Value-based care & the independent practice — what you need to know, what you're not talking about

Value-based care can endanger independent practices because of the financial investment they'll have to make to stay ahead of the curve, but making that investment isn't an impossible task.

SRS Health's Vice President of Sales Diane Beatini spoke to Becker's ASC Review about the impact value-based care will have on independent practices.

Note: This story has been edited for style.

Question: What are the biggest challenges going to be to independent practices as healthcare transitions to value-based care?

Diane Beatini: The healthcare environment has been changing very rapidly — from the ACA of 2010 to the advent of Medicare Access and CHIP Reauthorization Act of 2015/Merit-based Incentive Payments.

The greatest challenges to independent medical practices has been, and will continue to be, how to interpret and successfully navigate these changes while remaining independent.

Two crucial pieces of the puzzle will be the willingness to establish creative strategic partnerships — super groups, clinically integrated networks or accountable care organizations — and to adopt new technologies to reduce and streamline costs; exchange data and protected health information with other specialists and referral sources; and demonstrate quality to assure continued reimbursement and build a growing patient population/referral base. Both of these will depend on strong leadership to visualize, articulate the need for and effectuate these structural changes.

Q: Will smaller practices struggle to adapt to value-based care? Will quality reporting limit the amount of time physicians can spend with patients?

DB: Smaller practices need to develop a strategic operating plan that will work to reduce expenses, ensure the collection and reporting of data and engage the participation of patients.

If they have not already done so, they should make it a priority to develop a strong partnership with a healthcare information technology vendor well versed in their medical specialty.

The vendor should be more than simply a vendor — it needs to provide regulatory advice, guidance and training in support of the practice’s success. This is a cost-effective alternative to hiring an outside consultant service and/or relying on internal personnel.

As already mentioned, smaller practices can also form strategic alliances through joining CINs or ACOs based in their geographic region. Regular education through professional medical organizations and academies can be helpful in providing critical information and benchmarking data. The technology required for quality reporting can actually enhance the time spent with patients.

For example, the use of an integrated patient portal can ensure real-time access to personalized health information and facilitate an ongoing dialogue between the practice and the patient. This helps to create loyalty and repeat business, and to reduce no shows.

Involving the patient in patient-reported outcome surveys at the point of care not only provides the data needed to improve quality outcomes; it involves the patient in their own care while [ensuring] their attentiveness. Improved outcomes support improved income.

Q: As a follow-up, will value-based care put any independent practices at financial strain to meet new reporting measures?

DB: Independent practices will be at risk if they are reluctant to embrace the changes necessary to succeed under the value-based payment model. Specifically, if they are unable or unwilling to enlist strong internal leadership, to put a strategic operating plan in place, to partner with a responsive HCIT solutions provider for an EHR/patient portal/outcomes reporting tool and to seek regulatory guidance and training [they could be at risk].

These actions will require investment, but any cost will be far outweighed by the cost of inaction, particularly given the return on investment.

Again, there are options such as joining a CIN or ACO, or merging with other regionally based practices to form larger entities with bargaining power to negotiate directly with payers and employers — all of which represent additional options to mitigate costs.

Q: How will independent practices benefit from value-based care?

DB: Independent practices that successfully navigate these changes will benefit from the ability to attract more patients, more referrals and more physician/clinician recruits.

Done well, the HCIT solutions put in place can do more than simply demonstrate quality outcomes as a means of yielding higher reimbursements and compensation under MIPs; they can drive and enhance physician productivity and reduce overhead, providing more opportunity for investment in ancillary services representing alternative/additional income sources. Strategic alliances with local hospitals, health systems, physician groups and referral sources can positively impact negotiations with payers, employers and referral sources.

Q: What's the one thing practices should be talking about concerning value-based care that they aren't?

DB: The needs and evolution of the patient as a consumer of healthcare.

As patients gain more access to reported quality data and the overall performance of their physicians versus their physicians’ peers, they evolve into educated consumers shopping for an overall experience rather than patients simply seeking medical treatment.

The total patient experience represents another opportunity for independent medical practices to gain a competitive edge by marketing successful treatment/surgical outcomes, strategically improving their office location[s], enhancing communication with their patients and expanding their service offerings.

Patients with access to performance metrics can more confidently choose and recommend their physicians. Offices located near shopping centers, restaurants, banks, etc., can offer convenience along with the potential for increased foot traffic for urgent care and walk-ins.

Patient portals and communication/reminder systems keep patients informed, drive compliance and provide appointment options, preventing no shows or leakage.

Expanded service offerings such as after-care hours, urgent-care services, and imaging and physical therapy help to retain the patient within the medical ecosystem, extending the relationship and providing for a total experience.

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