Medical professionals are living — and working — in a time of immense change and uncertainty. Nobody knows for sure how any of the proposed healthcare reforms will impact medical clinics, if at all.
In Congress and within state governments, debates continue regarding the best way to ensure that Americans are, well, insured. There are vocal critics all along the political spectrum, and supporters of this change or that change are just as passionate.
But for those of you who run medical clinics, the questions are much more fundamental, although it’s sometimes hard to get them heard over the uproar and hubbub of local and national politics.
The questions: How does this impact me and my business? Just what kind of changes and challenges are on the horizon?
Medical practice managers are definitely at the helm of navigating these new and often turbulent waters. The learning curve will be steep.
One of the biggest concerns has to do with penalties associated with hospital readmissions. Let’s take a look at this specific concern.
Hospital Readmissions Reduction Program (HRRP)
Through the Hospital Readmissions Reduction Program (HRRP), hospitals and clinics are facing a 3% penalty for readmitted patients. This is great news for patients — not so much for healthcare providers. Yes, it helps to refocus efforts on community and holistic health, but there is little that 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
The American Recovery and Reinvestment Act of 2009 (aka ARRA or the stimulus act) contained controversial requirements regarding the “meaningful use of certified EHR technology.” (EHR stands for electronic health records.)
For practices that had yet to implement an EHR, the years following the passage of the ARRA were pivotal. Incentive payments decreased each year beginning in 2013. Furthermore, that incentive payment became a 1% penalty in 2015, quickly rising to 5%.
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 the use of computerized physician order entry, drug/allergy intervention checks, and maintaining an active allergy list.
Of course, the full list of requirements was vast and comprehensive.
Physicians Make Their Move
There is concern that the era of small practices may be coming to an end. Payment reform means that many doctors will give up small, family-style practices in favor of hospital settings or mega, multispecialty clinic environments.
Those who are determined to stay in private practice must prepare to embrace industry changes that will alter payment structures, 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, decision-making 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 certain to come their way, medical practice managers have more opportunities than ever.
Patients 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 could become an increasingly unfeasible expectation in an atmosphere of large clinics and hospital-owned practices.
National Health Coverage
Medical providers all want what’s best for the patient. Whether it’s via universal coverage, private insurance plans, or a continued reconfiguring of the Affordable Care Act, the United States remains on the path to health reform.
Medical clinic managers would be wise to consider the benefits and risks of each of the proposals as they come along — tax credits distributed through the health insurance system, health plans procured on the individual market, or an individual mandate, for that matter.
Practitioners on the front lines may find that over the long term, outcomes for patients will improve only with a coordinated effort to provide health care and health benefits to the nation’s 328 million people.