Santa Fe Pathology Services (SFPS) includes four board-certified pathologists who serve the greater Santa Fe area. The group is affiliated with Christus St. Vincent Regional Medical Center and Los Alamos Medical Center, and is associated with the Endoscopy Center of Santa Fe. SFPS also provides services for a number of physician practices throughout northern and central New Mexico.
Managing a pathology practice has grown evermore challenging with increased billing complexities, changing payer regulations that can lead to more denials, and reduced reimbursement levels. But when the COVID-19 pandemic hit the U.S. in early 2020, most practices faced the challenge of a lifetime: how to continue serving patients, keep staff safe, and maintain financial stability with significantly reduced volume.
Contributing to this chaotic environment were the multiple government relief programs designed to financially assist healthcare providers, including the Medicare Accelerated and Advanced Payment Program; the Department of Health and Human Services (HHS) provider relief funds (three rounds); the Paycheck Protection Program (PPP); and the Health Resources and Services Administration Claims Reimbursement for Testing and Treatment of the Uninsured.
Fortunately, SFPS had an ally in Change Healthcare, which had been managing their billing since 2007 and providing Physician Group Management Services since 2018.
Change Healthcare experts helped SFPS in three key areas: evaluating and accessing government financial relief, assessing and adjusting the practice’s budget to reflect the pandemic’s impact, and negotiating favorable contracts.
In March 2020, Change Healthcare’s Practice Management Services team immediately began evaluating the various government relief programs to determine which programs SFPS should apply for and what was involved. They then updated the practice regarding which programs required applications and next steps for accessing aid.
The first day the PPP application portal opened, the team assisted SFPS in gathering all the requisite information and submitting the application, using screensharing capabilities to walk them through the process. Then, throughout the year continuing into 2021, they kept the practice apprised of the Small Business Administration’s review of their PPP loan status.
Next, the team helped SFPS interpret the terms and conditions of accepting HHS financial relief, and helped it attest to the first two rounds of funds.
“Change Healthcare’s guidance alleviated much of the stress associated with the turmoil of the pandemic,” says Stephanie Rosen, M.D., SFPS. “We were impressed that our small group received this level of attention.”
As SFPS waited to hear back on financial relief, the practice management team began to deliver weekly “Flash Reports” to provide some level of predictability regarding procedure volumes and forecasted collections.
In mid-March, Change Healthcare’s financial management experts began advising the practice, recommending it adjust expenses and update its budget to better position the group for the short term, while being careful not to jeopardize longterm stability. For example, the practice was advised to reduce administrative expenses and accept a temporary reduction in compensation, with careful calculations to avoid jeopardizing its eligibility for PPP loan forgiveness.
As volumes began to recover in June 2020, the team worked with SFPS on updating its budget to be less stringent in managing expenses. As SFPS’s financial position began to stabilize, its confidence in making strategic decisions increased.
“We were able to recruit and retain a highly qualified pathologist triple board-certified in anatomic/clinical pathology and hematopathology,” says Rosen, “and we give a lot of credit to Change Healthcare’s expertise and diligence in 2020, as that was instrumental to our group’s financial position.”
While navigating the pandemic was SFPS’s priority in 2020, the group knew it had to address other challenges for long-term viability. Change Healthcare’s Consulting Services helped with two initiatives to position the practice for the future.
First, one of SFPS’s key customers, the Endoscopy Center of Santa Fe, asked the group to join a global payment arrangement. This program resembles a narrow network and is designed to reduce overall costs, which in turn helps drive additional volume. Under this arrangement, SFPS would be paid a case rate.
Because SFPS had minimal experience with these types of arrangements, the consulting team helped them navigate all facets of the written agreement, which included negotiating the case rate as well as nonfinancial terms.
“The team demonstrated their expertise with the negotiated financial terms as well as by ensuring certain key protections were included,” says Rosen. “This experience will provide us with the confidence we need to make decisions on similar arrangements in the future.”
Secondly, the consulting team also assisted SFPS with an ongoing challenge: negotiating a more favorable reimbursement rate with its highest-volume commercial payer. The practice had tried to improve the agreement for many years, and had even used an outside consultant to no avail. But after nearly five months of negotiations, the Change Healthcare team secured a sizable rate increase which will continuously benefit SFPS for many years.
If you’d like to learn how Change Healthcare’s Physician Group Management Services could benefit your practice, visit our website. You can also read about how we helped another pathology practice here.