How DoctorCare helped a busy Toronto FHO practice dramatically reduce outside use and streamline billing while improving patient care.
DR. LJILJANA MILADINOVIC
General Practitioner / Family Medicine
- Practicing primary care for 19+ years
- Leads a Toronto practice since September 2002
- With DoctorCare’s Practice Care program
- since May 2016
- Key Themes: High Outside Use, EMR Efficiently,
- Out of Basket Billing and Premiums, Billing
- Code Training
CHALLENGE: High outside use was costing thousands each year
Dr. Ljiljana Miladinovic has been a primary care physician in Ontario for more than 19 years. Her Toronto-based FHO practice has two doctors and two support staff serving a local population with a high number of seniors and patients with chronic illnesses. The practice is located in a neighbourhood with a lot of walk-in clinics and it is convenient for many of her patients to go to these clinics instead of making appointments with her. This is a common challenge facing many primary care physicians. As a result, Dr. Miladinovic has historically had a negative access bonus with MOH.
SOLUTION: Addressing high outside use and building workflow efficiencies to create a better FHO practice
In May 2016, Dr. Miladinovic brought in DoctorCare’s program for primary care practice management, Practice Care, to help her streamline billing and workflow at her FHO practice. “I decided to use DoctorCare FHO services when my co-worker started working with me.” said Dr. Miladinovic. “I felt we needed more guidance regarding billing and outside use. I realized that my office and I were doing a terrible job with outside use. When I was alone it didn’t bother me – but I felt an obligation towards my co-worker who was just starting out.” The doctor went into the DoctorCare engagement with some uncertainty. “Honestly, I hate having anyone meddle with my business, and I was expecting to be annoyed,” she says. “However, after my last negative access bonus, I thought I should give them a try.” Billing is incredibly complex and time-consuming, and not knowing the nuances of codes often result in missed revenue opportunities for primary care doctors. DoctorCare’s Practice Care program helped Dr. Miladinovic address these challenges and needs through detailed analysis for billing optimization and workflow efficiencies combined with easy to implement recommendations and staff training.
STEP 1: Identifying patients with high outside use
The Practice Care outside use report identified patients with high walk-in clinic usage. During the initial Optimization Session, her DoctorCare regional manager reviewed the top 20 patients with her, discussed best practices for recouping the revenue she was losing through them, and then recommended an effective roster management strategy.
“After my first quarterly Practice Care report, I realized how much outside use was depleting my revenue,” says Dr. Miladinovic. She quickly realized a bulk of her lost revenue was from the top 20. “After implementing the recommendations, just three or four months later I was rewarded with a large lump sum after addressing only a few patients through better roster management. That was such an eye opener. I was shocked.”
To mitigate further outside use, DoctorCare also met with the doctor to review best practices for after-hours availability and provide posters for her to use in the waiting room to reinforce patient education. Posters are a great way to let patients know that using walk-in clinics is not in their best interest for comprehensive care.
STEP 2: Implementing EMR efficiencies to address Out of Basket
To help the practice provide better care, DoctorCare implemented best practices in the doctor’s OSCAR EMR. Common searches and reports were added so she could easily identify patients with specific diagnoses. The Practice Care program includes EMR enhancements to help doctors maximize daily workflow and billing efficiency.
For Dr. Miladinovic, DoctorCare improved her Out of Basket code usage by working on the practice’s EMR to help address care for diabetics. The new billing process provided a list of diabetic and overdue patients so that she could ensure with confidence that her patients were notified and were coming in every three months for the care they need. With enhanced knowledge and better tools, not only is Dr. Miladinovic able to provide more care, she has increased her revenue as well.
As a part of DoctorCare’s comprehensive list of services, training around the use of correct billing codes and Out of Basket codes is routinely provided to help maximize revenue.
STEP 3: Identifying underused premiums and bonuses for PC-SMI to maximize revenue for existing patients
Like many primary care physicians, Dr. Miladinovic manages the care of patients with mental health diagnoses. However, she was not fully aware of the premium available for that care, and as such the practice was not billing with the correct tracking codes. DoctorCare identified that she was meeting the minimum service level of five bi-polar or schizophrenic patients in a fiscal year, which entitled her to a $1,000 annual premium. DoctorCare also let her know that adding another five patients with those diagnoses would double that premium.
STEP 4: Billing code training
As a trusted partner to many primary care physicians in Ontario, DoctorCare understands that many doctors are not completely certain of the thresholds for premiums and bonuses or how to bill for them. DoctorCare educated Dr. Miladinovic’s staff on codes for specific bonuses for care that they were already providing, which was uncovered during a billing optimization review.
RESULT: Better care and increased revenue
Dr. Miladinovic is now strongly positive for outside use: she hasn’t had a negative access bonus since improving her roster management. The doctors and support staff at the practice are now much more efficient with billing and have a clearer knowledge of when to use Out of Basket codes and how to bill for special premiums and bonuses.
“You’ve helped me save at least $20,000 – I’m impressed,” says Dr. Miladinovic. “I like everything about DoctorCare. The quarterly reports ‘digest’ everything for me so I can manage my practice more easily.”
Overall practice efficiency and revenues are up, and patient care has improved. Dr. Miladinovic couldn’t be more pleased with having her (and her patients’) expectations exceeded at every turn.