In a May 10, 2022, MGMA Stat poll, 55% of practices noted that visit volumes this year are higher than they were in 2021. As care demands increase along with rising expenses due to staffing, drug supply, information technology, etc., some practices may want to consider adding diagnostic or supportive care to potentially add revenue, as well as help to improve patient experience and outcomes.
An Oct. 25, 2022, MGMA Stat poll found that 28% of medical groups added an ancillary service in the past year, while 72% did not. The poll had 472 applicable responses.
For those who responded, “yes,” the types of services most frequently added were:
- Behavioral health
- Laboratory tests.
For those who responded “no,” 29% said that they plan to add ancillary services in the next year, while 68% responded that they don’t plan to add them and 3% were unsure. One respondent noted that their practice will only add ancillary services “if we can get back to usual staffing levels; we are limiting schedules for normal visits as it is."
How ancillary services can benefit practices and patients
During the early stages of the COVID-19 pandemic, medical group practices’ ancillary services were significantly impacted. This was reflected in a May 21, 2020, MGMA Stat poll, which showed that 55% of healthcare leaders said they experienced more than a 50% decrease in ancillary service volume.
As reported in that poll, ancillary services declined as telehealth services increased. As such, practices had to factor in the cost of these new technological expenses, while also addressing the impact of fewer elective procedures and an overall decline in visit volumes.
According to MGMA Consultant Adrienne Lloyd, MHA, FACHE, CEO/Founder, Optimize Healthcare, one of the benefits of adding ancillary services is that “there are opportunities to be able to pull some of that revenue in house, whether it's phlebotomy or lab services” for example. This helps “to better serve your patients so that they're not having to wait [for care].”
Lloyd notes that primary care practices and specialties such as OB/GYN, cardiology and gastroenterology are prime candidates because of the type of patients they see. “The ones that tend to benefit the most are those that provide general and ongoing chronic or repeat care business,” she says about specialties that may have an aging patient population. “When you realize you have a group of patients that are coming back to you, it’s an opportunity for you to capture some of that.”
As an example, Lloyd brought up diabetic patients. “Some of these patients may never get their diabetic eye exam once a year like they're supposed to if they have to go somewhere else,” Lloyd says. “You're really capturing that and then you're helping the Prevention Quality Indicators (PQIs)” regarding population health.
The importance of this can’t be overstated, Lloyd maintains, as patients can “get care right in their provider's office, ideally in less time than it would take them elsewhere, and potentially at lower costs versus getting care in a hospital or an outpatient facility and having that additional fee.”
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Considerations with ancillary services
When assessing ancillary services, Lloyd says practices should consider several factors, including space, equipment cost and hiring/training. With the latter, practices may already have someone on staff who is trained to facilitate services such as phlebotomy or they may have someone on staff who wants to broaden their scope of service. “You could invest in your current staff, which I think makes them more excited to have something else to do and hopefully makes them more willing to stay,” Lloyd states.
Lloyd says that if you have to hire someone, you should establish expectations in advance as the practice works to build its patient volume for that service. For example, she notes that you could tell a radiology technologist candidate that their focus will be mammography, but while the practice is increasing patient volume, that individual will only be doing mammography screenings 40% to 50% of the time. The rest of their time will be focused on cross-functional tasks to help the practice where needed. “You don't need to hire a separate person all the time, depending on what your numbers look like,” she adds.
Lloyd points out that practices may not always bring in a lot of revenue with ancillary services, but there are other benefits. “There may be certain circumstances where even if you are going to lose money, it makes sense to go ahead and do it because you can do the service right there,” she says. “You can get a diagnosis for your patient and you can conclude the care, versus having to wait a week or even months” for the results to come back and then review them with the patient.
Another important consideration, according to Lloyd, is patient flow. She says practices should determine whether they are “going to have [ancillary services] as separate appointments. [Will] patients come in and get them at any point or is it going to be as part of the actual episode of care?”
Before moving forward, Lloyd says it’s crucial for practices to be intentional with the process, as additional expenses, particularly those that may require adding staff, require careful assessment.
As part of this, she suggests taking a good look at your practice’s population health metrics, and asking, “Are there opportunities where we could improve these metrics?” Similarly, practices would do well to ask patients where pain points exist. “Where are you hearing from patients that they're having trouble getting in for an exam or study?” asks Lloyd about taking a look at these factors and determining whether your practice has the wherewithal to speed up the process to get results faster.
Most important, being intentional involves taking a 30,000-foot view. “It's one more process for your front desk all the way through to your billing office to know and have worked through,” Lloyd says. “Don't rush, ask questions, make sure there's a need there. Make sure you know you've got … the right resources to support it so that it can really be successful.”
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- “COVID-19 took significant toll on medical practices' ancillary services” — In this May 2020 MGMA Stat poll, more than half of medical practice leaders reported that their ancillary service volumes dropped by more than 50% amid the COVID-19 crisis.