Management Essentials

What a Consultant Can Do for Your Practice

An adviser can give employment law advice and navigate managed care.

By Farrell “Toby” Tyson, MD, FACS

Ophthalmologists and administrators are endowed with great confidence and knowledge. Yet, what usually makes us so successful is often what leads to our greatest failures. Our confidence and “know-it-all” attitude can become great liabilities.

Throughout history truly great leaders surrounded themselves with great advisers. King Henry VIII had Sir Thomas More, Queen Elizabeth I had Sir Francis Walsingham, and even President George W. Bush had Colin Powell. These advisers used their wisdom and experience to navigate conflicts and effectively advance their superior’s agenda.

Advisers in the form of consultants are available to ophthalmology practices to provide outside assistance, cumulative knowledge, and advise on contracts.

A Legal Safety Net

Consultants are prevalent in every industry. Over time, they have been given a bad name as an expensive opinion in line with whoever is paying the bill. However, the real problem arises when practices don’t really know what questions to ask their consultants.

When engaging a consultant, you need a clear idea of what information you are looking for. You want their reports broken down into observations, assessments and, most importantly, an action plan. This action plan needs to be detailed and obtainable. Too often a practice gets a list of deficiencies, but no course of action to correct or improve them. It is hard enough to teach someone to cook. It is even harder if they don’t get a cookbook.

Many practice administrators feel they only need consultants in times of turmoil. On the contrary, every practice should consider having different consultants on retainer. We have found it beneficial to retain a labor lawyer for our practice. This allows us to have basics such as our employee handbook or letters of engagement looked over by an attorney specializing in this area. When employment issues arise, it helps to have a relationship with someone who can give immediate advice to keep the practice out of legal trouble.

Spending to Save

Practices tend to bring in consultants every couple years to evaluate their billing habits and collections. While this should occur on a scheduled basis to prevent revenue loss, one should consider engaging in an on-call arrangement with a coding consultant.

This is not very expensive. Miscoding can now result in not only repayment, but also fines and other penalties. Since there are constant modifications to CPT codes, modifiers and bundling, few practices can stay on top of all the information. An on-call coding consultant can give you quick, definitive answers to coding and coverage questions. The time saved alone will usually pay for the service.

Getting Your Dollar’s Worth

One advantage of using a consultant is the ability to leverage their scale of knowledge derived from assisting multiple practices. When contracting with a managed-care organization , most practices feel helpless. They think insurance companies view them as small and insignificant. This perception leads to a lack of leverage, resulting in a take-it-or-leave-it style negotiation.

A consultant that specializes in managed-care contracting can help level the playing field. These consultants come armed with the knowledge of what the insurance companies are truly ready to pay and what they have negotiated with other practices for similar services. What’s more, these consultants have the personal contacts with the right people in the insurance companies so they get fair treatment.

Use a managed-care consultant primarily for your large insurance providers. You will get the most bang for your buck. Also, most contracts only need to be renegotiated every three years so the cost of the consultant can be spread over that time.

Not every consultant is right for every practice. The best way to find what will work for you is to look at similar practices and see which consultants helped them. As in our business, word of mouth is the consultant’s biggest driver. OM

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.