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Solutions for Thriving in the Midst of Rapidly Changing Healthcare Initiatives

The new millennium has brought substantial changes to almost every aspect of how healthcare is delivered in this country. These changes include significant changes to how physicians and other healthcare providers are reimbursed for services. In addition, physician office practices of every size and specialty are once again being acquired by hospitals and healthcare systems (in many cases, the same hospitals and healthcare systems that were buying and then selling them more than a decade ago). Regardless of the type of ownership, some practice challenges seem to persist while coexisting with some of the newer ones.

This is the first of two articles discussing some of today’s most pressing business challenges for physician office practices.

Is your practice a “valuable” one?

The last 10 years or so have brought about some substantial changes in how hospitals are reimbursed by CMS. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) and VBP (Value Based Purchasing) are continually evolving and expanding and changing the ways in which hospitals and other healthcare providers are paid. And now the CAHPS program is expanding to include clinicians and physician office practices in the form of CGCAHPS (Clinicians and Groups CAHPS) and OASCAHPS (Outpatient Ambulatory Surgery CAHPS). These programs aim to tie reimbursement to performance and value in a number of different areas so it is important to understand what they measure and how we stack up to other practices in the massive CMS databases.

The CGCAHPS scores are incredibly compacted: there is very little mathematical difference between the top and bottom performing practices in this country.

The CGCAHPS questions are asked using a variety of scales, but let’s look at the overall provider rating to demonstrate the variance (or lack thereof) in these scores. If 83% of a practices’ patients use the very top box for the overall rating of their provider, you might think that would result in a percentile rank in the top quartile. Unfortunately, while it is terrific that 83% of patients give the highest possible rating on this question, a practice receiving this score would only be at the 50th percentile. To be at the 90th percentile, a practice would need a whopping 91% of its patients using a 9 or a 10 to rate their provider. While it’s great that Americans seem to love their physicians, introducing these ratings into the reimbursement mix adds a pretty difficult challenge to an already difficult reimbursement environment.

In addition to the CAHPS family of surveys which will eventually impact almost every care setting, there are concerns about MACRA (Medicare Access and CHIP Reauthorization Act) and the growth of APMs (Alternative Payment Models) and their impact on reimbursement for specialty practices. As these scores are not yet publicly available, it remains to be seen how much these will help or hurt physician specialists, but if you haven’t yet begun, it is not too late to undertake some foundational activities, including:

• Reporting data on quality measures through the PQRS (Physician Quality Reporting System). If you haven’t begun to do so, it is not too late to start. If you have already started, take the time to better understand your performance and develop the appropriate improvement strategies.
• Consider developing strategies to align physician compensation to the MACRA and CAHPS metrics.
• Identify the operational areas that will need to be included in the Acts’ practice improvement requirements to better plan for how that improvement will happen.
• Physicians need to evaluate their practices with the same diligence with which they evaluate their patients. Is your practice up to date on every requirement including EHR, new coding and documentation requirements, etc? Is your practice continually seeking ways to insure that the patient and family experience is truly a “top-box” experience? Is someone in your practice on top of these new initiatives? Is your practice really ready to change?

Is your compensation model still relevant?

There are a lot of business activities associated with physician office practices and the race to insure that the practice isn’t completely overwhelmed by the alphabet soup of new initiatives aimed at measurement and ultimately reimbursement changes. However; if it has been 5 years or more since you have evaluated the practices’ compensation model, now is a good time to do so. These initiatives, while cumbersome and some somewhat daunting, do yield a great deal of information that we can use to develop a more meaningful compensation program that will reward performance in some of the newer areas where we are now formally collecting data.

Is your business model and strategic plan still viable?

While it seems like everything about the business of medicine is changing around us (and it is) one thing remains the same – physicians still need a solid plan to help sustain and grow their practices.

Physician office practices still need:

• Strong relationships with physicians in other practices and specialties
• Solid working relationships with hospitals and ambulatory surgicenters
• Collegial professional relationships between physicians in the practice
• Plans for developing the optimal physician office patient experience
• Ongoing CME for physicians and ongoing leadership development for physicians and other practice staff who will be managing the practice to meet new reimbursement objectives.

Lastly, know when to say when. It’s not realistic to expect physicians to be fluent in the requirements of all of the new initiatives (only some of which have been mentioned here) so it may be time to look for some additional help in managing and marketing the practice.

Next week we will focus on another business challenge for physicians – the relationship between physicians and hospitals. We will be focusing specifically on the issue of hardwiring physician loyalty versus creating “splitters.”

For more information, contact www.medology360.com