THE BUSINESS OF HEALTHCARE
BREVARD COUNTY, FLORIDA – Although physicians would much rather heal patients than tend to interminable paperwork, doctors– particularly those in solo practices – often must give up time that could be spent caring for patients in order to navigate through complex insurance requirements.
With Brevard Physicians Network, however, the doctors gain strength, and most importantly, time, by banding together. Insurance companies appreciate the fact that the Network provides them with a single contact to help negotiate.
Formed in 1995 by a group of local physicians, Brevard Physicians Network was created as a vehicle to free doctors from insurance hassles so they can do what they do best: care for their patients.
“It assists physicians with enrollment and credentialing,” said Dr. David Williams, president and CEO of MedFast Urgent Care Centers and a member of the BPN board. “I believe it is the way to go.”
Nephrologist Dr. Tim Ahmed has been part of the Network for nine years.
“It’s been very useful,” said Ahmed, who is part of Medical Associates of Brevard, an umbrella group of private practitioners. “I don’t know what it would be like without it. I joined because you need a voice larger than an individual’s to negotiate reimbursement rights.”
Currently over 300 physicians in the Space and Treasure Coasts are part of the network, representing 101 primary care docs and every imaginable specialty.
“BPN acts as intermediary between physicians and the insurance companies,” said CEO Brenda Radke. “It is very good for the community, because we have the opportunity to improve the quality of care.”
Take, for example, the often confusing array of Medicare Advantage Plans.
Last year, four new plans were introduced in Brevard. BPN signed agreements with three out of the four, adding more freedom of choice to patients.
“If the doctor they went to did not accept the plan the patient wanted, the patient may either have to select another physician or not get the plan,” said Radke.
“We Do The Work”
The Network frees physicians from the ever-growing administrative tasks of continually evolving payer requirements, for the organization has the authority to negotiate contracts for all members.
BPN currently manages 35 different insurance contracts. Network members have the option of accepting all 35, or picking and choosing those that best suit their practice’s needs.
“If they didn’t belong to the network, every single physician would have to sit down and read these 40-page contracts from each of the 35 different insurances,” said Radke. “We do the work.”
BPN staff reports to a seven-member board composed of local physicians. A three-person executive committee, consisting of administrators from large medical groups, helps the Network develop best practices.
“This is my front-line group,” said Radke. “They’re a great sounding board.”
BPN’s goal has always been to provide the highest quality medical care to patients, while keeping that care at a cost that is acceptable to both insurance companies and to physicians. The insurance industry, always conscious of costs, has high regard for Network clout.
“The insurance companies view us as a great resource to save time and money,” said Radke. “Working together, we are able to negotiate the best rates for managed care contracts and other services.”
Because BPN physicians must meet high credentialing standards, consumers can be confident they will receive care from well-qualified, high quality professionals. That’s the domain of credentials director Trish Beaulieu, tasked with checking the background of all physicians applying for BPN membership.
“We have access to the National Practitioners’ Date Base,” said Radke.
“We also contact the educational institutions that granted degrees to our physicians and also ask for several letters of reference. We verify everything. We are as thorough as the insurance companies with background checks, which is something insurance companies appreciate.”
Radke, who joined BPN in 2008, brings 17 years of experience in the insurance industry to the bargaining table.
“I can see both sides, so I bring a reality check to both parties,” she said.
“Knowing the needs of both sides can offer a better perspective and a more harmonious relationship.”
President Obama’s healthcare reform will undoubtedly provide additional challenges to physicians, but organizations such as BPN will help alleviate the confusion and hassle.
“There are so many moving pieces to the plan, but right now, physicians stand to see a 21 percent decrease in Medicare payments, which could potentially mean a reduction in office hours or staff,” said Radke.
Membership in BPN, however, could help doctors compensate for cutbacks in reimbursement through savings in medical malpractice insurance and other necessities of the trade.
BPN’s agreement with The Doctors Company and Oros Risk Solutions, for example, has snagged substantial insurance savings for member physicians.
“Many solo doctors found they can save 15 to 20 percent in malpractice insurance costs,” said Radke.
The Network also offers a group purchasing program with discounts that significantly reduce practice overheads.
“We also do a background check on all of our vendors, which can save physicians a lot of legwork,” said Radke.
Filing insurance claims can be a migraine-producing task for even the most seasoned office staff, but this tedious and complicated task can be simplified, thanks to BPN’s input.
“We will sit down with office staff to help them with billing,” said Radke.
“The more streamlined they become, the more profitable the practice can become, so if healthcare reform brings a decrease of income, physicians can continue to practice without cutting back on hours or staff,” said Radke.
If a particular claim is denied, the Network steps in as ombudsman.
“In many cases, the claim has been denied because of a technicality,” said Radke. “We are often able to correct the problem and have the claim approved.”
For patients and physicians traveling through the maze of today’s healthcare, Brevard Physicians Network is a guide to lead the way.
“It’s a win-win situation for all involved,” said Radke.