The Coyote's after YOU! Part 1

    Motion Analysis Labs: What almost everybody is doing wrong

                                                ...and how to fix it!

   Part 1 of a 3 part series

So you’ve got a high-tech Motion Analysis Lab as part of your health system! You’re capable of amazing 3D motion analysis! You can gather dynamic plantar pressure measurements while performing surface and fine wire electromyography! Finally, you’ve got a top-notch physician to analyze and interpret the data and put it all together into an invaluable report which help determine the absolute best treatment modalities to care for the patient!

You’re the envy of all your competitors – NOT!

Why? Because despite all the good work you do, all the people you help, all the outcomes you improved …you’re losing money on the damn thing!

Well I have three things to say to you:

The first is that you are probably losing money, but depending on how you look at it, you actually might not be.

The second is that no matter how you look at it, you can still generate a positive bottom line.

The final thing is the most important one: You will need to make changes regarding how you utilize your lab, but there is definitely incredible value in Motion Analysis, both in its benefits to patients and financially. However, you need to consider the long game.

If any of you have read my last article, you probably realize that I believe the future healthcare landscape will be dominated by ACOs. Now we can all argue about if that will make healthcare better or worse. I am somewhat ambivalent about that. I admit as an “old-timer” I am somewhat nostalgic about the “good old days”. But remember, nostalgia is simply how we view the past and that view is seldom 100% accurate. In any case, the ACO train is what I believe is coming to the station. Personally, I have decided to buy my ticket; because my other two options are to be left at the station, or worse… get run over by it.

So with this point of view, let’s examine the first statement I made:

1.  You probably are losing money, but depending on how you look at it, you actually might not be.

OK. So you have a Motion Analysis Lab. Depending on how you set it up, you probably have direct or indirect labor costs for one or more of the following staff:

A.  A physician who is qualified to interpret the data and potentially make treatment recommendation.

B.  A physical therapist to perform the physical tests necessary and assist in gathering the data.

C. Office support for billing and scheduling.

D. An engineer who understands the software and hardware, as well as the type of data that needs to be collected, and makes sure everything operates properly.

Now assuming you are billing Medicare or other insurers for this care using the CPT codes available (primarily 96000, 96001, 96002, 96003, & 96004), then this work must be carried out under very specific guidelines at a facility, not a private office. The CPT guideline further defining these codes reads; "Codes 96000-96004 describe services performed as part of a major therapeutic or diagnostic decision making process. Motion analysis is performed in a dedicated motion analysis laboratory (i.e., a facility capable of performing videotaping from the front, back and both sides, computerized 3-D kinematics, 3-D kinetics, and dynamic electromyography). Code 96000 may include 3-D kinetics and stride characteristics."

Based on the above, you are also likely to utilize some fairly expensive equipment: specialized cameras, instrumented treadmills, force plates, EMG equipment, and computers and software powerful enough to collect the data and present it in a form that has diagnostic value. Besides that, you need a space large enough to allow the patient to walk unrestricted far enough to gather a valid data set.

Now having managed one of these labs, I can tell you all of the above quickly adds up to a considerable sum. So what about the reimbursement? Well you can look up the reimbursement for those codes for your specific area and insurers, but I will give you a rough range:

96000 Comprehensive computer-based motion analysis by video-taping and 3D kinematics:                                                                                                           Approximate Reimbursement Range: $90-$110

96001 Comprehensive computer-based motion analysis by video-taping and 3D kinematics; with dynamic plantar pressure measurements during walking:                                                                                                           Approximate Reimbursement Range: $100-$120

96002 Dynamic surface electromyography, during walking or other functional activities, 1-12 muscles Approximate Reimbursement Range: $20-$25

96003 Dynamic fine wire electromyography, during walking or other functional activities, 1 muscle:                                                                                     Approximate Reimbursement Range: $15-$30

96004 Physician review and interpretation of comprehensive computer based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with written report:                                            Approximate Reimbursement Range: $110-$135

Bear in mind that all of the above codes are not billed per patient visit. At most you can bill a combination of 96000 or 96001, 96002 or 96003, and 96004. Another thing to consider is that while 96002 and 96003 are per unit, today many insurers are limiting this to 1 unit per procedure.

So let’s pick a best case scenario where we actually collect (WHICH THESE DAYS IS NOT ALWAYS A GIVEN) approximately $300.00 for the procedure. In most cases setting up the patient and doing the test is going to take approximately an hour, perhaps more. This is not counting any time spent on other duties related to the encounter, simply the time with the patient. Assuming we have a PT with some experience in this area, I think expecting to pay a salary of $30 - $35 an hour is conservative. If we have an experienced engineer involved, we are probably looking at a similar salary or perhaps even more. Let assume the combined salary cost for both in this case is approximately $70 per hour.

But wait there's more! We need a physician to interpret the data and write the report. We can expect that even an experienced physician very is probably going to take an hour to review the data and write the report. This physician is likely to be a specialist and I think everyone would agree that, at best, this will cost the lab about $150. So now we are at expenses of about $220.00 and we have still not worked in the additional time the PT and Engineer will require to prepare and check the data before sending it to the physician (approximately another hour). Nor have we worked in the cost of the support staff who will register and schedule the patient. What about the billing and collections staff?  I think it fair to say we have at least another $80 of salary expense related to this. And we haven't even considered if we are paying benefits to these people. Plus what about the overhead costs including purchase, maintenance and replacement of the equipment. Trust me when I say the overall costs involved in treating this patient will exceed that $300.00 reimbursement.

Well I think you get the idea. A lab whose solely relies on insurance reimbursable procedure to survive will NEVER be self-sustaining and will ALWAYS lose money.

At this point I am sure many of you are saying; “I thought you said that we might actually not be losing money?”  Well to be honest, I lied a little bit:

You definitely are losing money, but if you belong to a larger organization you may be offsetting that loss by helping them make more money.

More about that next time  in  Part 2

Owner of Logan Healthcare Consulting, Patrick Logan's professional experience covers broad spectrum: executive, clinician, consultant, manufacturer, manager, educator, marketer, lecturer, athlete, motivational speaker, and even an actor. He has over 25 years of leadership experience in the healthcare field at all levels including budgeting, administration, and project management. He is a recognized expert on the healthcare market, with specialization in the integration of ancillary care models into hospital systems, facility design, and the development of best practices for national, regional and local organizations. He can be contacted through LinkedIn.