Initial Practice Assessment

The relationship between The Apollo Group and a physician client commences with a comprehensive Initial Practice Assessment. The Initial Practice Assessment is a minimally-intrusive evaluation of virtually all operational aspects of the physician's practice. Apollo consultants first meet with the client physician to develop an understanding of the physician's objectives, concerns and general practice style. Thereafter, an objective evaluation of the practice's strengths and weaknesses is conducted. These findings are reviewed with the physician and a prioritized plan to address the identified internal issues is developed. A more externally-focused process follows as the practice's opportunities and threats to its continued growth and success are candidly and thoroughly evaluated. The result of this disciplined strategic process is a comprehensive and forward-looking Tactical Plan which provides a prioritized step-by-step guide for future action.

The physician/practice may then choose to enter into a comprehensive Management Services Agreement with The Apollo Group pursuant to which Apollo assumes responsibility for the practices day to day operations. Alternatively, a physician/practice may elect to engage Apollo to assist in some or all of Apollo's recommendations by selecting the specific Apollo services required to cost effectively "fine tune" practice operations.

Billing and Collection Services

Unquestionably, effective billing and collection services are the key to physician practice profitability. The Apollo Group will take a systematic approach to the collection of accounts receivable. Physicians frequently neither have the interest, time or expertise to develop and supervise a practice's ongoing collection activities. Apollo is vitally interested in each and every element of this vital practice function.

Commencing with consistently-proper medical record documentation and service coding, a practice supported by Apollo will utilize the billing and collection system to bill all payors and patients for inpatient and outpatient services provided to patients. Thereafter, Apollo will use a standardized collection methodology to timely and appropriately convert a physician's accounts receivable into cash. If necessary, Apollo will even handle the sometimes unpleasant, but necessary, "collection agency" portion of the process. A physician's consent will always be obtained prior to commencement of the more aggressive portions of Apollo's collection procedure. In such instances, however, a physician is freed of the sometimes-awkward decision making and exchanges which can occur in such cases. Apollo's objective is to diligently, but appropriately, collect all monies due to an Apollo client physician.

Managed Care Strategy Development and Contract Review

One of the key determinates of successful revenue generation in a physician practice is the development of an optimal managed care contract portfolio. Managed care (in the broadest sense of the term) represents a powerful and potentially positive force for change. Many healthcare providers are fearful of the changes the managed care trend has caused and are extremely concerned about the future of healthcare. Admittedly, if unbridled and unchecked managed care can bring out disturbing tendencies and behaviors in healthcare providers as well as payors. However, The Apollo Group believes managed care is here to stay. Accordingly, it is incumbent on our Firm--as a vocal advocate for providers and patients--to assist our clients in the development and implementation of systems designed to take appropriate advantage of the many opportunities presented to them by managed care. We are not fearful of managed care--we embrace it.

The Apollo Group develops and implements comprehensive systems to harness the power of managed care constructively. These approaches include strategic and tactical planning, organizational systems development, managed care relationship targeting, managed care contract negotiation, and--perhaps most importantly--managed care contract management systems.

The Apollo Group's proprietary Managed Care Management System systematizes a healthcare organization's managed care agreement portfolio and thereby helps assure maximally-effective billing and collection activities. The Managed Care Agreement Contract Terms Sheet summarizes all pertinent contractual provisions of each managed care agreement--including its term and payment sections. The Managed Care Operational Provisions Sheet contains all operational requirements associated with each managed care agreement including deductible, co-payment, pre-certification, pre-authorization, lab/imaging and provider relations specifics. Available to front desk as well as billing and collection personnel, the components of the Apollo Group's Managed Care Management System help our clients "manage" managed care.

Financial Systems Evaluation and Development

Along with solid service coding, billing and collection systems, good financial and accounting systems are essential to a well-run physician practice. For a wide variety of readily-obvious reasons, accuracy is important as financial statements indicate the worth of an organization, reveal trends from year to year, and may bring to light problems in an organization's management before they become a threat to its success. A practical working knowledge of the distinction between fixed and variable expenses is also necessary as this allows a physician practice to plan to meet overhead costs and to make decisions aimed at minimizing those expenses which vary with patient volume.

Despite the importance of proper financial and accounting systems, many physician offices still use systems originally designed for manufacturing concerns or other providers of goods. Healthcare--especially a physician practice--requires unique and customized financial and accounting systems. Budgets produced by The Apollo Group will contain both static and flexible components in order to reflect fixed and variable costs. This approach allows the physician to easily determine break-even points.

As a part of the process involving operational reporting, Apollo monitors a range of vital practice statistics on a monthly basis. Apollo analyzes these reports and interprets the trends for the physician in a concise monthly report.

Perhaps more importantly in an environment of increased managed care, the systems developed by Apollo permit the practice to ascertain the actual cost per unit of healthcare service necessary to deliver care which meets predetermined clinical quality and customer service standards.

In short, Apollo's financial and other reporting systems will allow physicians to objectively and quantitatively demonstrate a practice's "value"  to healthcare payors. Such Apollo systems create strategic competitive advantage for Apollo physicians and their practices because they permit payors to differentiate between Apollo physicians and others. These data will be immensely important to forward-thinking physicians, as the marketplace becomes more and more competitive.

Well-thought-out financial plans developed by The Apollo Group permit physicians to demonstrate "value" and have put many otherwise-concerned physicians' minds at ease during these uncertain times in healthcare.

Human Resources Management

As is the case with many--if not all--organizations, the most valuable asset in today's healthcare delivery systems is represented by its human resources. More than any other service industry, healthcare is a "people" business. Accordingly, the recruitment and retention of valuable human resources is a critical success factor for today's healthcare providing organizations. The Apollo Group has developed a wide variety of sophisticated systems to facilitate recruitment of high quality human resource talent and increase the potential for retention of key personnel. These systems include support and management recruitment and interviewing/screening, development of job descriptions and performance standards, training module development and implementation, policy and procedure development, salary range development, objective setting systems, and performance evaluation and bonus compensation methodologies.

Regulatory Compliance and Risk Management Systems

A wide variety of regulatory agencies continue to apply bureaucratic pressure to healthcare providers mandating complex and sometimes inconsistent compliance standards. The scope and variety of these review and audit activities have not only been expanded in recent years, but have also assumed more ongoing surveillance-oriented approaches aimed mostly at isolating performance that falls below acceptable minimums.

The Apollo Group will assist in the development of a customized, simple, easy to use, Safety Management Program designed to provide a physical environment free of hazards and to manage staff activities so as to minimize the risk of human injury. The Program is based upon applicable law(s), regulation(s) and accepted practices and will promote compliance with such programs as the Americans with Disabilities Act (ADA), the Occupational Safety and Health Administration (OSHA) standards and the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88).

The ADA is designed to allow individuals with disabilities the opportunity to function effectively in the workplace. Apollo assists physician practices to comply fully with the Act and to provide appropriate guidelines regarding reasonable accommodation required by the Act.

OSHA standards are designed to promote workplace safety and to decrease the potential for on-the-job injury and exposure of employees to hazardous and potentially infectious materials. Apollo will assess a physician practice's risk(s) and develop appropriate written procedures and employee education modules covering exposure control, blood-borne pathogens, personal protective equipment and hazardous materials. All programs are designed to promote good health and safety habits through the development of individual responsibility for personal health and welfare.

CLIA '88 sets forth requirements for laboratory certification, proficiency testing, personnel, quality control, patient test management, quality assurance and inspections. Physician offices that perform even the most simple laboratory testing are subject to the CLIA regulations. Apollo will assure that your office possesses the correct CLIA certificate based on the laboratory procedures currently being performed in the office, and additionally, develops policies and procedures applicable to laboratory tests in order to assure that all applicable CLIA '88 requirements are being met.

Many physicians find themselves involved in professional liability claims that are not prompted by actual medical negligence, but rather by deficiencies in administrative systems or communications in the practice setting. Lack of attention to details involving record keeping and results reporting systems, or inadequate communication between members of the healthcare team responsible for the patient, can place the physician in an extremely difficult legal position. Conversely, even in situations where a deviation in the applicable standard(s) of care has occurred, good patient relation skills and well-functioning risk management systems can serve to minimize or mitigate harm to the patient and may help to avoid a liability claim. Apollo develops practice-appropriate systems and procedures to assist physicians and other members of the healthcare team to improve the quality of service provided to patients, avoid patient injuries, and reduce the incidence and prevalence rates of professional liability occurrences and claims.

Strategy and Tactical Systems Development and Implementation Support

In order to be successful, all organizational entities must recognize the fundamental importance of well-developed strategic and tactical plans. Regardless of a client organization's business age, maturity or historic success, The Apollo Group recommends that its healthcare clients exercise the organizational discipline to develop or update strategic and tactical plans regularly. The best business idea--even if implemented flawlessly--will fail if built on a weak strategic foundation. Flawless tactical implementation of a poorly thought-out business initiative will fail without good tactical execution.

Apollo's support in this area includes the development or refinement of an organization's Mission, Vision and Values, strategic planning support, business plan development, tactical plan development and operations systems development. These components, applied appropriately and comprehensively, will virtually assure organizational success.

Patient Satisfaction and Clinical Outcomes Measurement Systems Including Benchmarking Methodologies

Healthcare providers are increasingly being called upon to continuously demonstrate "value" to payors. The Apollo Group has developed a wide array of tools and systems, which permit its clients to objectively and appropriately quantify and demonstrate the benefits of the relationship to which the provider is a party.

Among the most effective ways to differentiate a provider from the "pack" in a market in which price is in equilibrium or not pertinent is to implement straightforward, but effective, patient satisfaction and clinical outcomes measurement systems. These systems are increasingly demanded by astute healthcare service purchasers and by accrediting bodies such as the National Committee on Quality Assurance. The Apollo Group's well-designed patient satisfaction and clinical outcomes measurement systems also permit organizations to make effective use of the data collected by a variety of "benchmarking" approaches utilizing internal and external data derived from comparable and dependable national databases.

Marketing Strategy Review and Development

The Apollo Group strongly believes that, in order to maximize volume and revenue, physicians must assume a "hands on" approach to practice marketing and business development. Since patients continue to exercise choice in the selection of healthcare services (especially when it comes to selection of a primary care physician in a gatekeeper managed care situation), physicians must dedicate resources to practice promotion in order to enhance the practice's volumes.

As an important part of its relationship with a client physician, Apollo conducts an objective cost/benefit analysis to determine the feasibility of a business development initiative utilizing paid promotional approaches (including mass media advertising). If this avenue is chosen, Apollo will assist with the creation of the actual text or document and help select the most advantageous message delivery medium (newspapers, radio, television, church bulletins, fliers and direct mail).

Apollo also assists in public relations efforts; an article featuring a practice's physician(s) in the local newspaper can be an extremely effective and economical way to reach potential patients. In addition, Apollo can help arrange public speaking and presentation opportunities for Apollo physicians who are interested in personally presenting timely and interesting information on health-related topics to Community Groups.

Finally, Apollo will create a brochure for a physician's practice (or make suggestions to improve an existing brochure, if necessary) which outlines the physician's philosophy of patient care, the type(s) of services offered and other information helpful and attractive to patients.

Physician Practice Acquisitions and Mergers

The Apollo Group strongly believes that the era of the solo physician practice is rapidly drawing to a close. The severe cost containment and managed care pressures affecting today's small physician practices create the incentive to develop and operate larger fully-integrated physician group practices. These larger group practices can be single or multi-specialty organizations. Besides the undeniable "economies of scale" available to large practices, the potential for increased (and legally legitimate) negotiating "clout" with managed care organizations and other healthcare payors is both dramatic and significant. The overhead reduction and revenue-enhancing potential of such organizations is extremely attractive to physicians who have been rapidly losing control of the Nation's healthcare delivery system. Years ago The Apollo Group recognized that the fully-integrated physician practice model offered physicians the best single opportunity to regain financial stability and appropriate influence over healthcare delivery. As a generalization, though, physicians are fiercely independent. Accordingly, in order to encourage physicians to form larger group practices, The Apollo Group has developed governance and operating systems which encourage independent-minded practitioners to band together into groups in order to aid in securing the professional destinies of the various physician participants.

Tempting as it can be, The Apollo Group does not encourage the acquisition of physician practices by proprietary healthcare organizations and concomitant physician entry into employment and/or physician practice management arrangements. The Apollo Group does, however, strongly support physician-led integration initiatives in which physicians maintain both equity and strong governance positions.
The Apollo Group has long recognized the importance and potential of the large fully-integrated physician group practice model and, in response, has developed highly-effective governance and operating systems to support these kinds of initiatives.

Physician Group and Organizational Governance Structures including Governing Body and Subcommittee Development

Today's complex healthcare organizations require efficient and effective governance structures in order to be successful. Sound strategy is one thing--flawless tactical implementation is quite another. The Apollo Group has developed "tried and true" organizational governance models which help set the stage for successful execution of strategic initiatives.

Additionally, these models (customized to each Apollo Group client's unique needs) have been effectively used to redesign and streamline the governance structures of existing organizations buffeted by the winds of change. The Apollo Group carefully reviews organizational need and develops turnkey recommendations for governing body design and make-up.

Typically, appropriate subcommittees reporting to the governing body (dealing with clinical and service quality, outcomes measurement, service cost, practice algorithms, managed care contracting, income distribution and business affairs) are also created.
The Apollo Group also develops income distribution methodologies, which are carefully designed to incentivize appropriate behavior and discourage activity that the organization considers dysfunctional or unproductive.

The Apollo Group's governance and income distribution systems align organizational incentives, establish the template for effective operational execution and help assure that all necessary organizational functions are not only properly performed, but are also continuously monitored to assure organizational efficiency and effectiveness.

Integrated Delivery System Development and Implementation

Many traditionally-configured healthcare providers are maneuvering to attain strategic advantage in today's increasingly-complex healthcare marketplaces. These efforts frequently include the creation and operation of so-called "integrated delivery systems". Depending on each market's unique provider supply and competitive variables, integrated delivery systems can and do assume all conceivable shapes, sizes and configurations. Typically, however, such systems include physicians, hospitals and ancillary providers which utilize various legal and structural configurations. Designed to directly address healthcare payors' operational, cost and efficacy-demonstrating concerns, the healthcare services offered to payors by these providers are packaged in ways permitting the tangible demonstration of value to healthcare service payors. Occasionally, integrated delivery system initiatives include actual health plan or payer components.

As always, effective strategic and tactical planning--followed by exemplary execution--are critical success determinates for integrated delivery systems. In the broadest sense, so-called independent practice associations ("IPA's"), physician hospital organizations ("PHO's"), management services organizations ("MSO's") and partially and fully-integrated physician group practices ("PIGP's" and "FIPG's") are variations on a common integrated delivery system theme.

Importantly, a single organization need not own all components of an integrated delivery system. "Virtual" horizontal and vertical integration--accomplished via a wide assortment of collaborative and "joint venture" models--can be extremely effective from both cost and operational perspectives.