overcoming the struggles of small practices
DESCRIPTION
Small practices face many struggles on the road to success. This webinar overviews the top obstacles they face, addresses the reasons behind the decline in numbers of independent practices, and provides solutions for them to remain successful despite the challenges.TRANSCRIPT
Overcoming the Struggles of Small Prac5ces Wednesday, March 19, 2014
Disclaimer: Nothing that we are sharing is intended as legally binding or prescrip7ve advice. This presenta7on is a synthesis of publically available informa7on and best prac7ces.
Ques%ons/Challenges
• Describes the future for small prac%ce physicians – uncertainty.
• ACA is now underway • What happens when new, previously uninsured pa%ents poten%ally overwhelm your office?
• Can you afford to upgrade / implement / support an EHR system?
Difficul%es Implemen%ng/Upgrading an EHR
• Providers and staff not comfortable with the system / changing systems
• Centralizing pa%ent charts • Hardware Limita%ons
• Cost advantages & Disadvantages • Privacy concerns
Key Issues with Medical Records
Lost Charts
Secure Record Storage
Lack of Clinical Documenta5on for Coding
HIPAA and Regulatory Compliance
Processing Requests for Pa5ent Charts
Very important or important
84% 78% 87% 96% 80%
Somewhat or not important
16% 22% 12% 4% 20%
Source: HealthPort. “Key Issues with Medical Records.” Customer survey. Results may not total 100 due to rounding.
Decline in Independent Prac7ces
• Independent prac%ces are declining. • AAFP report in 2011 shows that 60% of ac%ve members were fully employed by hospitals
• Same report shows that just 35% were sole or par%al owners of their prac%ces
• An AMA survey shows more than 18% of physicians work in a solo prac%ce. Down 24% from a study in 2008
Why the decline?
• Lack of good business knowledge on the part of physicians
• Top five issues affec%ng physicians in 2013 as iden%fied by the Physicians Founda%on. – Ongoing uncertainty over the ACA – Consolida%on – Introduc%on of millions of newly-‐insured pa%ents – Erosion of physician autonomy – Growing administra%ve burdens
Affordable Care Act
• An es%mated 8-‐9 million Americans have obtained health insurance.
• Many implementa%on details are frustra%ng physicians, including, – The Insurance Marketplace
– Accountable Care Organiza%ons (ACOs) – The Medicare Physician Fee schedule – The Independent payment advisory board
Alphabet Soup
• Government Mandates aren’t helping either. • Hard to keep up with items such as without high cost: – PQRS – penal%es – ACA – ICD-‐10 (small breather, but coming soon) – etc…
How to Survive?
The best way to survive the changing landscape is to decide:
• Should I be acquired (and what are we worth), • Should I acquire (and what does that entail) • Or how do I make myself strong enough to survive?
Solu%ons?
• Lot’s of problems, what can we do about it?
Finance Management
• Plan for the Financial Future – Work with vendors and consultants to es%mate long-‐term maintenance and upgrade costs early on to avoid unan%cipated costs
• Maximize Ways to Offset Costs – Take the %me to assess thoroughly pa%ent mix, incen%ve eligibility, and the availability of addi%onal funding (grants, etc.) to maximize the ability to offset costs, engaging the RECs and consultants as needed.
Maximize Ways to Offset Costs
• Take the %me to assess thoroughly – Pa%ent mix
– Incen%ve eligibility – Availability of addi%onal funding (grants, etc.) to maximize the ability to offset costs
– Engage the RECs and consultants as needed.
Comprehensive Management
• Par%cipate In Collabora%ve Rela%onships – Collaborate with other small offices to overcome selec%on, financing, and implementa%on challenges through the pooling of resources and shared nego%a%ng power.
• Leverage External Resources (due diligence) – Seek external resources and exper%se to offset gaps in internal capacity throughout the process of financing, product selec%on, installa%on, workflow integra%on, and advancement of func%onali%es.
Product Selec7on
• Selec%ng the Right Product – Choose a product based on office-‐specific use, in addi%on to assessing its affordability, interoperability, and capacity for basic vs. advanced features.
• Nego%ate Vendor Contracts that Meet Expecta%ons – Communicate needs and implementa%on plans with vendors: unrealis%c expecta%ons can cause a minor setback to become major as staff buy-‐in decreases in rela%on to their percep%on of the process.
Implementa7on and Use (Cont.)
• Integrate Technology Into the Workflow – Engage users with the systems to overcome expecta%ons that it replaces exis%ng paper processes and work with vendors to build sooware based on best prac%ces, while integra%ng the health IT into the workflow.
• Invest In Training (one place not to skimp) – Beyond vendor training, train staff on complex or infrequently used system interac%ons, train new staff members, and provide supplementary training based on ambulatory-‐specific processes
Treat the Prac%ce as a Business
• A business that must profit • Offer the same conveniences to pa%ents that the big players do, such as weekend/evening hours
• Find inexpensive ways to market the prac%ce – Social Media
• Mul% faceted staff that can perform in clinical and administra%ve capacity
• Conveniences of allowing pa%ent access to a portal to schedule appts and pay bills online to reduce the burden on the staff
Reform Exemp%ons
• Claim exemp%ons for MU requirements where applicable.
• In addi%on to vendor issues, eligible professionals and hospitals can apply for hardship exemp%ons because of: – Lack of infrastructure – Unforeseen/uncontrollable circumstances – Lack of control over the availability of cer%fied EHR technology
– Lack of face-‐to-‐face interac%ons – And more
Interfaces – a blessing
• Lab Interfaces – Facili%es ooen foot the bill – Reduce scanning %me
• Document Interfaces to reduce scanning %me – Especially in the case of local hospital feeds
• Get crea%ve with interfaces – Automate CC’s if possible to reduce scanning
Automated Pa%ent Reminders
• Great case studies suppor%ng ROI here. • Even a slight reduc%on in pa%ent no-‐shows can mean large profit increases
• Case study of small office:
Gained Revenue in a Year – Appointment Reminders
• Average Cost per visit $90.00 • Provider Salary $62.50 • Total No Show Cost $152.50
• Total Pa%ent Visits 25,000 • No Show Rate 19% • # No Shows 4,750 • Cost per No Show $152.50 • Total No Show Cost $724,375
• Total Pa%ent Visits 25,000 • No Show Rate 19% • No Show Reduc%on 4% • Visits gained 1,000 • Revenue gained $90,000
Final Thoughts
These are only the most high-‐profile impacts to the healthcare industry during the current year. Tremendous pressures are coming to bear within a limited %meframe. We’re seeing an industry in the midst of tectonic change, with 2014 as the fault line. It’s unclear whether these disrup%ons will be for beter or worse. But there certainly will be winners and losers, and those who plan ahead are most likely to survive.
