What do the healthcare industry and politics have in common? Both can expect a wild year ahead in 2016.
While the political world will see a new president elected, one who will not only have to create more jobs, balance the budget, solve climate change AND defeat ISIS, the healthcare industry will continue to face confusion and uncertainty with shifting payment models to new government mandates to continuing battles over maintaining certification.
The silver lining in this dark cloud is that 2016 will also present more opportunities for doctors to improve patient care by leveraging technology and strengthening care deliver teams, and receive more reimbursements for time they actually spend treating patients.
In an effort to help small- and medium-sized practices avoid the pitfalls while enjoying the spoils, here are 6 things every practice owner needs to be aware of to plan for the New Year:
Be Prepared to Finally Embrace Alternative Payment Models
Payment models will continue to change in 2016 and in order to get paid what they deserve, physicians will have to prepare to take on more risk. When Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in April, providers across the country breathed a sigh of relief. It wasn't long, however, until doctors realized that solution came with a price: incentives to move away from the old fee-for-service payment model toward quality-of-care models for Medicare payments.
Practice owners will need to start adapting to the new payment models next year through 2019 when implementation of the Merit-Based Incentive Payment System (MIPS) begins. Though no one is entirely sure how CMS will determine physician scores under MIPS, or at what level (practice or individual) scoring will take place, or whether the new pay-for-performance focus will drive more providers into alternative payment models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs), what we do know is that starting in 2106, doctors will need to determine whether or not they want to participate in APMs because that will really change the nature of how they will be evaluated. Many suspect that APMs may be required to share in losses, which would mean practice owners who choose that track will take on more financial risk.
Like there aren't enough scary things in the world to keep us all up at night, now doctors have even more reason for midnight panic attacks: payer consolidation! If there are two things practice owners can't stand it's someone else having a tighter control on their practice and higher patient costs. Well, those would be the results if the four biggest health insurers end up merging as they have proposed to do.
If these firms end up consolidating it will mean lower reimbursements to physicians, which will lead to less time being spent with each patient in order to make up for the lower reimbursements per patient. Also, because a plan would account for a huge block of patients, doctors will no longer be able to leave a health plan if they don't like the terms. Practice owners will have less and less negotiating power and be ill-prepared to handle the complexity involved.
Robert Laszewski, president of Washington, D.C.-based Health Policy and Strategy Associates, LLC., has voiced what many others in the industry are silently thinking, "We're on track for the system getting bigger for the sake of getting bigger."
Patients Unable to Pay
Patients can expect to face higher co-pays and deductibles in the New Year and many can be expected to crumble under such dramatic increases. This will force many patients to forgo some care or seek lower-cost providers, which will in turn force many doctors to scramble for new revenue.
As more and more small- and medium-sized practices adopt technology to comply with ever changing government mandates, more physicians will feel the potential heat of a cyberattack. Even big hospitals with much bigger budgets are struggling to protect infrastructure and ensure enough security is in place to thwart a breach of patient data. According to research from the Health Research Institute's 2015 consumer survey, consumers are concerned about the vulnerability of their personal medical data. Providers must be certain their EHR vendors has measures in place to keep these records safe or they (the doctors) may face a lawsuit.
The Future of the Affordable Care Act (ACA)
As of now it's anybody's guess what will be the outcome of the 2016 presidential election. While Republicans have tried to repeal the ACA more than 50 times, it is highly unlikely the ACA is going anywhere, no matter who wins the race. After all, who wants to be the big, bad bully that takes away insurance from over 23 million people who have gained it under the ACA?
Industry experts are predicting that if a Republican should win the White House, physicians can expect the new administration to alter the ACA through a regulatory approach. For instance, they may change the definitions for what are the necessary (essential) healthcare services covered. Republicans are typically against coverage for birth control, as an example. All of this could mean more coding and revenue cycle management nightmares on the horizon for providers.
Meaningful Use Stage 2 Reporting
Those physicians who do plan on moving forward in MU Stage 2 will be challenged with having to report for a full calendar year in 2016. For those practices who are organized and have all of their proverbial ducks in a row, this shouldn't be a problem. But if physicians think they can get away with starting to measure their performance on MU measures later in the year, they are in for a rude awakening as they would have to be nearly perfect to reach thresholds.
What will 2016 be like for the healthcare industry? At this point it's anybody's guess. What seems to be clear is that in order to plan for the upcoming year, physicians need to focus on protecting their revenue flows at every turn.
Alex Tate is a health IT Consultant at CureMD who provides perceptive, engaging and informative content on industry wide topics including EHR, EMR, practice management and compliance. EHR Vendors.
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