A New Game Plan: Otolaryngologists and consultants devise solutions to ride out the recession

Traditional remedies physicians relied upon during previous hard times—working longer hours to increase volume, hiring more staff, and investing in technology to improve productivity—may not be enough to keep practices growing. In response, otolaryngologists are devising creative strategies to address decreases in patient volume and reimbursement.

Impact on Patients

In Chicago, Michael Friedman, MD, an otolaryngologist and chairman of sleep surgery at Rush University Medical Center, heads a four-physician practice attached to the hospital. The group provides comprehensive ENT and audiological services. “We’ve been particularly hard hit because reimbursements for audiological services have been cut by as much as 50 percent because the law changed so that audiologists can bill independently of us,” Dr. Friedman, said. He was referring to the change in Medicare regulations in 2008 that directed audiologists to bill for Medicare patients using their own National Provider Identification (NPI) number rather than the NPI of a supervising otolaryngologist. Dr. Friedman also faces previously employed patients who lost their insurance, those deferring elective procedures and high deductible insurance plans that leave cash-strapped consumers vulnerable, particularly early in the year, as they spend until they reach the deductible’s limit.

Even at New York-Presbyterian Hospital, a tertiary care center with built-in referral sources to the ENT department, patients are struggling with financial uncertainty. “Even patients with jobs are more cautious. We’ve had patients put off elective surgery because they don’t want to make waves at work by being absent,” Dr. Stewart said.

The plight of some of Dr. Datta’s patients at South Nassau Communities Hospital seems even more dire. “To have honest, middle class people who always paid their bills cancelling appointments and cancer surgery breaks my heart,” he said. Despite Dr. Datta’s willingness to waive his fees for those patients, hospital and other professional fees remain. “Even though the hospital has funds for indigent care and our social workers try to obtain emergency Medicaid cards and other funds, some patients are so stressed about money that they won’t focus on their urgent health care needs,” he said.

I saw elective procedures and all volume dropping one or two years ago, and as much as a 40 percent falloff in ENT practices that do a lot of plastic surgery.
—Marc Lion, CPA, CFP

Solutions

Despite the recession’s toll, doctors are taking steps to keep their practices afloat. Dr. Friedman, having seen hard times coming several years before the downturn, repositioned his practice for growth. “I looked at our practice and reimbursement rates and knew we’d lose the volume of surgeries in a slowdown. We combated that with a plan for significant growth by doubling our space and adding another physician and in-house CT scanning. We also changed the style of our practice by giving appointments promptly rather than having patients wait.” Overall, the strategy has worked; surgery volume is down but billing is up, both from ‘bread and butter’ otolaryngology services and additional revenues generated by the new doctor, Dr. Friedman said.