Financial viability of a hepatology practice

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Abbreviations

EHR

electronic health record

PQRS

Physician Quality Reporting System

RVU

relative value units

1.

In a comparative study of downstream revenue of gastroenterology and hepatology patients in the tertiary care center, Cohen, Jensen, and colleagues1 found superior financial benefits of the hepatology patient. Despite this finding in the tertiary care center, without the procedures of the gastroenterologist, it has been assumed that the financial feasibility of private hepatology practice would be challenging at best. With the increased disease burden of hepatitis C virus and nonalcoholic steatohepatitis that the United States is now facing, there is an increased need for the private practice of hepatology.2, 3, 4, 5

Despite the fact that there is very limited evidenced‐based data regarding the economic viability of the private practice of hepatology, there have been a number of successful hepatologists in this setting to date. Furthermore, data suggest that the advent of the electronic health record (EHR) has made a significant contribution to this success. Given the complexity of the hepatology patient, the EHR maximizes the ability to bill at the highest level of care.6

In addition, provider referrals, patient referrals, and practice diversification are all critical for financial success. Growing your practice is also an area of focus to better achieve financial success.

2. Provider Referrals

The mainstay of any successful practice is provider referrals. Accessibility and prompt follow‐up are tantamount to this end. A primary source of provider referrals is through the use of the EHR. The EHR provides patient follow‐up in real time to referring providers. As such, it is a very valuable advertising tool. In addition, attending at community hospitals is a valuable means of connecting with referring providers. Developing partnerships within the community and local medical centers for opportunities and medical directorships is always useful in acquiring more patient referrals. Direct marketing, community lecturing, and the use of social media (e.g., LinkedIn) are invaluable means of increasing provider referrals (Table 1).

Table 1.

Provider Referral Sources

Real‐time follow‐up via EHR

Direct marketing to community physicians

Connecting through community hospitals

Provider involvement in the community

Social media (e.g., LinkedIn)

Lecturing

3. Patient Referrals

Patient referrals are another important source of referrals. Never underestimate the power of the patient or the social media they use to help you or hurt you. To this point, patient satisfaction is critical in keeping patients and building patient referrals. There are a number of proven measures in guaranteeing this success. Some of those measures include using a patient portal (an electronic connection of the patient and his or her chart to his or her providers), quality time with the provider, and an individualized Web site offering resources and links for patient‐related care (http://phcgi.com).7 In addition, increased accessibility for acute illnesses with same‐day appointments, an on‐site laboratory for blood draws, a knowledgeable and responsive staff, and provision of clinical summaries at each visit will boost patient satisfaction. Initiating a patient support group has also been shown to improve patient satisfaction and increase patient referrals (Table 2). Most importantly, never forget that patients do not care how much you know until they know how much you care.

Table 2.

Patient Referral Sources

Patient satisfaction

Patient portal: electronic connection of the patient and the patient's chart to his or her providers

Quality time with the provider

Individualized Web site offering resources and links for patient‐related care

Increased accessibility for acute illnesses with same‐day appointments

Knowledgeable and responsive staff

On‐site laboratory

Clinical summaries provided at each visit

Initiation of a patient support group

4. Practice Diversification

Practice diversification can increase revenue to your practice and includes means such as offering an on‐site clinical laboratory, developing a clinical research department, implementing a wellness program, lecturing, and adding new technologies such as transient elastography. When developing a clinical research department, it is important to account for the time spent as a principal investigator when considering budgets for clinical trials. It is imperative to ensure fees for specific study‐related activities, such as physical examinations, are included in the budgets, along with an overall investigator fee at each visit. Ways to determine appropriate amounts of compensation can include calculating relative value units (RVUs) based on time required or by consideration of fees on a case‐by‐case basis with each sponsor. Although transient elastography has not proven to be a valuable direct source of income, it provides other benefits, including physician referrals and improving level of assessment affecting efficiency related to clinical decision making, and it meets requirements needed for new research studies.8, 9 Finally, partnering with community and local medical centers for teaching opportunities or medical directorships can serve as a source of revenue to the private hepatology practice.

5. Growing Your Practice

A competent office manager is needed to keep up with the ever‐changing federal laws regarding patient care, private practice, and most importantly, reimbursement in this ever‐changing health care landscape. In 2017 the Medicare Access and Chip Reauthorization Act of 2015 goes into effect. As well, the Physician Quality Reporting System (PQRS) is Medicare's new pay‐for‐performance program where final payment in 2017 is determined by successful reporting of the PQRS measures.10

Another area of growing your practice and adding important revenue is through the utilization of physician extenders. Likewise, adding additional hepatologists to the practice will provide valuable revenue as accessibility to your practice dictates.

Growing your practice will also require continued visibility in your community, involvement with local teaching hospitals, and as previously mentioned, involvement with patient support groups and lecturing locally and regionally.

Also important to growth of your practice is joining professional organizations. Professional organization membership provides benefits to the hepatologist, as well as the practice, including a source of continued education, networking, and keeping up with current standards and policies.11

Finally, investing in yourself can never be underestimated. Learning new techniques and technologies as they develop, developing specific areas of interest and expertise in hepatology, and participating in continued education and recertification will likely end in a financially successful private practice of hepatology.