Healthcare Reform and Your Medical Practice

Medical professionals are living – and working – in a time of immense change and uncertainty. Nobody knows for sure how the healthcare reform is going to fully impact medical clinics. However, medical practice managers are at the helm of navigating new waters, and the learning curve will be steep. Just what kind of changes and challenges are on the horizon?

One of the biggest concerns is the new penalty associated with hospital readmissions. Hospitals and clinics are facing a three percent penalty for readmitted patients, which is great news for patients but not so much for healthcare providers. Yes, it helps to re-focus efforts on community and holistic health, but there’s little providers can do once a patient is released. Still, providers should prepare to take on a disproportionate share of the responsibility for improving patient outcomes, and the financial burden associated with it.

In addition to evolving their practices to facilitate a reduction in hospital readmissions, providers should also adapt their practices to embrace a strong focus on patient satisfaction. In order to maintain or improve payment levels in a value-based payment system, providers must not only provide quality care, but also score good reviews by patients in both CMS core measure programs and commercial payer quality programs. They will need to adopt new routines that consider patient happiness without providing unnecessary care.

Meaningful Use of IT

One of the Stimulus Act’s biggest controversies is the “meaningful use of IT.” For practices that have yet to implement an electronic health record system, 2013 is a pivotal year. Incentive payments will begin to decrease each year from 2013 on. Furthermore, that incentive payment is about to become a one percent penalty by 2015 and quickly rise to five percent.

There are different rules and eligibility requirements in Stage 1 for professionals and hospitals. A few of the requirements for professionals include registration in the program and use of computerized physician order entry, drug/allergy intervention checks, and maintaining an active allergy list. Of course, the full list of requirements is vast and comprehensive, but the good news is there’s still time to apply for Stage 1.

Physicians Make Their Move

The era of small practices might be coming to an end. Payment reform means that many doctors will be giving up small, family-style practices in favor of hospital settings or mega, multi-specialty clinic environments. Those who are determined to stay in private practice must prepare to embrace industry changes that will change the payment structure, referral networks, and patient relations. While lacking the resources of hospitals and mega-clinics, small practices have the advantage of being able to implement changes quickly, without large bureaucratic committees. However, in order to stay competitive practices must embrace or even take the lead on industry change, rather than reacting to it after it occurs. With healthcare reform underway, and new challenges coming their way, medical practice managers have more opportunities than ever.

Patient may find industry changes even more challenging than providers do. There was a time when the option of starting or working with a small, local practice was what drew many people into the field. Many patients prefer a more personal approach to their healthcare. This would become an increasingly unfeasible expectation in an atmosphere of large clinics and hospital-owned practices.

Guide: Accountable Care Organizations

Click here to download our Guide: "How Independent Practices Can Succeed in a Healthcare Industry Shaped by ACO Programs". If you would like more information you can Request a consultation.

Practice Management

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  • Full-service medical billing
  • Patient account management
  • Encounter form design
  • Patient balance collections
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Guide: Accountable Care Organizations

Click here to download our Guide: "How Independent Practices Can Succeed in a Healthcare Industry Shaped by ACO Programs". If you would like more information you can Request a consultation.

Practice Management

  • Anesthesia Billing
  • Full-service medical billing
  • Patient account management
  • Encounter form design
  • Patient balance collections
  • Learn More

MBA In The News

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