Empowering an Independent, Physician-Owned Emergency Medicine Practice with Data Analytics and Education

Overview: About WEMS

Westmoreland Emergency Medicine Specialists, P.C., (WEMS) is one of the few remaining democratic, independent physician groups in its region. Located in Westmoreland County, PA, WEMS contracts with three medical facilities, each with very different patient and financial personalities. Their communities range from densely populated and affluent to more rural with a larger Medicaid population. Western Pennsylvania is also known for its significant population of older adults, and a third of the patients WEMS serves are Medicare recipients. This wide variation in patients and financials requires sophisticated data analysis and ongoing provider education to ensure the practice performs at the highest level. 

A Long-Standing RCM Partnership

For nearly 15 years, WEMS has relied on Ventra Health for data-driven, comprehensive business solutions. The Ventra team has more than 40 years of experience managing the complexities of revenue cycle and practice management for Emergency Medicine and other facility-based specialties.

Each Ventra Health client is supported by a dedicated team who are experts not only in RCM but also in the specific needs of the medical specialty. Committed to white-glove service, they work with clients to optimize the entire revenue cycle—from providing physician education to improving documentation, from leveraging best-in-class data analytics to reducing denials to optimize and improve practice performance.

Beyond standard billing and coding, Ventra’s services for WEMS also include:

  • Identifying performance and staffing gaps
  • Providing predictive analysis for current and future financial needs
  • Assisting with managed care contract negotiations
  • Educating WEMS doctors on how to navigate charting and regulation changes

“Despite being in a challenging socioeconomic area with one of the fastest-growing aging populations in the country, WEMS has consistently maintained a higher-than-average range for collections per encounter,” says Bryana McGill, SVP of Client Success for Ventra Health. “Those are impressive results for their region.”

Data Analytics that Drive Performance

Ventra’s deep dive into WEMS’ analytics includes standard financials, but also reports on productivity, stability, staffing, and even ad hoc specialized reports like a recent one on observation patients in the ED.

To help WEMS understand the diverse patient populations they serve as ED physicians, Ventra generates reports per reimbursement category, such as commercial insurance, self-pay, or government reimbursement like Medicare, Medicaid, TRICARE, or the VA.

“Oftentimes, Medicare makes a change first and other insurance companies follow. When Ventra alerts us that a Medicare change is coming, it hits home with our providers very clearly,” Dr. Walker notes. “And, when one entity makes a change, Ventra helps predict how our income will be affected over the next quarter or year. Even a small change can financially impact the larger picture.”

Ongoing Education Optimizes Reimbursement

  • Physicians at WEMS are co-owners with a joint interest in its success, so continuing education is essential both for the performance of each provider and the financial stability of the practice as a whole.
  • Ventra provides training classes and online resources to keep WEMS physicians up to date on regulations and policies that impact their billing. They also provide individualized feedback to help physicians improve their documentation and capture the details needed for accurate and complete billing.
  • When the AMA rolled out the new E/M coding guidelines in 2023, for example, WEMS was prepared. Ventra held a series of webinars, issued white papers and FAQ handouts, and provided physicians with documentation feedback to help them navigate the change.

Looking Forward

  • As a longtime client, WEMS’ day-to-day financials are running like clockwork, so the Ventra team continues to look for opportunities to optimize. The team now meets with Dr. Walker before key business meetings, providing custom reports and contributing exhibit slides.
  • “We are there for WEMS not only to help with operations, but also to help them think strategically to achieve their financial goals”, says Neil Makhija, Director of Client Success at Ventra Health. “We embrace being trusted advisors for Dr. Walker and her team.”
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