Fix My Practice –Can Independent Physicians Survive in the Current State of Healthcare?
The Physicians Practice S.O.S. Group® www.ppsosgroup.com
If you feel like you’re glued to your computer or tablet for much of the day, it’s not your imagination. Many independent physicians say mounting paperwork is keeping them from spending enough time with patients. According to the Practice Profitability Index, the percentage of physicians who spend more than one day per week on paperwork has increased. This trend is eroding physicians’ on-the-job happiness. The physicians I know truly enjoy spending time with patients and teaching, and anything that takes them away from that is a negative.
A Kaiser study a few years ago indicated physicians spend more than 868 million hours annually on prior authorization activities. Payers say prior authorizations hold down costs, improve treatment efficacy and ensure patient safety. To physicians, however, they are an obstacle to providing the best care for their patients.
Then we have the technology-driven changes — from meaningful use to ICD-10 — which are key administrative tasks that take up time. However, surveys show that for three quarters of physicians, electronic health record (EHR) systems do not save time – despite increasing costs.
It seems that payer interference is increasing and dictating healthcare. Physicians have to deal with a range of audits tied to meaningful use and other programs. The federal government can audit Medicare patients’ charts, while individual states can audit the records of Medicaid patients (since they fund Medicaid), up to 10 years after a patient’s treatment. The audits are just one sign of a trend toward payers influencing—or some would say dictating— patient care that can erode job satisfaction for medical professionals.
Audits are not the only way payers insert themselves into the physician-patient relationship. Prior authorizations are another way payers attempt to take decision-making out of physicians’ hands. In addition, more payers are tightening their provider networks in an attempt to rein in costs. This move toward narrower networks results in more physician evaluations.
More and more physicians must decide whether to stay independent or join a hospital system. For some, joining a large hospital system offers a haven from the rising administrative burdens of staying independent, and from competitive pressures that can drive a small practice into insolvency. But joining a hospital system is not a panacea for the challenges facing physicians.
Some physicians are returning to private practice because their compensation from hospitals were not as lucrative after their initial contract expired. During the initial “honeymoon period”, pay is typically based on the previous three years of tax returns. When physicians’ contracts ended however, hospitals would often switch to performance-based fee schedules, which are usually much lower.
Here are a few survival tips for Independent Practice and Employment Options:
- Join Forces: Consider joining an IPA (Independent Physicians Association) to align with other physicians and create negotiating power.
- Look for High Impact Saving: Major expense items that practices can easily investigate are occupancy and personal cost. Look at your leases, overall expenses, and automatic deductions.
- Revamp Billing Practices: Make sure someone on your staff is held accountable for checking that all services are billed and reimbursed, and that no claims go over 90 days.
- Re-examine Fee Schedules: This is much easier to do if you are part of an IPA.
- Get It In Writing: No matter how minor it seems, delineate all responsibilities in writing.
- Learn About Compensation Details: It is to your advantage to be an expert on your compensation package and method. Knowing RVU’s and quality-based compensation are very important.
- Find out Who to Call: Going from a private practice to a large corporation is a big change in culture. One of the most helpful things to know is who to call when something goes wrong. Make a flow chart that shows who contact and how to do so depending on the problem.
- Know Your Limitations: Sometimes other people really do know their stuff and can teach you quite a bit. When you find these people, listen to them.
Whatever your choice in practicing medicine make sure you do your leg work, read every contract in great detail, and hire the right consultant and/or attorney familiar with healthcare laws when needed.
Regina Mixon Bates, CEO | The Physicians Practice S.O.S. Group | www.ppsosgroup.com
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