physician,� Tucker said. Primarily, the company works with independent physicians who don’t have access to back-office services from local health systems.

The key, however, is to help physicians grow their practices by allowing them to focus on medicine. Focused Physicians is paid a percentage – on average 7.5 percent – of practice revenues for its services, Tucker said, which means they share risks with their doctor-clients and have a vested interest in helping them grow their practices.

With established doctors, the first thing Focused Physician does is give the medical practice a checkup, examining 10 aspects, including scheduling appointments, upfront payments, record coding, billing and claims and accounts receivable.

“We do something called Vital Signs as a courtesy for the physician. … We do that at no charge just to give an initial overview of what our findings might be,� Tucker said. Focused Physicians also works with new practices, which Tucker said is nice in that the slate is clean and the doctor can get started with things set up correctly.

For Dr. Tom Brooks, using the advice of Tucker and Focus Physicians was reassuring as he was starting his practice.

“I had my plan and had it all worked out for six or seven months before I finally decided to go (with it),� Brooks said. “There was a certain amount of self-doubt. Did I have my assumptions correct? I met Don and we began talking. Their group reviewed that and came back and told me, ‘You are on the mark … you can do this.’�

Collecting payments

One key problem Focused Physicians helps with is collecting payments. The company uses a Web-based system from Athenahealth Inc. Data is kept on a central server near Boston, which allows Athenahealth to make changes to payment rules and procedures on the fly.

“We have a complex piece of software called the Payer Rules Engine,� said Athenahealth spokesman John Hallock.

“Within that rules engine, we currently have over 40 million permutations of how payers want to receive claims. You can imagine how many requirements there are that doctors need to know or that need to be known by his or her staff. They need a partner to have an economy of scale,� he added.

Athenahealth has hundreds of people to track and enter rules changes from insurance agencies and other health care payers.

Hallock is not surprised that complexity is driving demand for Tucker’s business.

“We grew at 41 percent last year,� Hallock said. “There are thousands of insurance packages (and) each one has its own procedure for getting paid. It all has to be documented correctly and claimed correctly.

“Insurance companies have to sell new products. As they design those products, that can only add to those requirements.�

From Tucker’s point of view, helping doctors deal with getting paid lets them focus on practicing medicine.

“In terms of getting paid, this is probably the largest challenge that faces a physician working outside of a hospital,� Hallock said. “These are small businesses. They are somewhat at a disadvantage in that most insurance companies are very large. They have thousands of members and are demanding more information.�

For Brooks, getting back-office help was a relief.

“It takes a tremendous load off,� Brooks said. “First, they provide the billing service. They take care of my collections. Second, they help me with contract negotiations and general business stuff that, as a physician, I didn’t have any experience with. We didn’t learn anything like that in medical school.�

Tucker sees many challenges for independent physicians in Springfield.

“They face a unique challenge in being a network provider. The way (networks are controlled) is by controlling access to who gets paid,� Tucker said. “So you can imagine how long a doctor is going to work in this town if he doesn’t have the ability to be reimbursed for the services he provides – not long.�

According to Hallock, control like that can lead to limited choices and limited competition.

“(Doctors) are really at the whim of that payer for the price of that service,� Hallock said. “If you were to say, ‘I won’t see the patients of hospital ‘X’ or health-care system ‘Y’ because I don’t like what they pay,’ then you wouldn’t be seeing very many patients.�
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