Five Key Changes for Physician Practices

Vital Signs: December 2013/ January 2014

The U.S. health care system is changing at lightning speed and the pace will intensify through 2014 and beyond. Value-based reimbursement models, health information technology (HIT), and consumer engagement are just a few of the current trends influenced by government regulations and new market forces. Given the rapidly changing environment, we wanted to share five key things we’re watching for in the coming year and the potential impact on your practice:

1. Employment and Contracts. Expect physician contract arrangements to become increasingly complex in the era of health care reform. More physicians were employed by hospitals in 2013 than 2012, and solo practice is decreasing. As such, physicians are entering into multi-layered contract arrangements that are linked to complex bonus structures and reimbursement arrangements. Risk contracts are gathering momentum in this market as well. Blue Cross Blue Shield of Massachusetts (BCBSMA), Harvard Pilgrim Health Care, and Tufts Health Plan have increased their risk contract offerings from approximately 19 in 2008 to 34 in 2012.

>>How will this impact your practice?

Given the changing environment and the increasing complexity of contracting arrangements, you may encounter scenarios where you have existing informal relationships that must be formalized through a contract. If you encounter this, take your time and be sure to complete your due diligence and consider seeking legal review before entering into a contractual relationship.

Resources

2. Physician Reimbursement.

We will see more ACO models and global budgets. The emergence of new payment models such as value-based care will continue to influence reimbursement strategies in 2014. Both commercial and public payers are working on creating plan benefit designs that incentivize patients to seek physicians who provide quality care at a lower cost and in turn reward physicians who provide quality care at lower cost.

For physicians, achieving high patient satisfaction and quality scores is paramount as reimbursement continues to incorporate rewards for meeting predefined metric targets. In today’s health care environment, using data to help drive the decision-making process is becomingincreasingly important and ultimately linked to physician reimbursement.

>>How will this impact your practice?

Data is your friend. Learn how to use your electronic medical records (EMRs) to help address care and quality gaps in your practice. Understand what you are required to do in order to position yourself for success under both your public and commercial payer contracts. Focus on implementing processes that help to support the use of data in your practice. Understand what your benchmarks are and focus on improving one area at a time.

Resources

3. Federal and State Regulations.

Federal and state legislative changes will continue to occur as components of the Affordable Care Actcontinue to roll out. As components of Chapter 224 continue to beimplemented in 2014, Massachusetts physician practices will be subject to new requirements. Two specific examples are price transparency and consumer engagement.

>>How will this impact your practice?

These changes will impact your practice mainly from an administrative standpoint. Understanding what the changes are (e.g., new requirements for physician licensure, ICD-10), flexibility in terms of adapting your practice to accommodate these changes, and communicating with patients will be vital.

Resources

4. Wellness, Prevention, and Patient Engagement.

The increased adoption of accountable care organizations (ACOs), integrated care delivery models coupled with the requirements of Meaningful Use Stage 2 and the Massachusetts Chapter 224 requirements around medical home implementation have kindled discussions on wellness, prevention, and patient engagement in 2013. These conversations will continue throughout 2014 as the health care industry works to implement initiatives to promote wellness, facilitate disease prevention, and engage patients as active participants in the care delivery process.

>>How will this impact your practice?

The movement towards wellness and prevention activities will require physicians to create new strategies to involve patients in health care decision-making. A focused effort on wellness and prevention may be accomplished through patient education (for instance, on healthy eating), disease prevention activities, and the sharing of information and data with your patients.

Resources

5. ICD-10.

The emphasis on ICD-10 will intensify starting in January 2014, as we prepare for the October 1, 2014, deadline for compliance. While that may seem a long way off, the transition to ICD-10 is highly complex and can lead to the need for significant changes in people, processes, and technology in your practice.

>>How will this impact your practice?

ICD-10 implementation requires significant preparation. Practices are urged to perform documentation gap analysis now — under ICD-9 — to identify weaknesses and develop a plan to address any issues that might arise while implementing ICD-10.

Resources

  • The Transition to ICD-10 Video Series
  • The Transition to ICD-10: Key Considerations for Physician Practices White Paper
  • www.massmed.org/icd10
—Talia Goldsmith 
PPRC Specialist
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