Athletic Trainers in the Physician Practice: How they add value and increase revenue

How much is a patient E/M worth?

 
Example of the impact of office throughput on E/M revenue:

CPT 99213 - Follow up visit for an established patient (middle level of care)
Medicare rate: $61.73 (2020 Medicare Fee NNJ)

CPT 99203 - New patient visit (middle level of care)
Medicare rate: $132.81 (2020 Medicare Fee NNJ)

Assuming the new vs. established patient ratio is 1 to 4, the expected reimbursement for E/M (Medicare rates) is $79.50.

Using this expected reimbursement amount, if one patient was added a day for a provider who sees patients 3 days a week, this would generate $11,448 in additional annual revenue. Using the same calculation, if 6 new patients were added a day, collections would increase by just short of $80,000 per year.

E/M revenue impact in orthopedic practice: Using the average 22% increase in throughput, the average orthopedic surgeon would get approximately 700 additional visits. With an expected reimbursement of $79.50 per visit, this would generate more than $55,000 in additional revenue from that increase in throughput alone.

E/M revenue impact in primary care practice: Using the 22% increase in throughput, the average primary care physician would get approximately 830 additional visits which would generate almost $66,000 in additional revenue from that increase in throughput alone.
 

How much is surgery worth?

 
Emory Sports Medicine did a thorough review looking at their new and returning patient visit value and the percentage of patients that went on to get other services such as physical therapy, surgery, and MRI all to determine what the impact of one patient is on downstream revenue. They determined that their average collections per new patient was $1029.46 (Pecha, Hajart, & Greene, 2012). Emory also reported their revenue per surgery was $1,855. This means that if they were to add one additional surgery a week (assumes 48 working weeks a year) they’d yield an additional $89,040 in revenue a year.

Based on Medicare dollars, revenue per surgery is approximately $1,176.63. Following the same calculation, this would yield $56,478.12 in additional revenue a year with just one additional surgery a week. Using the 22% increase in throughput, the average orthopedic surgeon would get approximately 115 new surgeries which would generate over $134,000 in additional revenue.
 

How much is concussion testing worth?

 
According to the Centers for Disease Control and Prevention, there were approximately 2.5 million TBI-related ED visits in the U.S. in 2014, including over 812,000 among children. Many of these concussion patients require follow-up care beyond the emergency room or initial visit. If your practice is prepared to acquire and retain these patients, there’s an opportunity for them to become long-term patients who return for their multidisciplinary care throughout recovery.

The potential for revenue with concussion testing comes from being able to couple reimbursement for concussion testing with reimbursement for the E/M. For this reason, it’s important to use concussion assessment tools that are eligible for reimbursement, and leverage the right billing codes.

Example of the impact of concussion testing on revenue:

CPT 96132 - Neuropsychological testing evaluation by a physician or other qualified healthcare provider
Medicare rate: $58.94 (2020 Medicare Fee NNJ)

CPT 96136 - Neuropsychological test administration and scoring
Medicare rate: $161.86 (2020 Medicare Fee NNJ)

When the two are coupled, there will be a per unit impact of $151.67. Using the previously established 22% increase in throughput, let’s assume patient volume increased from 100 to 122 concussion patients a year, in turn revenue would increase from $15,167 to $18,503.7. This means that adding just one new concussion patient every two weeks can increase revenue by over $3,000.

One often overlooked revenue opportunity for athletic trainers in the physician practice is CPT 99211 which is defined in the 2011 CPT Standard Edition Manual as an office or other outpatient visit that may not require the presence of a physician. There are considerable opportunities to use this code for concussion management, especially if the physician service is minimal or incidental to the overall care provided in the office. If provided under the direction of the physician, you can bill this code assuming the service provided is focused on evaluation and management. For example, if you are assessing and providing care to the patient and administering ImPACT, then using this E/M coupled with the concussion testing code (CPT 96132 or CPT 96136) can pick up the otherwise unreimbursed clinical services provided in that visit.

Northside Hospital (previously Gwinnett Medical’s Concussion Institute) did a 5 year study on the impact that their concussion program had on patient acquisition and revenue and found that it increased their patient volume by 211% and by the fifth year generated almost $500,000 in revenue.

When deciding to incorporate a concussion program in your practice you need to decide if this will be your core business or an ancillary service in your business. If you’re a sports medicine physician, this will likely be a core part of your business as opposed to an orthopedic surgeon who may use it to build relationships with athletic trainers, schools, and athletic programs in the community.