Patients are more educated than ever before—and hungry healthcare entrepreneurs see opportunity. Coupled with the fact that some analysts believe reforms like MACRA pose a major threat to physician independence, it’s time to take a hard look at how effective physician practice and delivery models truly are.
New delivery models are emerging, targeted at making low-cost care more convenient and effective than ever before. Concierge care, telemedicine, and the ability to see a primary care professional while taking a break from shopping are among the seismic shifts shaking the foundation of traditional PCP delivery models.
Dr. Albracht, President, Village Health Partners, a community medical group based in Plano, TX, also said,
“Convenience is ever changing and practices need to evolve to get healthcare to their patients immediately—practices that can’t evolve won’t fare well.”
While these new models pose a threat to primary care practices, they also introduce opportunities. By embracing novel means of streamlining your organization and connecting with your consumer-minded patients in new ways, you can take a proactive approach to your future sustainability. Here are four things you can start doing today:
1. Assess your revenue cycle
Over the past decade, the implementation of electronic medical record (EMR) and electronic health record (EHR) systems has been complicated by changing payment regulations and quality measurements, which means that your revenue cycle may not be operating as well as it should be. Effective RCM requires good software. But, more importantly, it needs intelligent people.
Michelle Martin, VP, Sage Growth Partners points out that,
“When it comes to quality RCM, the best software in the world is worthless without capable people using it. In today’s marketplace, frontline folks have to be seriously savvy, with a multi-faceted understanding of insurance expectations and their effect on appointment scheduling, reporting, and reimbursement. Skilled staff will accomplish far greater results—even with dated technology—than entry-level staff with advanced technology.”
The reality is this: It’s easy to think that your revenue cycle will take care of itself, but it needs evaluation, monitoring, and updating as often as all of your other systems. There are 5 key questions you need to ask your billing manager to ensure that your revenue cycle is operating effectively and at maximum efficiency:
- What is your gross collections percentage?
- What is your average number of days in accounts receivable?
- What is your average reimbursement per encounter?
- What is your overall claims denial percentage?
- What are you doing to improve 1-4?
James Way, SVP Revenue Cycle Management, Continuum Health Alliance, a physician enablement company based in Marlton, NJ, says,
“I’ve seen a lot of physicians resist spending time on any system that doesn’t seem directly related to care. After all, they chose to be an MD—not a CPA, not an MBA. The reality, though, is that by being open to investing time and energy into optimizing their RCM, EMR, and workflows, they’ll be able to spend more time providing enhanced care to their patients—and creating a more positive patient experience overall.”
Learning from experience
We recently spoke with members of the Catalyst Health Network, an independent primary care physician alliance based in Dallas, TX, to find out how they are trying to be more proactive with their patients to improve care and patient experiences. Here are their suggestions:
- Extend hours
- Offer weekend appointments
- Hold reserved visits that only come open that day for sicker patients
- Allow walk-ins
- Create an urgent hour
- Actually thank patients for coming in
2. Optimize your practice
When you look at where your practice is today, you need to understand the unfortunate stereotype many patients carry with them—visiting their PCP means facing long wait times, navigating bureaucratic processes, and feeling a loss of control over their health decisions. Many patients worry their doctors aren’t as engaged as they could be.
Whether or not these notions are justified, it’s important to keep them in mind when considering how to best design your practice to meet the needs of your patients. A key place to start is by changing your mindset to think of your patients as healthcare consumers, and treat them as clients.
There are some innovative new delivery models for primary care that can provide inspiration for how to make your practice relevant and attractive to your clients. There are 3 increasingly popular models that are emerging as successful methods. Consider how you can integrate these into your practice to better serve your patients:
- Concierge medicine is akin to a healthcare subscription service. Patients pay a monthly or annual fee for physician access; the physician can profit from both the access fee and bill insurance for the visit. Two-stream revenue helps providers spend more time with each patient; the provider, however, is still subject to new regulations and reform.
- Direct primary care (DPC) is an even more revolutionary practice that approaches the concierge model a little differently. Featuring a retainer fee that is typically lower than those offered by concierge models, DPC focuses on a patient-centered care approach that allows practices to move away from traditional fee-for-service (FFS) models without exposing themselves to unreasonable risk. The DPC model can help to reduce the need to spend significant time on claims filing, helping to drive down overhead costs.
- Hybrid models offer a combination of new and traditional approaches. By delivering some patients the traditional private practice experience, with options for some patients to participate in a concierge approach, physicians can manage patient expectations without fundamentally disrupting practice workflow. Concierge fee patients expect the shortest wait times, so be sure to seek the help of a consultant for financial and operational planning.
Fewer than half (48%) of the patients of physicians with heavy computer use during clinical encounters rated the care they received as excellent on patient experience surveys, whereas the majority (83%) of patients whose physicians were less engaged with their computers during the encounter felt the care they received was excellent.
As a side benefit, these models can drive a predictable revenue stream, maintain a very satisfied patient panel, and help even out the ups and downs of managing an independent practice. Consider implementing them now to support effective revenue stream management.
Efficiency doesn’t stop there, though. It needs to be institutionalized throughout your practice. This demands changing the mindsets of your staff to focus on quality outcomes rather than patient volume; finding the right process and technology to support that shift is critical. Done well, the right approach and technology have cascading effects on the practice as a whole, allowing providers to reduce care gaps, make more effective use of patient time, improve patient satisfaction, and reduce costs.
The alliance approach: Staying independent, together
Independent physician alliances offer a few key benefits for physicians who want to thrive in the new market without joining a hospital or health group. Think of independent physician alliances like the NFL: Individual teams run their organizations themselves while gaining the benefits and rewards of participating in the league. A way to have your cake and eat it too, they help independent physicians with the following:
- Strengthening buying power
- Increasing access to data and reporting information
- Enhancing negotiation strength with payers
- Allowing easier support in value-based and alternative payment programs
According to Chris Crow, MD, MBA, President of Catalyst Health Network,
“It’s an amazing way to embrace both the ‘me’ and the ‘we.’ As patients become more consumer-minded, providers have to be able to deliver and compete against the large organizations—and these kinds of independent physician networks help to drive that capability.”
3. Embrace payment change
Resist the urge to think of payment change as a negative. Instead, look to how new, alternative payment models can be a catalyst to improving quality and outcomes while reducing total cost of care. Medicare’s quick path to alternative payment models presents practices with unique opportunities to receive additional funding to make the changes they need to transform or evolve their practice.
“Physicians have to understand how quickly payments are moving away from FFS models to quality-based payments. Learning how to capitalize on the strategies of the new reimbursement systems is going to be key for success in the coming years,”
says Kathy Maddock, Vice President, Physician Enterprise Solutions, Sage Growth Partners.
The recently announced Comprehensive Primary Care Plus (CPC+) initiative will provide practices with two tracks to drive additional revenue to fund transformative methods like telemedicine. In one track, practices will receive a monthly fee to provide specific services—this fee is in addition to the regular fee for service claims. In a second track, practices will receive up front comprehensive primary care payment along with a care management fee, with a reduced fee for service claims payments.
Both models allow practices upfront payments they can use to invest in evolving their practices while still receiving FFS payments. Considering the evolution from PQRS bonus payments to penalties in the current program, it might be wise to take advantage of these payments to invest in the practice before the payment models become permanent. You will be much better off having taken the opportunity and upfront payments to prepare for mandatory alternative payment models.
Of course, CPC+ is just one of a number of new initiatives, ranging from pay-for-performance models, patient-centered medical home initiatives, and chronic care management programs. The volume of these programs may seem to create a barrier to effective implementation, but the cost of not participating may be too much to bear.
According to Mason Beard, Chief Product Officer, Wellcentive, a leading population health management services provider,
“The proliferation of new payment models may seem daunting, but the fact of the matter is that organizations who are using these models are already seeing transformative benefits.”
While the investment associated with changing to a more VBC-focused model may seem daunting, it’s important to evaluate what the cost of value-based inaction can be. Wellcentive has developed a powerful tool to demonstrate what providers stand to lose if they do not participate in new payment reform initiatives. Consider, for example, if your practice has 15 providers, an annual revenue of $1 million, and a payer mix of 40% Medicare and 60% private payer. Based on the Cost of Inaction calculator from Wellcentive, not participating in value-based payment models means you could be leaving $712,000 on the table over the next 5 years.
4. Create capacity
As payment models change and healthcare consumers look for convenience and ease, physician practices will need to create capacity and meet the demands of a changing patient base. Of course, this creates a balancing act. “This idea that there’s a staffing shortage coming in the next three or five years is not exactly right,” says Hung Davis, Co-Founder and CEO of MDICS, a private hospitalist group based in Hanover, MD. “The talent shortage is already here.”
While traditionally, providers have looked to address this issue by bringing on more staff, increasing practice efficiency is a much more effective—and often, less expensive—way to meet that demand.
For example, by allowing clinical staff to work at the top of their licensing capabilities, practice workflow can be optimized to see one or two more patients a day, resulting in an increase in revenue and improvements in customer satisfaction. This is only one of many ways for providers to improve practice flow and efficiency to increase patient volume. By seeing only one additional patient per session throughout a 46-week year, a primary care practice can realize close to $50,000 in collected payments without adding staff, extending office hours, or taking on burdensome additional supply expenses.
While that may be easier said than done, there are a couple of first steps to take to meet the capacity need:
- Offer walk-in clinic hours on weekends or evenings for sick visits. Staff these hours with nurse practitioners. Patients would most likely prefer their doctor’s office rather than a retail clinic when they have urgent needs.
- Engage with telehealth services to give patients an even easier method to talk to a healthcare professional. Practices can start small and grow a network of physicians who are willing to establish telehealth and remote health practices. While not a replacement for a face-to-face encounter in many instances, a telehealth service can help triage patients with significant concern, quickly and easily treat relatively routine sick visits, and provide physician practices with a means to increase patient satisfaction, increase capacity in an environment where demand outpaces supply, and provide for an increased profit margin for the practice.
- Reimagine administrative workflows. Automating registration, offering web-based payment options, and providing online communication vehicles saves time for front desk and billing staff while delivering more convenience to patients.
By seeing only one additional patient per session throughout a 46-week year, providers can realize close to $50,000 in collected payments without taking on burdensome additional expenses.
From the independent providers to the large, integrated delivery network, traditional care delivery models are challenged by changes in the physician landscape. Don’t wait to start; jumping in and trying is a far better strategy than waiting for change to come. To foster a sustainable business model, provider organizations—particularly independent physicians—have to consider making drastic changes to attract and retain patients and create a financially viable practice. Embrace innovation and seek novel partnerships to sustain and grow your business as the industry evolves.