These days Buffalo may be synonymous with chicken wings and the Buffalo Bills, but nearly two centuries ago, following the opening of the Erie Canal in 1825 and the construction of railroads in the late 1840s, the city became a commercial and industrial hub for a burgeoning nation. Transportation of raw materials through the city sparked the development of several industries, including iron and steel, but also led to the growth of agricultural equipment makers, dry-good and grocery stores, flour mills, furniture makers, and clothiers, among others.
One MGMA Better Performer group is carrying Buffalo’s tradition of innovation forward through effective EHR optimization. Buffalo Medical Group (BMG), one of the largest and longest-serving physician-directed group practices in New York State, earned MGMA Better Performer status in two categories in 2022.
Buffalo Medical Group, Buffalo, N.Y.
- Founded in 1946 by Drs. Ramsdell Gurney, Murray S. Howland Jr., George F. Koepf and Frank Meyers. It is one of the oldest and largest physician-directed group practices in the state.
- 850 employees, including more than 100 doctors and specialists, at four primary offices.
- MGMA Better Performer in Profitability and Value
A physician-owned multispecialty practice, Buffalo Medical Group has 34 surgical and medical departments, including primary care, family medicine, internal medicine, cardiology, dermatology, OB/GYN and podiatry. In addition, BMG also provides clinical support services, such as behavioral health, imaging services, laboratory services, palliative care and pharmacy services, among others.
Profitability* and Value**
As an MGMA Better Performer in Profitability, BMG surpassed MGMA’s criteria in the following areas:
- Less than the median for total operating cost per work RVU (MCT: $80.02; MSP-PO***: $89.33).
- Less than the median for total cost per total RVU (MCT: $65.00; MSP-PO: $69.95).
- Less than the median for total operating cost as a percent of total medical revenue (MCT: 52.52%; MSP-PO: 60.12%).
- Greater than the median for total medical revenue after operating cost per FTE physician (MCT: $599,199; MSP-PO: $599,199).
*Data from 2022 MGMA DataDive Cost and Revenue, based on 2021 data.
**To qualify in the Value category, a group must report quality metrics and achieve Better Performer status in at least one other category
***Multispecialty, physician owned
BMG prides itself in providing innovative care for its patients. At the heart of this is the belief that technology can play a big role in patient satisfaction.
Using technology to engage patients
EHRs are no longer just for billing and reimbursement; they offer many features that can benefit patients, including patient portals, appointment management, scheduling, medical templates and e-prescribing. Even though the Office of the National Coordinator (ONC) for Health Information Technology reported in 2021 that more than 88% of office-based physicians had adopted EHRs,1 not all organizations get the full bang for their buck.
That’s not the case with BMG. “We really try to use our EHR platform to its full capacity,” says Chief Financial Officer Deborah Bauer. “The less that we have to engage outside third parties to do things, the more seamless that is.”
For BMG, this starts with care access. For patients, the convenience of self-scheduling appointments through the EHR’s portal sets a positive tone for one of their first points of contact with providers.
“If somebody cancels an appointment, it makes it possible for patients not to have to wait for someone to call them; they can check to see if appointments open up,” notes Bauer, adding that patients don’t have to worry about making multiple phone calls to the practice, which “improves access and wait times a little bit.”
Bauer maintains that many of the providers recognize the benefits of self-scheduling. “Those who have opened it up in the physician office said it works great and they have fewer no-show slots that are open because they’ve allowed that option,” she says.
Patients also fill out paperwork online prior to their appointment. “We don’t even hand out paper anymore. … We got 99% of that out of the offices,” Bauer says. Before patients arrive at the office, BMG verifies eligibility electronically through its local Health Net for 96% of its patients to save time at check-in.
Beyond the front desk, BMG also offers online and kiosk check-in at clinic locations. A self-check-in app allows patients to confirm arrival up to 30 minutes before an appointment.
Once arrival is confirmed, patients are checked in automatically if the practice is not missing any information. “We have about 30% who are using the e-check-in and 10% who are using the welcome kiosks in our main locations,” says Bauer.
The practice also offers phone and online payment options for patients, including a software program with an automated teller, which allows patients to simply press a number on their phones to pay their bill and offers a guest option when paying online. “If somebody wants to pay something on your behalf, then they can just go online and pay it,” says Bauer, noting that they just need your account information.
Before patients pay their bill, they have a good sense of what they owe: BMG’s price estimation tool includes 95% of the practice’s fee schedules. “It seems to be popular,” says Bauer. “Instead of having to call patients and tell them what the estimate’s going to be, they can go online and look at it ahead of time.”
In addition to copays, the practice has a prepay program and payment plans. For example, Bauer notes that because oncology services can be expensive, BMG allows patients to pay in installments.
“If patients meet certain criteria, certain dollar amounts, they have a time period that they can pay their bill,” she says. “Sometimes they’ll even start it before their appointment just so they can get a heads-up … so they don’t get a big bill all at once.” She adds that this can all be done online, where patients can also add a credit card through a third-party vendor.
Virtual appointments
During the pandemic, BMG started offering telehealth services via Zoom, but shortly thereafter the practice shifted to ramp up virtual care through its EHR. BMG’s EHR vendor “has some opportunities for current customers to jump on board with new offerings immediately,” Bauer notes. “It doesn’t come at a high cost if you’re one of the early clients to implement these services.”
This made it easier for patients to schedule virtual appointments directly through the EHR. BMG also offers training for patients. “If you have a telemedicine appointment coming up and you don’t have any idea how to do it … you can contact one of our trainers and they’ll set up a test appointment,” she says. “Then the trainers will navigate you through so you’re not fumbling at the time of your appointment.”
Bauer points out that most of BMG’s patients, who are covered by Medicare, have embraced the group’s telehealth offerings. “They’re the best utilizers of technology,” she says. “They use these services a little better than the younger generation with training and trying things out ahead of time so they know that it works.”
Telehealth has been particularly beneficial for older patients during the winter months, when getting to their doctor’s office is no easy task, especially if rescheduling the appointment will take too long. “We’re in Buffalo, so inclement weather is a given,” asserts Bauer. “Once snow starts to fly or it’s a little bit cold or icy out, telehealth visits become a little more popular for their annual wellness visits. … Wherever it’s clinically appropriate, our doctors are able to do telehealth appointments.”
Key performance indicators and benchmarks
Bauer notes that BMG presents performance information to physicians in two ways: financially, via a dashboard, and clinically, via the practice’s EHR. The former provides their monthly statements, their billing and collections information, and patient panel size for primary care providers. The latter allows providers to view their quality metrics goals, such as the Healthcare Effectiveness Data and Information Set (HEDIS), in value-based care programs such as MIPS.
“We try to home in and focus on the measures that matter,” says Bauer, adding that HEDIS measures are quite important, because meeting them can bring in additional quality revenue outside fee schedules. Since the practice primarily has a Medicare Advantage population, it focuses on developing programs for the aging.
Related to performance, BMG reviews clinical goals annually. Bauer expresses that “If a provider sees red [when reviewing clinical measures], then they should focus there. Green, you’re doing good, so don’t change what you’re doing.” She also notes that BMG is constantly streamlining the data it shares with physicians, because there’s so much available to them.
For financial data, BMG’s EHR has a revenue cycle dashboard to benchmark with national performance. “We gauge ourselves constantly to see how we’re doing with other entities that are similar to us — size-wise, multispecialty, outpatient-only,” she says, noting that the dashboard is typically updated each month, which provides near-real-time information. There is also a feature that allows BMG to reach out to comparable practices on the same EHR to potentially share best practices.
BMG also uses MGMA DataDive to dig into practice data and fill in gaps. “We can get a little more granular detail on things that aren’t on the clinical benchmarks,” she notes, particularly when it comes to staffing information and operations. When it comes to compensation, the practice strives to stay around the 75th percentile and values being able to compare itself to specific specialties in other areas.
That said, according to Bauer, it’s difficult to compare the Buffalo market to other cities when taking a regional view regarding provider compensation. “It’s harder for our market because it includes areas like Albany, Boston, and sometimes even New York City,” says Bauer. “We do look at our local market, because we know what we can compete with locally.”
She adds that in the Buffalo area, BMG mostly competes with hospitals and can typically offer a better work-life balance. “We hope that offsets higher salaries, because we don’t work nights, weekends, and holidays, and we don’t have 10-, 12-hour shifts for the most part, unless providers are in the hospitalist program,” she says, noting that physician compensation is productivity based.
By participating in value-based care, BMG keeps a close eye on benchmarks for coders and claims. “It determines how many staff we need based on the volume, and since we have risk-based contracts, there is a different level of coding for risked-based coding,” says Bauer. “Coders are tracked by hour and by day … and we track them on charge lag so we can determine how long they’re taking.”
The coding process starts when a patient makes an appointment, which creates an encounter in the EHR. Bauer notes that providers are pretty good with providing basic information. Coders then focus on accuracy, and a scrubber will kick out anything that’s coded improperly.
“If claims go through the scrubber clean with all the rules built in by the carrier, then they go out the door,” says Bauer. “If not, a coder will have to step in and look at the work queue to see why it kicked it out.” She adds that this policy may stand in the way of matching other practices’ metrics for getting claims out, but BMG does not typically have many denials.
As for managing the small number of denials, BMG assigns work queues to coders by specialty, which allows the practice to track performance and compare benchmarks in its EHR by specialty. “As a multispecialty group, we do them by specialty because not all carriers allow the same things even within the same specialties,” says Bauer. “We have workers comp and Medicaid that one person works just because we don’t have as much volume.”
Focusing on the well-being of providers and staff
Medical group practices continuously look for ways to help reduce stress and the effects of burnout on providers and staff and help them feel valued. BMG developed several initiatives for promoting employee well-being.
According to Bauer, this starts with BMG’s employee assistance program (EAP). “We have a very robust EAP program, so we have a lot of training tools that we engage employees to work on,” notes Bauer. “We give them tips about things that might be best to focus on based on feedback we get from patients or related safety or other things that are going on in the community so they don’t have to go through thousands of sources.”
The group’s leadership team prioritizes visits to each of BMG’s locations and established a well-being committee to address physician burnout. For example, during the summer the chief executive officer, medical director and other members of the leadership team delivered ice cream to each location. Bauer notes that this was a great icebreaker to spark conversation and make interaction less awkward between the leadership team and staff.
Separately, a door decorating contest, focused on the beloved Buffalo Bills, paired providers and staff together, helping them to engage and get to know each other. “It’s difficult having as many people as we do in multiple locations, so we want to ensure that nobody gets left out,” says Bauer. The contest was so successful that BMG has planned other team contests in the coming months.
Keeping costs down
To help monitor financial health, BMG conducts an annual review with outside auditors. The practice also presents its financial information to its finance committee and board each month.
“We don’t go into every detail line item by line item, but since we’re physician-owned, we are productivity based, so everything that the physicians earn, they want to know where that’s going because it impacts compensation,” says Bauer. She adds that since the physicians are shareholders, they can join any committee, including every financial committee.
As is the norm in healthcare, BMG’s biggest expense is labor. As such, Bauer notes that the practice strives to find the right balance with staffing. “We’re looking at how we can best serve everybody by having the right people in the right job and the right ratios,” says Bauer.
This is made more challenging by the practice’s location. “We’ve got a large market equity increase in New York State and in our region, and we’re competing with nonhealthcare service entities here,” says Bauer. “If we can’t fill a position with a person, [we look for] an automated way to do that.”
The next biggest expense, according to Bauer, is supplies. To keep on top of rising expenses, BMG has a budget and audit committee. “We review our contracts every year or two depending on how long they’re for,” says Bauer about determining whether they have the best pricing or may need to consider changing vendors.
Even though BMG works with a group purchasing organization (GPO), inflation has impacted savings. “It’s becoming challenging to save money because the GPO is the middleman to the vendor, and depending on how much volume we get from a particular vendor, is there consolidation?” she asks. “The savings are there but not as much as there used to be.”
Other prominent expenses that have become palpable recently are the cost of drugs, which Bauer says has been challenging to address, particularly as reimbursement continues to decrease, and cyberinsurance and liability insurance. “We didn’t used to have to worry about liability insurance,” notes Bauer, “but it’s something we have to put in place just in case,” pointing to the racially motivated mass shooting at a Buffalo supermarket last May.
As BMG continues to grow, the practice has to account for building costs. “Construction is very expensive, and even doing small modifications and maintenance is becoming costly,” says Bauer.
On the other hand, she notes that there’s more land available for expansion than there has been in a while. However, this has created another issue: “We’re expanding into another location … but you can’t get connectivity out there quick enough to expand into that space,” she says.
Note:
- HealthIT.gov. “Office-based physician electronic health record adoption.” Available from: bit.ly/3A3nbRK.
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