Is your OBGYN practice a failing business? BHN (Brighter Health Network) would like to know. So should you.You’re busy. Your parking lot has a brisk turnover and your lunches are hurried. CME costs much more than tuition when you add up the money lost while out of your office. You have good months most of the time, but you also have your “marginal” months. All the more confusing is that today’s shortfall is based on what you did six weeks ago, while the piper who demands payment demands it today. If the working man’s or woman’s life is thought to be tenuous when lived paycheck to paycheck, it is sobering to realize that this is not really much different from a successful obstetrician-gynecologist living by the monthly caprices of a fluctuating accounts receivable. Lawyers call this “feast or famine,” but you call it having lunch with your banker. Even when things are going well for a long stretch, you may easily be tempted into a lifestyle that perpetuates the next struggle, proportionate to the what you think you’ve put behind you. (“How much is that Tesla?”)
The Problem? Not you, certainly.
Obstetrics and gynecology is a special calling. It is one of the few specialties in which your being there makes the difference—were it anyone else, the results easily could be quite different and you know it. You know it after that difficult delivery. You know it after that difficult surgery. You have worked hard to be at the top of your game because that’s what your patients deserve. This is not where you fail.
Where, Exactly, Is the Failure?
If you do the math, you will see that overhead keeps going up but that reimbursements keep going down. While everyone was so worried about the specter of nationalized medicine, private organized medicine (aka, the health insurance industry) pulled the rug out from everyone with the politicians’ blessings—the very ones for whom you voted. The Republicans weren’t there for you. The Democrats weren’t there for you. Even your professional society couldn’t care less. You remember talking to the old-timers about the good ol’ days of 80/20 fee-for-services. “O.K,” you say to yourself, a BMW drives as nicely as a Mercedes, or a Volkswagen drives as well as a BMW. Kind of. At least it’s still German. Even that Ford Fiesta isn’t all that bad, is it, especially if you can get Apple Play, right?
History has taught us that in “the noble profession,” less money to you means more money to those who hand it out. Medicare invented this because it had to. This was not lost on the insurance industry, embracing this imprimatur when it landed in its lap on a silver platter. Nothing personal, as it was explained in The Godfather—it’s just business. This is where the failure is.
Where Does the Friendly, Neighborhood OBGYN Fit In?
Your practice has been dealt a terrible hand by managed care. It contains a 2 and a 7—off suit; a 7-10 split; bad karma blown in by an ill wind on an uneven playing field. Cost containment, utilization review, quality assurance, best practices, and all of the other deceptive euphemisms made to sound like you’re lucky to have them, have insidiously pushed you down to become the bottom feeder in the vast food chain of medical capitalism. Yet, you’re the one doing the most work. Karl Marx could have a field day with this.
From the School of Hard Knocks, there are lessons out there on the healthcare dog-eat-dog Serengeti:
Lesson #1: Your competition isn’t your ungrateful ex-partner or the guy next door offering the same things that you do; your competition are people you’ve never seen before who want more drinktime from the same watering hole than you—the watering hole you dug.
Lesson #2: Less for you means more for them, and they knew this before you did.
It’s just business, Vito. They push pencils and wonder how much more they can keep from you, to keep for themselves. If your patients deserve your being at the top of your game, your practice deserves better for the time, work, education, and expense you’ve been through to get there.
Can you beat them? No. They’ve already won. How you survive it depends on that big brain of yours that got you through the Krebs Cycle, fluid and electrolyte balance, and the steps you should take for a severe shoulder dystocia.
You Are Special. Not Only Your Mom and Mr. Rogers Think So.
If obstetrics and gynecology is a special calling, then how you present it is special, too. It is a very personal specialty, involving very personal aspects of medical care. Your office—from first telephone contact to the plush seating in the reception area to the glib personnel who escort your patients through the women’s care processes beyond your reception room door—all have honed their personable social skills designed to instill trust and, most of all, faith in you as the top of their women’s healthcare pyramid. It’s all in their job description.
So…as you become busier over time, you wonder why you’re making less. Is the solution to work even harder? Not if you want to keep your family…or not die all alone as a bitter, yet materialistically successful old curmudgeon. (At age 50 with a set of raggedy coronary arteries.) What about overhead? Can you subscribe to a cheaper EMR? Not while you’re still paying for the one you have, especially since your entire office has finally gotten used to it—even that one employee you’ve had on double-secret probation for two months now. Reduce services? Send your ultrasounds out instead of paying an ultrasonographer? Then you lose control of the way your patient is treated by others when they get the care for which you sent them away; to them it may seem like a betrayal. Too dangerous.
Fewer nurses? Are you out of your iatrogenic mind? What about the one who does all of the pre-certs and prior authorizations? Let her go and add that to what your nurses already do? Goodbye to the scheduler? Shouldn’t the receptionist be able to do scheduling? And pre-certs, while at it? And prior authorizations? What about the denial appeals for the percentage of unapproved, disapproved, and unproved income that seems more like breaking even than profit? Especially since the services had been rendered months earlier. Have you already absorbed the loss? Did you even know it?
Should you hire a practice manager (translated, expensive consultant)? That makes no sense in the mindset of reducing overhead.
If you’re smart enough to know you shouldn’t send patients out to strangers who get paid the same whether they’re nice to them or not, e.g., for the routine obstetrical ultrasounds or gynecological measurements of ovaries—especially those requiring a vaginal probe—you can only imagine! —then you should be aware of another service that, sadly, is often a great void in your practice. It is one that you can fill easily and one that will:
- Improve the scope of services you offer.
- Tilt favorably toward extra income in the income/overhead ratio.
- Help you keep patients who otherwise would be at the mercy of how others treat them.
- Save your patients from the humiliation of “presenting” themselves to strangers which wastes—even jeopardizes—the sanctity of the doctor-patient relationship that has matured between you.
You are well aware that urogynecology is a subspecialty and there is extra training needed to call yourself one of its practitioners. But you can certainly practice it up to a point of comfort which you decree. There has been a friendly turf battle between the gynecologist and the urologist ever since the surgical specialties fell out of the protospecialty of general surgery generations ago. It all began with the prostate, which left women out altogether. Nephrologists ran like screaming banshees when they traded eager scalpels for their brains and glomerular filtration rate gauges. Urology was left as an all boys’ club. History shows that misogynistic hesitancy gave way to capitalism and like the Boy Scouts, girls could finally get in.
And so it was “on.” The turf battle began between the urologist and the gynecologist, but the gynecologist had the advantage, a sensibility for the intimate nature of gynecology and the established trust of the hard-earned doctor-patient relationship. Another advantage was when obstetrics and gynecology was officially declared a primary care specialty, a designation supported by that National Institute of Health, the American Congress of Obstetricians and Gynecologists, the American College of Surgeons, and other prestigious organizations. This allowed treatment in a whole ‘nother specialty, urology, under the manifest destiny umbrella of primary care.
And then you put on the brakes...
Treating UTIs is one thing; even pursuing incontinence with colporrhaphy, pessaries, and hormonal support, another. But when your challenge crosses that line from structural support to bladder spasm, from stress incontinence to urgency, you send your patients away. Like hitchhikers. To the stranger. To the person who could inadvertently sabotage the doctor-patient relationship for which you’ve worked so hard.
Yet you keep your ultrasonographer and your tech who does the pregnancy tests and draws blood. And even that employee who’s on double-secret probation.
There are so many things you are amply qualified to do before entrusting your patient’s care elsewhere, but you hesitate. Or refuse. It is a bit anxiety-producing at best and overwhelming at worst to introduce entirely new and unfamiliar protocols into your well-oiled OBGYN machine. You eschew learning curves, especially those of a technical nature, not the least because you just don’t have the time. It’s bad enough you had to take the time to figure out the apps you have on your smart phone.
About 85% of OBGYN residents are women, according to the American Medical Association. In stark contrast, only 23% of urology residents are women Whether you’re a male or a female obstetrician-gynecologist, your female patient has already dealt with your gender. Perhaps it was not important. Perhaps it was, but she has made a concession toward someone in whom she has complete faith. Regardless, if a patient has to be sent to another specialist of a gender with which she cannot immediately abide, any inroads you’ve made in her trust are in peril. She picked you, while you pick the urologist. It is not the same thing at all, and this is no small consideration; having urodynamics services in your office will sidestep this entire gender controversy.
When You Have Already Seen the Light
If you’ve already incorporated urodynamics into your practice, you’ve been struck already with the Promethean thunderbolt of foresight. In doing so, however, you have already provided the extra capital outlay. That’s O.K, because now your new services are cranking along; your pay-back algorithm has met the threshold, finally, for the break-even point; your staff is trained; and you have begun seeing a profit. You are now living the sweet life.
And then your urodynamics nurse gets pregnant and is subsequently placed on bedrest; or quits; or is caught pilfering. Your algorithm, while the urodynamics area of your office sits inert, bites you hard. The profits plunge faster than a serum creatinine in end-stage renal failure. You again cross the threshold, but this time it’s in the wrong direction. You will be interviewing prospective replacements and your on-going urogynecology patients either have to wait or go to the very people to whom you have avoided sending them. And then you discover Brighter Health Network.
Where Does the Friendly, Neighborhood BHN Fit In?
The nightmare scenario of “GU-interrupted” has a cavalry at the ready.
Brighter Health Network (BHN) is available to remedy the costly interruptions in your important work. One bugle call away with “Charge” and they can step in without missing a beat. These are well-trained professionals who know what you and your patients want. This is their specialty.
BHN is also the turnkey on-site medical testing provider to begin urodynamics in your practice. They do it under your own roof, using their equipment, their personnel if you desire, and your patients—for your income. It is a win-win solution on-the-fly, slipping in smoothly and unnoticed in any type or size of OBGYN practice.
Behind the regular goings-on of your busy practice, cystometrograms, voiding pressure studies, and urethral profile studies, as well as the applicable complex procedures (EMG and abdominal pressures), are performed in the background while you’re wondering how much of an office hit you’re taking for that delivery for which you have to run out to attend. The hits are kinder and gentler if there is another income stream on autopilot at work.
With BHN, you and your urogynecology patients can benefit from your office doing all of the preliminary services and diagnostics before your protocol calls for handing them off for more GU specialty-specific therapy or surgery. You will be able to add billing for CPT codes 51729, 51784, 51797, and 51741 to your accounts receivable without any capital outlay on your part. You pay BHN and they make you more money than you pay them.
There is no down time for your employees to learn what are, to them, strange and alien procedures. BHN provides the trained staff, the equipment, and all of the supplies. Your patients will submit to these prudent diagnostics in an environment of which they already approve and in which they feel comfortable.
The results will be accessible via the BHN web-based server, and once you’ve incorporated urodynamics testing into your diagnostics, you’ll wonder how you got by without it. (The practice with the pregnant urodynamics nurse already new this!). The sobering lesson here is that with such an overlap between urology and gynecology, you may be doing only half the job before moving on to more aggressive therapy. (Do you really want that lawyer to ask if you did the urodynamic testing before your patient claims she never bargained for that “pain-and-suffering” postoperative Foley?)
More information is always better than less information, and without urodynamic testing, you are practicing your specialty with less information. If you really feel you’re at the top of your game, are you really?
Partnering with Complementary Services
You, your practice, and BHN are all on the same side: your patient’s side. It is no sin to avoid leaving money on the table if it is ethical, helpful—even important—and part of the standard of care. BHN feels it is your synergistic partner. Our success requires that everyone must be happy, from your patients to your nurses to yourself. Oh, and your family—while adding enough income for that extra vacation! Hawaii is very nice.
It’s Just Business.
It is possible to still feel like you’ve chosen “the noble profession,” while fighting off those who whittle away at your income—those who are in, well, less nobler professions. It really is just business with them and it should be with you. But the dichotomy between noble pursuits and profitable margins are not exclusive of each other. You can do both and hold your head high. With BHN, you not only subscribe to the standard of care, you exceed it. Once you are partnering with the best business adjunct you’ve ever had, you will realize the only downside is that you may not have enough parking places. That is a good problem. With BHN, even the asphalt engineers benefit.