'Adjust your ship accordingly:' How practices can win under the current ACA, healthcare reform moving forward

News of healthcare reform has heavily circulated in the media for quite some time, and physicians of all practice settings and specialties are challenged to continue their trade in the wake of such uncertainty.

During a panel titled "The State of the ACA and the Impact on Practice," industry experts discussed how the ACA has changed the way providers practice medicine throughout the years and how various healthcare entities can succeed, despite not knowing what is coming down the pipeline. The leaders spoke during Becker's 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in Chicago.

"The ACA was disruptive from the beginning. [Physicians] didn't sign off on this and we are told to adapt," said Damian "PAT" Alagia III, MD, a health system physician executive. "We talk about reimbursement models and what that means for us and it means different things for different people."

ASCs in the value-based care landscape
Some healthcare entities have fared well under the shift, which prioritizes high quality at reduced cost. While some surgery centers have faced obstacles with the many reporting requirements and quality indicators, many payers are seeing the value ASCs hold in lowering healthcare costs and providing excellent patient outcomes. As patients become increasingly financially responsible for their healthcare, they will seek the most cost-effective setting of care. Therefore, many surgery centers will post their prices online, as a procedure at a hospital carries a larger price tag than an ASC in most cases.

"With consumers becoming savvy, ASCs have a great opportunity," said Marilyn Denegre-Rumbin, director of payor-reimbursement strategy and business development at Cardinal Health. "The next set of bundled payments is for cardiology and oncology. It will be interesting to see which unorthodox treatments can take place in the ASC. I am optimistic that the glass will be half full."

Using data to win in the new healthcare era
The ACA has required providers to show they are proving quality care through data.

Fred David, MD, president and chief medical officer of Grand Rapids, Mich.-based ProCare Pain Solutions, a NAPA company, said physicians have to understand both the business and clinical intelligence of the collected data. ProCare has worked with a large health maintenance organization for five years and has taken on some of their more complex cases. Within several years, the partnership has yielded improved quality of life, higher patient satisfaction scores and an average cost reduction of $3,000 per patient annually.

"The winds of change have been happening for a while and physicians have to harness the power of practice which is collecting the right data on our patients," he added. "This puts you in a different relationship with payers by having data showing the impact you have on patients' lives."

In healthcare, data is king and the industry is tasked with maneuvering the many challenges in data collection, such as using the data to drive clinical decision-making. Physicians spend a large portion of their time inputting their data into EHRs, with the shift to value-based care often taking face-time away from patients.

"Physicians just want to practice medicine and we have to hire the right staff to take the burden off of them," said Mae Caime, RN, executive director of Commack, N.Y.-based Long Island Spine Specialists, president of Rebooturlifenow and a certified life coach.
Adapting to change
Remaining competitive in the healthcare field is crucial and practices should ensure they not only are aware of changes taking hold in the industry, but they too are fully able to adapt successfully.

"The major trends in hospitals are volume and reimbursement going down. The government is trying to take $800 million out of the system and you can see the writing is on the wall. [Many] hospitals are closing," Dr. Alagia said. "You need to adjust your ship accordingly and people who respond to reality will do much better. [Change] is coming."

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