In this Money Tree Series Episode #8, Coach JPMD talks about the role played by hospitals and their influence on the Money Tree. He discusses how they impact the flow of money from insurance companies and care providers. The Money Tree Series episodes are geared to helping physicians and other healthcare providers learn the ins and outs of running a successful Medicare Advantage practice. You can download the money tree diagram at www.coachjpmd.com/moneytree.
Don’t forget that Coach JPMD helps physicians go from overwhelmed to confident while increasing their income in 90 days or less. Book a call using this link to learn how you can decrease your stress and earn more. Our goal is to help you understand the business of medicine and Practice Impossible.
Welcome to the Practice Impossible Podcast. We're your host, Jude Pierre MD, also known as Coach JPMD discusses medical practice topics that will guide you through the maze that is the business of medicine, and teach you how to increase profits and help populations live long. Your mission should you choose to accept is to listen and be transformed. Now, here's your host, Coach JPMD.
Coach JPMD 0:26
Welcome to the Practice Impossible Podcast with your host, Coach JPMD. That's me. And if you have heard any of the money tree series episodes before you know that I love that sound, because that means that we're going to be talking about money.
So today's money tree series is on hospital expenses. And as you know, we started this series a couple months ago, to detail how monies flow from the government to your pockets as primary care providers as specialists as ambulatory surgery centers as hospitals. Today, we're going to be talking about hospital expenses and how it impacts the revenue stream of a managed care panel, or of a patient population in the managed care world. If you haven't had a chance, go to www.coachjpmd.com/moneytree and you can download the PDF of the money tree and the flow of what I've described in the previous episodes.
So I'm not sure if in previous episodes, I've talked about the 80/20 rule. But the 80/20 rule is like is the Pareto Principle, which kind of states that 80% of your efforts will lead to 20% of your results. And that goes, that's true for many things in the world of finance in the world of efforts that you produce. And in the hospital expense world 20% of your patient population will account for 80% of the expenses out of your managed care panel. And that is a rule that I've seen over the past 20 years apply to my Medicare Advantage panel. And hospital expenses are big expenses. So if there's any way for you to help decrease hospital expenses in your Medicare Advantage practice, that's where you're going to make a lot of money, or at least save a lot of money in your managed care population. And so if you save money in the Medicare Advantage world, then that means more money is going to come to you in your pocket when the when the pool of monies are distributed at the end of the month. So in the course on learn about Medicareadvantage.com, I described what a medical loss ratio is. And I bring up medical MLR medical loss ratio, which is the total expenses paid for services in a Medicare Advantage world that's divided, or that's over the premiums paid to the insurance company.
So what does that mean? So if you understand the medical loss ratio, and you understand that 20% of your hospital expenses accounts for 80% of the monies that are flowing out of your managed care population, you'll understand that the ratio that you want your your medical loss ratio to be low, so you want your medical expenses for services to be much, much, much lower than the total premiums paid by the insurance company for services rendered. Because then that means there's more money to care for other patients in your managed care panel. And it allows you to also receive bonuses at the end of the month. So in order to decrease the total expenses or your medical loss ratio, you want to do a couple of things in your practice. And what I'm going to do is describe five things that you can do in your medical practice that can help improve your medical loss ratio, and increase your bottom line revenue or top line revenue and your practice. Prove your bottom line I should say.
So there's decreasing ER visits. So how do you decrease ER visits in your practice? Well, one of the things you can do is be available. If you're never in your office, and you're only working half days or you're only in the office a couple of days a week, and your patients are sick. If they know that you're not available or they don't feel as though you're available then they are going to go to the emergency room. And as you know as primary care providers. If your patients at the emergency room. Many times they get admitted to the hospital, which will increase your medical expenses and which will contribute to an increase in your MLR. So one of the things I do in my practice is have a triage protocol. So I decrease your visits by becoming avail making myself available but we also have triage protocols that allows patients to speak to the provider or a nurse or someone that's knowledgeable Another practice, that can help decrease the anxiety of patients so that they don't go to the emergency room.
So triage protocols are really important things that at least we do, where if a patient calls with specific complaints, we get the providers instantly. And we try to bring them into the office as quickly as we can. I kind of said, the third thing in the first thing, so decreasing your visits by making ourselves available that's number three, make yourself available, even if you're not available in the office, but at least be responsive to your patients. So they call the office and want to be seen or heard. Because a lot of times when patients hear your voice as a trusted provider, then they will, they will go to the emergency room.
Fourth thing is decrease the length of stay by staying involved in your patients while they're in the hospital. So one thing that we used to do, and I'm hoping to implement in the near future with my new hire, is a way of following patients that are in the hospital on a daily basis. What does that mean? So if you're a primary care provider, and you don't go to the hospital to see your Admitted patients, you probably have a hospitalist that are set seeing your patients. Well, sometimes there are things that are done in your office, you may know the patient, you may know the patient's family, families better than the hospitals, and just being involved in their care will allow you to help decrease the length of stay, thus decreasing expenses and improving your medical loss ratio. So that's number four. And number five thing and there's more, but I'm just listing five today is see your patients once they're discharged from the hospital. So if a patient goes to the hospital, you follow them every day in the hospital, through a phone call through consultation with your primary care with the hospitalist that is or with a specialist, as soon as they're gonna get discharged, bring him into your office, so that you can then follow up with them and decrease the risk of them having a readmission, which would then increase your medical loss ratio, and increase your expenses.
So those are the five things that I feel that you can do to help decrease your expenses because hospital costs are the biggest driver of medical care in a managed care population. And like I said, at the beginning of this episode, you can download the money tree diagram, with all the things that we've discussed in previous episodes. And if you go through the list of podcasts, you'll see that every money tree series has it labelled as the money tree, and the subject that's been discussed on there. So again, it's www.coach jpmd.com/money tree. I'll have links to that, that diagram as well as links to the course, that you can look and even take a free course. Because our goal is to help you practice impossible is to help you understand the business of medicine, help you decrease stress, increase your revenues. I know it sounds like a mouthful, but that is my mission is to help you as primary care providers as specialists, as care providers in the managed care space is to help you understand this world better. So thanks for listening. Thanks for leaving a review. Thanks for helping me on this journey. And we'll see you in two weeks.