Overview: About Bay Area Emergency Physicians
Bay Area Emergency Physicians (BAEP) is an independent physician group that serves emergency departments in the Tampa Bay area. Based in Clearwater, FL, BAEP treats 130,000 patients each year at two hospitals and one standalone emergency facility in Pinellas and Pasco counties. This area on the West Coast of Florida is home to many elderly residents and has a high concentration of nursing homes and assisted-living facilities. With such a vulnerable population, recent changes to coding standards could have hampered the practice’s ability to serve the community needs, but a partnership to optimize RCM ensured their growth and success.
Being Prepared
Like physician groups everywhere, BAEP has had to adapt to the January 2023 update to the AMA’s CPT coding guidelines for hospital-based Evaluation and Management (E/M) services, the first significant change to these guidelines in 25 years. The AMA said the changes were meant to reduce the administrative burden and simplify what had been an arduous process, but it has created a steep learning curve for emergency medicine practices. Industry experts estimated early on that emergency departments could see a short-term 15% to 17% reduction in Level 5 charges, with many physician and RCM companies facing difficulty in adapting to the new guidelines.
This has not been the experience of BAEP and Ventra Health, who partnered in May 2022 to take a proactive approach to prepare for the update. Experts from Ventra’s Provider Education team worked with BAEP practice leadership to train clinicians before the rollout. As a result, BAEP has seen an increase in revenue for their services.
“We did not see the loss in revenue that we were expecting because we were prepared in time for the changes to begin,” says Haley Todsen, DO, Board Chair and Director of Business Development and Recruiting for BAEP. “That has everything to do with how Ventra is educating our providers.”
Led by Nettie McFarland, Ventra Health’s Director of Provider Education for Emergency and Hospital Medicine, the education collaboration has included:
- One-on-one training for each of the 60+ physicians, advanced-practice providers, and nonclinical employees
- Providing customized reports to each provider, pulling individual charts to show which ones were down-coded and why
- Ensuring that clinicians and coders follow best practices for complicated documentation issues, such as split/shared observation visits
“We did not see the loss in revenue that we were expecting because we were prepared in time for the changes to begin.”
~ Haley Todsen, DO, BAEP
Customized Support
BAEP’s documentation is further challenged by its population, which includes a higher percentage of patients with complications and comorbidities than the national average.
“We’re seeing more critical care CPT documentation from their group, and they are achieving leading practice benchmarks for critical care documentation,” notes Gilda Romero, Vice President of Client Success for Ventra Health.
The new guidelines emphasize medical decision making, which enables reimbursement for activities such as consults with specialists and diagnoses considered but ruled out. However, this also requires physicians to be better at “showing their work,” creating an even greater need for accurate documentation with high-acuity patients.
Several of BAEP’s providers have been practicing medicine for 30+ years and using the old E/M coding rules for their entire career. By tailoring the training to each provider’s needs, Ventra helped Dr. Todsen deliver a training solution that was efficient and impactful for each provider.
“You cannot teach 60 physicians the same way. You have to know the personalities of each of your physicians and individualize how you’re going to teach them. Ventra helps us do this.”
~ Haley Todsen, DO, BAEP
Ongoing RCM Optimization
Once the provider documentation issue had stabilized post coding guideline implementation, Dr. Todsen and the BAEP leadership partnered with Ventra’s specialty teams to optimize their entire revenue cycle.
- The Data & Analytics team gives BAEP visibility into their provider production metrics and financial performance through specialized monthly reports and real-time dashboards.
- The Client Success team follows trends carefully to ensure BAEP stays informed and agile. When Medicare lowered its ED reimbursement for the first three months of 2024, Ventra’s diligence helped prevent a decline in revenue.
- The Provider Education team provides specialized training to help BAEP physician’s follow the most current coding guidelines or address problem areas.
- Analysis from Coding & Billing experts enabled the team to increase BAEP’s overall net collection rate materially.
- BAEP is currently working with the Payer Strategy & Contracting team to review and renegotiate payment terms.
Download Success Story as PDF“The whole purpose of my job as a director of a democratic practice is to make sure we’re not leaving money on the table. That’s where this partnership is so important.”
~ Haley Todsen, DO, BAEP
