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Neurosurgery Operations Assessment: Ten Opportunities for Improvement

In response to the COVID-19 pandemic, neurosurgery practices across the United States are looking for creative ways to remain independent in private practice while ensuring they meet the needs of the neurosurgical care demand within their communities. Physician owners, partners, and private practice executives often wonder whether a diagnostic “biopsy” of their practice can be performed to verify if they are most optimally managing their practice’s business operations. However, private practices may lack the bandwidth, knowledge, or the resources to perform this “biopsy,” or neurosurgery operations assessment.

Likewise, hospital systems with neurosurgical service lines are also strategically planning how to best serve their communities while maintaining financially sustainable business models in a specialty that comes with some of the highest physician compensation and call pay seen across the nation. Hospital systems are often undergoing multiple strategic initiatives at any given time, and projects such as operations assessments may fall on the backburner amongst competing priorities, such as quality initiatives aimed at achieving prestigious designations in the healthcare community.

Neurosurgeons, when was the last time you paused and took a moment to evaluate where your practice is performing from a business operations standpoint? For many of you, the answer to that question could be, “Never,” or “Not within the past 5 – 10 years.”

There is an opportunity to identify and overcome operational inefficiencies in the outpatient clinic operations of neurosurgery, the inpatient neurosurgery on-call duties, and even the daily and weekly management of the surgical schedule. Working with our neurosurgery practice clients, we have been able to identify some common issues during our neurosurgery operations assessment.

Top Ten Opportunities for Improvement with Neurosurgery Operations Assessment

One: Fluctuating Monthly Cash Flows

Large monthly fluctuations in elective spine surgery collections, which are critical for any independent surgical practice to maintain positive cash flows and avoid utilization of debt, with very limited understanding of the expected “True Charges” to be collected for each case.

Two: Emergencies Disrupting Clinic and Elective Surgical Schedules

Cancellation of elective surgical cases and/or outpatient clinic schedules due to emergencies from on-call duties, with no true plan to accommodate displaced patients and protect the outpatient clinic and elective surgical schedules.

Three: Underutilization of Advanced Practice Clinicians

Underutilization of Physician Assistants and Nurse Practitioners in the outpatient clinic setting to generate surgical candidates on the Physician’s clinic schedule, and/or treat patients in follow-up who do not require Physician consultation every visit.

Four: Lost Reimbursement Despite Strong Payor Mix

Practices collecting on average under 100% of the Medicare Professional Fee Schedule for various services despite a large Commercial, Workers Compensation, and/or No-Fault payor mix.

Five: Frequent Denials of Prior Authorizations for Fusion Procedures

High frequency of denied prior authorizations and/or claims for primary arthrodesis (fusion) CPT codes for failing to explain recommended surgical approaches in a manner that substantiates the CPT codes being billed or requested.

Six: Frequent Denials of Prior Authorizations for Spinal Instrumentation

High frequency of denied spinal instrumentation CPT codes for failing to explain the implant technology being utilized and the points of fixation into the spinal anatomy.

Seven: Inefficient Use of Resources for Documenting Office Visits

Significant extra time spent by physicians dictating or typing office notes, or waiting for dictated notes to be transcribed, and correcting transcription errors, thus creating a backlog of prior authorization requests or even contributing to a high denial rate of prior authorizations.

Eight: Inappropriate Under Coding of E&M Services

Under coding of Evaluation & Management CPT codes based on old habits of avoiding complex Medical Decision-Making criteria from CMS (prior to the implementation of time-based E/M billing).

Nine: Inappropriate Upcoding of E&M Services

Upcoding of Evaluation & Management CPT codes for failure to document time spent reviewing tests, obtaining and reviewing history, counseling patients, ordering medications, tests, or procedures, documentation, care coordination, and making referrals for patient follow-up when Medical Decision-Making does not substantiate the CPT being reported.

Ten: Failure to Leverage KPIs in Physician Practice Management

Overall lack of understanding of Key Performance Indicators needed to proactively manage business operations in a manner that promotes patient access, quality of care, financially sustainability, and clinician career satisfaction.

Contact Blue about Neurosurgery Operations Assessment

At Blue & Co., LLC, we regularly perform Operational Assessments to diagnose operational issues, and then investigate the root cause of those issues to provide best practice recommendations for remediation. Oftentimes the diagnostic assessment leads to a longstanding relationship whereby Blue will facilitate the implementation of any recommendations for our clients.

If you or any of your colleagues may benefit from conducting an Operational Assessment with Blue & Co., LLC, please contact Jake Lewis or your local Blue & Co. Advisor to learn more.

Jake Lewis, MBA
Physician and Hospital Services Manager

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