Maximizing Profit for Mohs Surgeons

Dermatologists are acutely aware of the significant provider shortages in the market. The challenges of sourcing high-quality staff for billing and recruiting Physician’s Assistants, Nurse Practitioners, as well as M.D.s and D.O.s, are extremely difficult.

Dermatologist Staffing Challenges

The shortages in our field can be attributed to various factors, and it’s important to understand these challenges:

1. Training Programs: Training programs are seeing fewer applicants, which impacts the pipeline of new dermatologists.
2. Carrier Oversight: Government regulations and carrier oversight are prompting some private practice dermatologists to consider retiring earlier than expected.
3. Reimbursement Decline: Reimbursements are on a declining trend, posing financial challenges for dermatologists.
4. Technology Demand: There’s a growing need for technology, including practice management systems, electronic health records, and telemedicine capabilities, which can be daunting to implement.
5. Practice Management Changes: Many board-certified dermatologists are now selling their practices or joining private equity-backed entities, altering the landscape of private practice.
6. Documentation Challenges: The burden of paperwork and documentation can be overwhelming for practitioners.
7. Coding Complexity: CPT and ICD-10 coding are becoming more intricate, requiring additional time and effort.
8. Increased Demand: As the population ages, there’s a rising demand for dermatology services.
9. Work-Life Balance: Newly trained dermatologists seek a more balanced work-life, leading to reduced office hours.
10. Aging Workforce: A significant portion of dermatologists in private practice are over 55 years old, with many considering retirement in the coming years.

Due to the above causes, the Mohs surgeon can optimize his/her ability to access more patients by concentrating on their area of expertise.  It’s a matter of establishing a strategy that will allow the highly skilled surgeon to see the least amount of non-surgical patients. It comes down to what kind of patients you want to attract and/or see.

Strategies for Mohs Surgeons

One of the things that Mohs surgeons have not done due to their already busy patient schedules is:

1. Patient Selection Management: Assess the types of patients you want to attract and prioritize those that align with your surgical expertise. This helps maximize your effectiveness and patient satisfaction.
2. Delegation: Consider delegating non-surgical patient care to other qualified providers within your practice. This allows you to concentrate on your surgical specialties while ensuring comprehensive care for all patients.
3. Collaboration: Explore partnerships or alliances with other medical practices, particularly those in need of additional providers such as Physician Assistants (PAs) or Nurse Practitioners (NPs) specializing in minor surgeries. This collaborative approach can help expand your patient base and services.
4. Patient Recalls: Implement a recall system for patients with previously treated skin cancers to ensure ongoing monitoring and care. This proactive approach demonstrates your commitment to patient well-being.

In this evolving healthcare landscape, it’s essential for physicians, including Mohs surgeons, to think creatively and proactively, and not just for the billing of Mohs surgery. By taking these steps, you can enhance patient care and optimize your practice’s efficiency and sustainability.

Innovative Alliances in Healthcare

Dermatology practices across the board are facing a pressing need for additional providers. Traditionally, this gap could be filled by recruiting Physician Assistants (PAs) or Nurse Practitioners (NPs). However, the challenge now lies in finding qualified PAs and NPs, which has become as demanding as recruiting new physicians. So, what’s the solution? Is there a way forward?

Physicians in all specialties including general practice, family practice, and internal medicine are experiencing shortages while the demand continues to grow.  For the most part, most primary care practitioners are underpaid, have extended hours seeing patients, and many are required to see patients in the hospital.

Why not consider forming a strategic alliance with an Internist in your local area?

1. Group Practice: You could establish a group practice together.
2. Shared Providers: Alternatively, you could share healthcare providers. Your PA or NP, or even a general dermatologist, could see patients in the Internist’s office for specific diagnoses like cysts, boils, keratosis, moles, lesions, warts, and more. Identifying lesions that require treatment, especially potential skin cancers, can significantly increase cases requiring Mohs surgery and other excisions and repairs—ultimately aligning with your practice’s goals.
3. Location Indicators: On days when dermatologists see patients in the Internist’s office, they can still be considered part of the dermatology practice, with the location noted accordingly. In return, the Internist can attend to more patients requiring services such as EKGs, lab work, injections, venipuncture, and some imaging. These services often result in higher reimbursement per visit.
4. Cross-Training: Consider having one of the PAs or NPs from the Internist’s office spend one day a week at the dermatology practice, receiving training in dermatology procedures.
5. Potential Merger: Over time, the two practices can explore the possibility of merging. This arrangement addresses provider shortages, diagnoses more lesions requiring surgical intervention, and enables the Internist to increase revenue earnings by providing services that typically command higher reimbursement rates than standard primary care services.
6. Mutual Benefits: This relationship stands to benefit both practices financially and satisfy the increased demand for services.

Executing such a concept would require careful planning to ensure compliance with legal regulations, carrier contract requirements, mutual benefits for all providers involved, and the preservation of high-quality patient care.

Exploring resources online can provide valuable insights and innovative ideas. By thinking creatively and considering unique possibilities, you can gain access to providers who might not otherwise be part of your dermatology practice. Such out-of-the-box thinking has the potential to result in a mutually beneficial arrangement for all parties involved.

Read more from our published resources:

UNDERSTANDING THE ROLE OF MODIFIERS IN MEDICAL BILLING
PROPOSED PHYSICIAN FEE SCHEDULE ADJUSTMENTS CY 2024
CODING AND DOCUMENTATION GUIDANCE FOR MOHS SURGERY REIMBURSEMENT