Applying Business Concepts to C-L Service Said to Pay Off

Smart business practices can ensure the survival and ultimate success of a psychiatric consultation-liaison service.

So said Joseph Antonowicz, M.D., director of consultation-liaison services at Lehigh Valley Hospital in Allentown, Pa., at the Institute on Psychiatric Services in Washington, D.C., in October.

Antonowicz oversaw a substantial increase in the number of consultations since he became the C-L director in 1988. Three board-certified psychiatrists with added qualifications in geriatric psychiatry make up the C-L staff.

Antonowicz recommended four steps to developing a fiscally sound C-L program: billing, expanding your business, knowing your profit-loss margin, and being perceived as a "regular doc."

His C-L service has four rules for billing:

• Be fast. You stand a better chance of getting paid if you get your bill in on the day you see the patient.



• Be accurate. Have a billing card with all the necessary information including the referring physician, insurance status, diagnoses, and CPT codes.



• Be current. Know Medicare’s rules, especially changes in requirements for different CPT codes.



• Be persistent. Pursue delinquent accounts and insist on receiving statements regarding current accounts receivable and payable from your billing service.

"Don’t be afraid to hold your billing service’s feet to the fire if [it is] not getting bills out in less than three or four days," he advised.

Antonowicz also suggested that C-L services expand their services beyond the hospital walls. "There are a lot of things we do very well that other people don’t," he said.

For example, his C-L service has a contract with a county nursing home. "We get to keep whatever we collect, and we also receive a stipend from the county for our services provided there."

Antonowicz also has a contract to provide services and educational staff activities to a long-term residential center for people with physical disabilities.

"We have a relationship with hospital outpatient satellites, such as the women’s health center and radiation oncology. We get at least three calls a week from a radiologist saying he has a patient who doesn’t want to live anymore. Whenever possible, we have a psychiatrist see the patient on site, which enhances our visibility and often results in payment."

Because all three C-L psychiatrists have added qualifications in geriatric psychiatry, "we are a rather awesome marketing entity when approaching nursing homes and geriatric facilities."

Knowing who your payers are is critical, because some services may not produce a profit but serve to attract business in other ways, said Antonowicz.

For example, "we know that when we provide consultations for trauma services, the patient typically does not pay his or her bill. However, the trauma surgeons remember us and refer paying patients to us."

Antonowicz also recommended getting to know institutional administrators. "I know our hospital administrator who negotiates managed care contracts. I make sure that he knows what I do and will try to include our services in contracts with managed care companies."

Antonowicz suggested that C-L psychiatrists take advantage of opportunities to interact with other staff so they are not perceived as loners.

"Do grand rounds when everyone else does, call back your referral sources when doing a consult, have lunch with people, sit down with interns, and go to hospital social events," suggested Antonowicz.

He also cultivates referral sources. "We send gift baskets to everyone who refers patients to us. This costs us money, but it’s money well spent."