American College of Physicians: Internal Medicine — Doctors for Adults ®

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'Want a stress management class with your physical?'

Bringing ancillary services in-house offers patients one-stop shopping while it helps boost your bottom line

From the January-February ACP Observer, copyright 2006 by the American College of Physicians.

By Janet Colwell

As physicians continue to be squeezed by decreasing reimbursements, many are taking a new look at bringing ancillary services in-house.

Patients are looking for one-stop shopping with clinicians they trust, said practice administrators who spoke about enhancing primary care revenue at a recent Medical Group Management Association conference. Internists who balk at offering the kind of services now springing up at dermatology offices across the country—such as laser hair removal, Botox injections and product supplement lines—can still add services related to existing patient needs. (See "Get creative with marketing.")

But before you launch a new ancillary service, here are a few ground rules. First, check your insurance contracts to make sure you can perform certain services—or negotiate carveouts, if those services are covered by insurers. (Many ancillary services, the San Antonio-based practice administrator Alan Himmelstein pointed out, are on a strictly cash basis.)

Also, check with local authorities to see what training and/or certification you or your staff may need to offer a new service. Check as well with your malpractice carrier to see if and how offering a new service could affect your liability coverage. And survey patients to gauge the demand for a new service.

Find a physician within your group who wants to champion the new service. And check with your attorney to make sure the service—or a partnership you'd have to create to offer that service—won't get you in trouble with Stark self-referral regulations.

Here is a list of some ancillary services to consider:

  • Weight loss clinics. Practices can hire a dietician and offer after-hour, evening weight loss group clinics. Clinics can feature a practice physician stopping in to give weight-loss counseling.

    "Patients would much rather be counseled on weight loss by a physician than by a commercial weight loss plan," Mr. Himmelstein said. Most weight-loss clinics operate on a cash basis, and most host between 25 and 50 patients per session. Like commercial weight loss plans, you should consider offering a certain number of sessions and signing up patients for all of them.

  • Smoking cessation clinics. Some insurers—including Medicare—now cover smoking cessation counseling for some patients. Check Medicare guidelines and insurance contracts for how to bill smoking cessation counseling and clinics.

  • Pulmonary function testing and breathing treatments. While many practices offer spirometry, Mr. Himmelstein pointed out that groups may want to offer pulmonary breathing treatments as well. Physicians need to make sure they properly bill breathing treatments, using demonstration codes for inhaler use as well as codes for medications used.

  • Dermatological procedures. When doing biopsies and incisions, physicians tend to bill these incorrectly, Mr. Himmelstein said. Most insurers won't pay for skin tags unless patients are symptomatic, he said. Check with your insurers—and always get an advance beneficiary notice signed before performing the procedure, in case the insurer doesn't cover it.

  • Executive physicals. If your area has large employers, approach them to see if they're interested in executive physicals for top and mid-management employees. While such physicals may be billed through insurers, many are on a cash basis as well.

  • Stress management services. Like weight loss services, stress management—which typically entails counseling, group visits and biofeedback—an be offered after-hours. You can market stress management services to area executives and through large employers.

  • Travel management. Consider offering travel management services to patients who are international travelers. Such services typically include immunization management; counseling on potential illnesses, food differences and infectious diseases; and precautions travelers should take.

    "Typically an all-cash service, travel management sessions are usually billed at between $100 and $200," Mr. Himmelstein said. Most of the vaccines you'd offer wouldn't be covered by patients' insurance carrier—but check with local insurers.

  • Immigration physicals. Here is another service you can offer to local employers for workers who are legal immigrants who need to renew visas. Most are on a cash basis, although some insurers now offer coverage.

  • Aviation physicals. Physicians who work near local airports may want to consider offering these. To do so, physicians have to complete a certification process through the Federal Aviation Association that must be periodically renewed.

  • Department of Transportation physicals. In many states, commercial drivers need physicals every two years to maintain their license. To advertise, you can contact grocery chains, moving companies, local long-haul drivers and even local newspapers. Check for local department of transportation requirements, guidelines and train-the-trainer sessions.

  • Court-ordered drug screening services. Interested groups can do a fair number of court-ordered drug screens for persons with DUI- and drug-related charges. "Depending on the contract you negotiate with your lab," Mr. Himmelstein said, "a physician may not even have to be involved in the screening service to report results back to the court." The service is on a cash-only basis, with physicians typically charging between $35 and $50 for each screen.

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Get creative with marketing

Many physicians scorn advertising—but referrals may no longer be enough to thrive in a competitive market.

"Advertisements are only one part of marketing," noted Garry Mac, principal of The MAC Group, a health care consulting team based in Apison, Tenn. "But you can grow a practice faster from within, by making marketing people out of the patients you already have."

For example, said Mr. Mac, send out a practice magazine telling about your physicians, services and locations. "People love magazines—and having your own practice magazine is better than a three-year-old copy of TIME."

Create a Web site that allows patients to pay their bills and book appointments online. "If your site is nothing more than an online brochure, it is useless," warned Mr. Mac, who spoke about practice marketing at a recent Medical Group Management Association conference. "It has to function and, if nothing else, it should help you improve collections by allowing patients to pay their bills online with a credit card."

When you hire a new physician or launch a new service, Mr. Mac recommended sending out announcements to people in the local area. Some practices have been able to save money by cross-marketing with local banks, for example, who agree to include medical office brochures with their mailings.

Physicians can often market themselves to the public and to other referring physicians by becoming speakers at educational programs held at community hospitals, he said. You can also host continuing medical education sessions for area physicians at your office.

And pay attention to how well your office markets your group and your physicians.

"Waiting rooms are one of the most important marketing tools and point of contact we have with patients," said Mr. Mac, "so what's on your walls? How old are your magazines?"

Why not make your waiting room interactive by installing a kiosk with Web access keyed to your practice home page? Or, he said, you can put in a television to show video programs on health topics or profiles of your physicians.

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