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2013 Ahead ! Will your Practice fly across the Fiscal Cliff or fall into an Abyss?-Infographic

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Beware Medical Practices 2013 Ahead !

And we are not exaggerating. The whole nation is gone into a huddle, discussing about the eminent Fiscal Cliff. Medical practices, small independent practices in particular, are going to be the worst hit. Across the board sequestration cuts and a 2% reduction in Medicare reimbursement, have left physicians fuming.

716 Billion Payment cut over the Next Ten Years…

The patient protection and affordable care act are aimed at improving the quality of patient care and reduce duplication. But, at what, cost ? From 2013 to 2022 it is going to be one rollercoaster ride for medical practitioners. Hospitals are increasingly merging and affiliating to handle the reimbursement cuts.

Declining reimbursement means, acquiring and consolidating independent practices seems to be the most viable and sustainable model. Doctors, who want to continue to be independent, are facing the possibility of becoming endangered species.

Small Practices Shutting their Doors…

A recently published whitepaper by the Physicians Foundation and Merritt Hawkins suggest that small practices will be uniformly replaced in the coming years. It is a known fact that physicians are under-compensated.

Small and medium practice owners should focus completely on maintaining RUV production at a sustainable level to tackle operational costs.

A Few Ways to Survive the Tough Years Ahead !

  • Review and rework on existing physician compensation formulas.
  • Renegotiate contracts with payers.
  • Develop a strategic plan. Every staff member should remove themselves from the everyday workday, to reflect, and devise strategies to stay profitable.
  • Concentrate on meeting Meaningful Use standards to receive MU incentives while they are still around.
  • Consider outsourcing certain aspects of the Medical Billing Workflow such as  to cut back on costs.
  • As reimbursement models place a greater share of financial risk on physicians, it is important that they focus more on their Revenue Management Cycle.
  • Conduct internal analysis and identify throughput issues.

Bracing for Change !

Change is the only constant. This is the time for medical practices to scale up and meet the financial pressures placed on them. And wait for the regulatory changes to see how they play out !

In-fact, the Fiscal Cliff can even prove to be a good thing. According to a poll conducted by TCB around 51.7 % respondents felt that going over the cliff, could prove to be a good thing after all !

It could induce people to look beyond the tried and tested, and focus on coming up with novel solutions. The reimbursement and tax cuts can help a staggering economy get back on its feet. And, like they say when you hit the bottom the only is up ! As with every New Year, this is the time for reflection, resolutions, and most importantly, hope.

Can Free EHR’s bring about big changes to the Small Practice ? Yes, According to a recent study.

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Busting a Few Myths !

The healthcare industry is evolving. From unwieldy and time consuming paper records to streamlined electronic medical data. As with every transition, there are bound to be a few myths. And by far the most widely popular among them is that EHR’s are expensive.

Are free EHR’s too good to be true ?

There is a long held belief that, anything that comes with a “free” tag is bound to be inferior and counterproductive. So you cannot blame people who turn up their noses at free EHR systems. It is bare boned and doesn’t offer training or support, are the usual complaints. But there are a few free EHR systems that have managed to hold their own in a highly competitive industry.

If free EHRs are half as bad as they’re claimed to be, they simply wouldn’t exist.

Nobody likes being out of Business !

It is a big lie that free EHR vendors are, non responsive, and offer no support. Unlike paid for models, charge-less EHR’s are largely dependent on advertisers for revenue. And we all know advertisers know where to invest. If the support leaves a lot to be desired, it means fewer clients. Fewer clients mean no big advertisers.

So, Obviously…

It doesn’t take a genius to figure out that free EHR vendors should actually be pulling out all stops to offer their clients great support. It works for everyone, the EHR vendor, advertisers and the most important person in the equation, physicians !

Tie-ups that work !

Costless EHR’s tie up with practice management systems so users not just get all that they want but are also offered a great deal of flexibility. Users can integrate the PMS or medical billing software that works for them. But doesn’t all this sound like too much of DIY?

Oops ! so the physician will have to deal with technical issues ?

Thankfully no ! Most popular free ehr’s have partnered with certified consultants to offer integration support and training. There are also a few billing firms that go a step further and offer free practice management systems as well. This means the entire argument of paid ehr’s being a whole lot superior to free ones, doesn’t hold water anymore.

Not a Bad choice at all !

This is not to say cost free EHRs were designed in health IT heaven and have an edge over high end EHR systems. But for the small practice down the road saving on a few hundred dollars can mean a lot.

Here are a Few Facts and Figures that prove Free EHRs help Small Practices…

  • 60%  of doctors report they are doing better than last year due to the adoption of technology.,

  • 45% of small practices cite they’re doing much better than last year.

  • In 2011 only 26% practices said they were doing better than the previous year.

But what is all this got to do with free EHRs. Well, this survey was conducted by Practice Fusion, one of the leading free EHRs in the market.

Costless EHR’s can ultimately act as an incentive and motivation for those who are reluctant to make the switch, due to the costs involved. And that includes a majority of healthcare providers.

Practice Fusion – The free, web-based EMR

It is time for Small Practices to tie up the loose ends.

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Beware of the Money Drainers ! 

Money is had to come by. As pressure mounts on small practices to stay in business without drowning from financial losses. It is important for small and solo physician practices to identify where they lose money.

Unfair reimbursement cuts and onus on offering higher quality of care, have added to the big troubles small practices face. Even as you device new strategies to improve the collections of your practice, it is more than likely you are losing money down the drain.

Sticking to middle of the Road Coding ?

A small sized medical practice cannot afford to hire smart lawyers straight out of a Grisham novel. Having to cough up money for upcoding penalties is the worst nightmare of small practice owners.

What is the safe way out? Downcoding! Most practices resort under the relative safety of downcoding. But the fact remains that leaving money on the table can be a costly mistake. According to a study published in Medical Economics downcoding can cost a single doctor 40,000$ annually!

Insurance plans, and fee schedules, that are miserly…

You bill and code perfectly, but why is it you still find it difficult to make ends meet ? It could be because of a poorly reimbursing insurance plan. If your insurer pays you 25% less than normal you will have to see 40% more patients, to make up for the loss.

Where is the Doctor ? 

Probably learning the ropes of working with an EMR! Or, trying to make sense of the, latest CMS update. Compliance and regulatory pressures mean physicians see fewer patients. And fewer patients mean lesser revenue. Loss of productivity is the major threat to the survival of small practices.

A few ways to Sail through Reimbursement Storms !

  • One way to prevent undercoding from eating its way into your profits is to conduct regular billing compliance audits.

  • Educate billing staff that coding level 3 for a service that demands level 4 is not just a lost opportunity, but plain laziness.

  • Update fee schedules annually. If you are good with numbers do it on your own or hire a consultant.

  • Advice your patients to switch to better insurance plans.

  • To increase productivity and see more patients, consider outsourcing billing and administrative tasks.

Opportunity of Building a Niche Market !

While everybody gravitates towards partnering with, or, becoming salaried employees, it is going to open a small niche market at the other end. That’s how economics works! It is not the time for small practices to back down but to scale up and work towards healthier practices !

Compliance Thresholds and Reimbursement cuts. How can Radiologists Survive 2013 ?

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Can Radiologists cope with the changes Ahead ?

It is a particularly challenging time to be a radiologist. In fact a majority of radiologists would rather forgo financial incentives instead of participating in meaningful use programs. We all know that MU 1 left a lot to be desired. There were rumbles and murmurs about imaging being sidelined.

The stage 2 meaningful use guidelines is believed to be more achievable and radiology specific. But are radiologists ready to embrace the changes ahead ?

“I have no idea”

Most radiology practices especially solo physician practices have no idea about MU guidelines. A survey conducted by RSNA and KLAS sheds more light into this subject. It is reported that about 40% of radiologists complained about lack of clarity. Or, a steep decrease in efficiency after adopting MU guidelines, were the major reasons why they were reluctant to join the MU bandwagon.

More to it than meets the Eye !

Complicated guidelines that are difficult to report against, no penalties at least for the time being are just the apparent reasons. The pressures and financial stress associated with running a radiology practice are the stuff nightmares are made of.

Medicare Physician Fee Schedule; Can have a Chilling effect…

The reimbursements cuts for the year 2013 will lead to a drop of almost 19% in the collections of radiology practices. A 25% cut for interpretation of images has led to voices of dissent and ruffled feathers. Against this backdrop it is only natural that radiologists are not up to speed with the proposed guidelines.

A lot to cope with !

Compliance and quality thresholds, lowered payments and radiology billing issues ensure that the physicians cup of woes brims over ! There are always a million things to do. And that could well be the reason why adopting the latest guidelines, has found its way to the bottom of the priority list.

Take the First step now !

It is likely that radiologists are going to avoid MU as far as possible. But with challenges come opportunities. Though the pains faced by radiologists are not new, the pressing need to address them is increasing by the day. It is important that radiologists step back and take stock of the situation.

Innovative Solutions ?

Healthcare providers have heard this term all too often. But the remedy that radiologists need is certainly nothing unique or path breaking. It is a fact that good old outsourcing can save radiology practices from sinking into an abyss. Letting third party associates to handle billing and clinical documentation needs can reduce costs.

It can also give radiology practitioners the much needed space to concentrate and adapt to changing guidelines. And with financial incentives being available only till 2016 it is time for physicians to take a call, fast.

Why EHR is the Dinosaur in the Room for Pediatricians?

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Pediatricians, it is reported are the most reluctant to take the ehr leap. A recent study conducted by the Seattle Children’s Hospital and APA, throws light into a subject that is often underreported.

According to the researchers pediatricians are a good one to two years behind physicians from other specialties, when it came to ehr adoption and use.

“I cannot Afford it”

Low pay checks, heavy Medicaid cuts, and ehrs that don’t cater to the specific needs of pediatric practices are backing pediatricians into a corner. The financial pressures that pediatric practices face can make pediatricians an endangered species in the near future.

Pediatricians have always been underpaid. There is a huge reimbursement difference when it comes to paying for treatment rendered to children and adults. And to add another log to the fire, pediatricians gain very little ancillary revenue. 56% of physicians surveyed, cited lack of money, the major reason for putting off ehr adoption.

The Pediatrician EHR wish list !

What are the features that can make pediatricians invest those big dollars into an ehr? Most of them feel that the majority of ehrs available in the market offer just straight out of the can templates and nothing much.

The needs of a pediatrician are more specific and distinct than other specialties. Most pediatricians would love to have features such as growth charts, immunization administration templates and an information sheet for vaccine information.

But how many ehrs really do provide the features that can make work easy for pediatricians, is a huge looming question.

A way to bring in the Sunshine Again !

The healthcare industry is changing for the better. And it is important that pediatricians are a part of the change. To join the race pediatricians will have to re-engineer their revenue cycle and make a collective demand for more pediatric specific ehrs.

To, identify where they lose money and explore avenues and opportunities to increase reimbursement, is now more important than ever.

What does Obama’s Second Term as President mean to your Practice ?

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The election frenzy is over. Everybody is sipping coffee and exchanging “I told you so” looks across the water cooler. But not everyone is as relaxed. Healthcare practitioners in particular will have to ensure their ehrs are interoperable and meet compliance standards.

Not just Digitizing Paper Records.

Adopting an Electronic Health Record is not just about computerizing existing workflow patterns. The core purpose of an ehr is to get rid of fragmented, incorrect and incomplete medical information and facilitate seamless exchange of healthcare data.

Failure to select an ehr that is highly interoperable means not just facing compliance issues, but losing millions of dollars.

                             

  Case in Point…

An Illinois hospital was in the news recently for losing millions of dollars due to interoperability issues. According to IOM the hospital lost a staggering 700,000 dollars every year. It includes the money spent on hiring five pharmacists to manually verify prescriptions. So, doctors who couldn’t access the ehr didn’t end up prescribing the wrong drugs and dosages.

The Road Blocks !

In a perfect world doctors would be able view and share data seamlessly. Patients needn’t be worried about their employers getting info about their medical problems. And nobody needs to lose sleep over data security. But the healthcare landscape is far from perfect.

Heavily proprietary, ehr systems, which fiercely, prevent competitors to gain access. Medical terminology, and abbreviations, that differ across specialties. And confusion about where to start, are the major hindrances towards achieving seamless interoperability.

Knowing What Matters !

But before deciding on where to look it is important that physicians have a clear idea of what to look for. There are four key components that experts believe, play a vital role in determining whether you meet interoperability standards.

  • How applications interact and communicate with users.
  • The way different systems communicate with one another.
  • The manner in which healthcare information is used and managed.
  • And the ability to work across different devices and platforms, like smartphones and tablets.

Getting it Right Without Learning the Hard way…

Physicians and practice managers need to keep a cool head. Being pressurized by promises, brochures and tight deadlines is not the way to go. The ehr is an expensive investment, which when done right can save a practice millions of revenue.

How Interoperable is your EHR ? A Quick Checklist

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Why must the Focus be on Interoperability ?

Most physicians are waylaid by features they’re hardly going to use. Smart, intuitive options are great. But if you are the only one who can access and work with them, you are way behind when it comes to interoperability.

It is essential that you can share data effortlessly. A closed door policy isn’t going to work and it is important that doctors speak up to their vendors about this.

Not just about Incentives…

It is not just about incentives and a pat in the back. Being interoperable means you save thousands of dollars. Cut down on additional staff. Reduce the time spent communicating with other physicians and technicians. And above all it means you are on the right path, as far as the future of your practice is concerned.

As with all important decisions, it is essential to be thoroughly informed before taking the plunge. And yes have a thorough check-list to ensure that the ehr ticks all the right boxes.

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Here is What Physicians can do to make 2013 the best year for their Practice !

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 Time for Self Reflection…

As the year draws to an end, it is important that physicians spring clean their revenue cycle. 2013 is going to be a hectic year with major regulatory updates, compliance issues and, yes, unfair deadlines !

So, now, is the best time to take stock of their revenue management cycle process and performance, and formulate better strategies.

Run a Quick Audit ! 

Audits needn’t be extensive or time consuming. Focusing on any one major area to audit can save on time and streamline the auditing process. To start with review the codes that have a high error rate.

According to a CERT report there is a 24% error rate for 99205, 20.8% for 99204 and an 18.6% error rate for 99215.

Run a check on these codes and see if your practice is getting it right.

Cloned claims, non specific diagnosis codes, and errors while assigning evaluation and management codes, are the other few problem areas.

Bundled Payments ; Work out the Math

Work out a clear strategy for bundling and unbundling claims. Most practices lose money due to submitting separate claims instead of one single bundled claim. Determine which claims can be bundled and which ones need not. Work out a reimbursement formula that works for all concerned.

Test the waters…

ICD-10 isn’t going away, no matter how hard you pray. Have an ICD 10 implementation plan in place. If you work with a third party biller, ask them to start checking and working with the new set of codes.

Cut Costs not Corners !

Where does all the money go ? Don’t ask yourself this question again this coming year. Contain costs. Draw up a detailed income and expenditure spreadsheet and enter all the information that matters. Analyze and see where you can scale down on costs. It could be over-staffing or inefficient coordination with ancillary service providers.

Pick out the main reasons and start working on a better future for your practice, now !

Why Physicians are in Verge of a Meltdown ?

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You didn’t really need statistics to know this. For the last few years, physicians have been complaining about having to juggle a million tasks. But the toll it takes on the mental health of physicians is clearly illustrated in a study conducted recently.

According to a finding published in the Archives of internal medicine, an alarming 45.8%, of physicians surveyed suffered from, at least one symptom of a burnout.

Bitter Pills…

Facing a rejected claim again, trying to stay in compliance, chasing deadlines, there are dozens of bitter pills physicians have to swallow everyday. The high level of stress associated with practicing medicine, is not just unhealthy but can lead to doctors becoming endangered species in the near future.

Can I Meet the Doctor ?

This is the first question that most patients ask. And there are chances that they’d be meeting a nurse practitioner or physician assistant, instead. Due to severe shortage of physicians, NPs and PAs are backfilling, to provide patient care.

Not all Grey and Bleak !

Training and hiring staff to shoulder a bit of the responsibilities physicians handle can be a huge relief for doctors. Healthcare providers should work in an environment that facilitates teamwork and shared responsibility, to stop stress from chipping away at their efficiency and morale.

Taking Time off to Catch up on Basketball…

Having a cup of green tea, going for strolls and taking a holiday now and then are important. But to make major decisions such as hiring third party associates or physician assistants, it is important that physicians take time off to reflect. And build a strategy that can help them step over stumbling blocks instead of pretending they don’t exist.

Will Accountable Care Organizations Pave the Way for Change?

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 ACO’S- And the Debate continues…

Are accountable care organizations the future of the healthcare industry ? Or will they force independent practices to shut their doors ?

According to a recent report 49 percent of primary care physicians and 53 percent of endocrinologists are expected to switch to the ACO model in the coming year.

Financial Security and Better Care.

Physicians who’ve partnered with ACOs are provided incentives for prescribing more generic medication. They are also encouraged to lower hospitalization costs. This accent on the quality of care and containing costs can offer clinical benefits and savings, for healthcare providers.

 The much needed Compass…

One of the major reasons attributed to the popularity of ACOs is that they provide a sense of direction. And help physicians to focus on quality metrics, to receive reimbursement and incentives.

It is Not all Gravy…

There are strong oppositions to practices adopting the ACOs model of working. Some section of the healthcare sector, feel it can pressurize independent practices, to join larger organizations. The clinical benefits it offers are also viewed with a sense of skepticism.

The sustainability of independent hospitals is one major concern. And the fact that it focuses more on hospitals rather than physicians is another key factor that works against acos.

Will it join the IDNs of the 90’s ?

Integrated delivery networks were followed by several healthcare providers in the 90’s. Hospitals followed and pursued two strategies, of vertical and horizontal integration. There were different models such as strategic alliances and acquisitions. There was one common factor that bound all the models together, they just didn’t work.

Whether acos join the ill fated idns of the 90’s, or become the, future of the healthcare industry, remains to be seen.