HPA

Case Study: How one physicians' group met the challenge of modernization

Salem Emergency Physicians Service, P.C.
Democratic Partnership of Physicians
Committed to providing the highest quality care

For over 40 years and counting, Salem Emergency Physicians Service (SEPS) has been serving the community of Salem to provide the highest quality of care possible. Part of that mission has been facilitated by their commitment to empower doctors within a democratic partnership completely owned and operated by independent physician practices. SEPS has built strong relationships with the local hospital and other organizations with the community to reach as many patients as possible. With a love for the people they serve, and the region they live, SEPS attracts physicians with likeminded values and a similar sense of purpose.  

Modernization brings benefits…and a few challenges

Like many health organizations that have weathered the test of time, SEPS has implemented healthcare technology such as electronic health records (EHRs) and other innovations to serve their patients better. While all these changes have certainly expedited care and streamlined operations, modernization also brought complexities in other areas such as billing and managing payor contracts. Judy Carroll, an Administrator for SEPS, explains how her capabilities had been pushed to the limits with constant payor renegotiation that included ever-evolving language and current procedural terminology (CPT) codes.

“My bandwidth just could not support all the time and focus that goes into keeping up with so many continuous contract renewals. When we decided we needed help, it had been 2-3 years since all our contracts had been renegotiated or reviewed for standard market language and fees. I didn’t even have a budget for this since it was a job I had been doing so, I felt like a little bit of a failure as far as administrators go. It was pretty tough telling the team we were going to have to pay ‘x’ amount of money to get this done because I just could not find the time for it. Over time however, we knew we’d made the right choice.”

Judy Carroll, MBA, CMPE; Administrator, SEPS

 

Sometimes outsourcing just makes sense

It can be difficult to make the leap to outsourcing especially when a task technically falls under your job description. That said, sometimes outsourcing special projects is the best possible choice because it allows your focus to remain on the essential operations that dominate your day-to-day. Not only can outsourcing save time and energy but it can actually pay for itself by increasing revenue. For SEPS, payor contract negotiation consulting was the perfect outsourcing opportunity for their organization.

“This is one of those outsourcing opportunities for administrators that is really wise because it’s never simple to renegotiate payor contracts. The first hurtle is to make sure you are working with the correct provider relations person assigned to your account but even then, they can be incredibly elusive and hard to get ahold of. It takes a lot of diligence on top of everything else that is already on our plates. So, most of the benefits that come from payor contract negotiation outsourcing is the time and energy that would be devoted to looking at all our contracts and comparing them across the board. Additionally, it is important to consider how often the terms and language within the field change so, for me not working in that world day-in and day-out, it is easy to miss changes that should be made. There is a real benefit to finding one group with the expertise to review your contracts, compare them to others and can reach out to ask, “Did you really know that was in there?” Just having that conversation is super helpful.”
Judy Carroll, MBA, CMPE; Administrator, SEPS

Find the right outsourced partner

“I was familiar with company Founder, Kate Othus,  from another organization prior to her launching DataDx so, I already knew the high-standard of work to expect. When I heard of the new firm, I made a couple of calls including one to MGMA (Medical Group Management Association) and realized they already had a relationship with Kate. That gave me some additional confidence. Also, I love to support small businesses that also serve independent physicians, so after being introduced to their premier contracting specialist, Courtney, it just felt like a really good match.”
Judy Carroll, MBA, CMPE; Administrator, SEPS

It is always a good idea to find an outsourcing partner that either comes highly recommended or has a reputation for fantastic service. In Judy’s case, she took the time to not only draw from her own experience working with our Founder in the past, but she made some inquiries to uncover more information about DataDx from other trustworthy sources. Doing that kind of homework when looking for help with complex projects like payor contracting always yields the best results.

There is no substitute for expertise

Once you have found your outsourcing partner, there are key signs you made the right choice. Communication lines should flow easily so that unhappy surprises are kept to a minimum and you should always feel like your needs are a top priority. Luckily, Judy found this with DataDx and so much more.

“DataDx’s payor contracting specialist did a great job staying connected with me and the lines of communication were always open. She built a spreadsheet called a payor matrix so that I could get monthly updates and look at the different tasks in the workbook to know where we were on our contracts. That is a fantastic resource I’ll use for years to come. Also, if I ever had a pressing need, they were there to handle it. I recall an occasion when I realized one of our biggest contracts  was super outdated with the renegotiation deadline fast approaching and the payor’s provider representative would not get back to me. Courtney took that on as a priority and was able to work with them to understand where our historical rates had been and how they had grown. She even wrote it up into a nice value proposition that I could draw on in future. On top of that, the DataDx team worked between me and our billing company to gather data that would help us analyze our fees as well as our top-billed codes. That way we could better understand our strengths and weaknesses on payor contracts. Honestly, they were able to everything I wish I had time for, but it really is a full-time job if you’re going to do it well.”
Judy Carroll, MBA, CMPE; Administrator, SEPS

Value beyond measure

Some outsourced projects’ return on investment (ROI) is difficult to quantify because there are so many moving parts. Payor contracting is definitely one of those. Of course, calculating the time saved from not paying someone to spend scores of hours working on it internally is one way to track its value, but there are many other gains possible. Once a contract is renegotiated, there can be measurable ROI that can range from a 1:1 to 8:1 when fee increases are calculated. Beyond that, making sure the language is updated and understood by the providers can ensure you are minimizing lost reimbursements from procedural mishaps. You may never know a concrete number when it comes to the ROI of outsourced payor contracting, but the lack of headaches alone is worth it.

“There were definitely some gains. Most of it came from getting everything current and then building some escalators so we could see some built-in gains for years to come. I have not done a full financial analysis of it all, but it goes without saying the fees we have paid for DataDx to get this done have been well worth it. If you just look at my time and the energy saved for those outsourcing fees, it was a DEAL . But then when you add in some additional revenue because of the contracts review, that is just the icing on the cake. The gains may seem small at first glance but when you multiply them by the many payors that we deal with over several years, it really adds up.”
Judy Carroll, MBA, CMPE; Administrator, SEPS

DataDx makes it easy to say yes

There is no better testimonial than when a client recommends your services to others. Judy has some very specific reasons why she is more than happy to refer her colleagues and peers to DataDx for payor contracting.

“Their whole team was very professional and understanding. In the beginning, I really had some financial constraints because we did not have this service budgeted for. DataDx was willing to work with me to maximize the value and keep the expense at a minimum. Once we saw the value they brought, resources for it grew over time with some pretty big contracts that need to be reworked. Along the way, I was able to short track some contract work and long track more complex negotiations which really helped keep the costs down. They did a great job customizing their service to meet my needs and target my priorities. I would definitely recommend DataDx to any organization looking for help with payor contracting.”

Judy Carroll, MBA, CMPE; Administrator, SEPS
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