More than ever before, physicians are facing an abundant amount of challenges. Declining reimbursement, changing payment models, and uncertainties surrounding new administration and the Affordable Care Act just to name a few. While the coming year presents many challenges to physicians, we’ve identified six of the top challenges most common among physicians that can also be less intimidating through further education and, of course, much preparation.
1) Chronic Care Management
About 25 percent of primary care doctors reported that they’re not fully prepared to care for patients with chronic diseases according to the Commonwealth Fund National Survey in 2016.
Among 117 million U.S. adults, half suffer from chronic diseases and these numbers are estimated to increase 86 percent of healthcare costs according to the Centers for Disease Control and Prevention (CDC). Patient education through health coaching, use of electronic healthcare records (EHRs), and implementing new programs to promote preventative care are just a few ways to reduce costs associated with chronic illnesses.
One program in particular is the Medicare Chronic Care Management Service (CPT Code 99490). In 2015, CMS began reimbursing physicians $40.39 per month per eligible patient for nonface-to-face Chronic Care Management Services. This can quickly add up to a significant amount of revenue for providers but providing the service, documenting it, and being paid for it can be challenging.
Getting reimbursed for the service means meeting all of the requirements of Medicare's chronic care management which must take at least 20 minutes per month. The practice will not only need to create and regularly update a comprehensive care plan according to Medical Economics but will also need to obtain written consent from the patient before moving forward with the service.
The comprehensive care plan must detail the patient's health problems, prognosis, treatment, goals, interventions, medications, and the need for social services.
In the end, capturing all of this information in your EHR software can be a challenge for physicians which in turn can make reimbursement that much more challenging. If all of these conditions are met, then providers stand to make a substantial amount of revenue each month considering reimbursement is about $40 per member per month.
2) Particular Attention to Mental & Behavioral Health
A similar review additionally found that 84 percent of U.S. primary care doctors reported lacking expertise in treating mental illness.
Each year, roughly one in 25 adults in the U.S.—10 million individuals—encounters a psychiatric disease that severely interferes with at least one major life activity according to the National Institute of Mental Health.
The mental health of a patient is an issue for all physicians. Mental health conditions often impact the patient’s ability to manage disease independently, leading to increased readmission costs. Psychiatric education will need to play a major role in physician training and reimbursement in 2017.
Additionally, one of the subcategories under Improvement Activities under the Merit-Based Incentive Payment System is Integrated Behavioral and Mental Health. A majority of clinicians will need to attest to completing up to four activities for at least 90 days. Some activities under the Behavioral and Mental Health category include
- Implementation of Integrated PCBH Model
- Diabetes Screening
- Depression Screening
- Tobacco Use
- Unhealthy Alcohol Use
- Major Depressive Disorder Prevention and Treatment Interventions
3) Care Coordination and EHR Interoperability
The 2016 Commonwealth Fund survey reported that one out of three U.S. primary care doctors are notified when a patient is released from the hospital, in contrast to 69 percent—more than two in three—in other countries like the Netherlands.
The absence of care coordination and communication not only causes disappointment and confusion for patients; it can likewise prompt readmissions. Furthermore, because of the Affordable Care Act, clinic readmission rates will be vital for doctors going forward.
Successful care coordination starts with EHR interoperability. Facilitating coordination across the care continuum has improved with initiatives like the Sequoia Project, a public-private collaborative to remove barriers to interoperability in healthcare nationwide. But coordination is multifaceted and will require more than just EHR interoperability to improve care delivery and reduce costs.
Removing barriers to health information exchange and improving how patient data is collected and measured will certainly assist in filling the gaps that exist within the continuum of care. Physicians can focus on the accuracy of their patient data today and work on ways to improve communication among providers, patients, and office staff.
Digital health devices used for improved patient-doctor engagement — such as wearable technology — will continue to be a debated issue in 2017.
Nearly half of patients hospitalized in 2016 used wearable technology after their hospital discharge, according to Health Catalyst. Wearable technology reduces hospital stay costs by alerting doctors of early changes in the patient’s condition offsite. The popularity of FDA-approved wearable technology for chronic diseases like heart disease, hypertension, and diabetes has grown by 65 percent this year alone.
1,000 industry leaders, physicians, nurse practitioners, and physician's assistants were surveyed in a report by PricewaterhouseCoopers’ Health Research Initiative (HRI), Healthcare delivery of the future: How digital technology can bridge the gap of time and distance between clinicians and consumers.
The HRI survey showed an open attitude among physicians with digital technology and adopting it in their practices. In fact, nearly 66% of physicians would prescribe an app to help patients manage chronic diseases such as diabetes.
The challenge ahead is whether wearable technology can be implemented to make a meaningful change in caring for patients and if it will be recognized by payers.
5) Incentive Program Transitions to MACRA
The Final Rule of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), released publicly on Oct. 14, puts patients and clinicians at the center of the Quality Payment Program while streamlining existing incentive programs such as Meaningful Use, PQRS, and the Value Modifier Program.
The new payment system creates two pathways (The Merit-Based Incentive Payment System and Alternative Payment Models) which allow clinicians to pick their pace for participation in the transition from a fee-for-service health care system to one that uses alternative payment models that reward quality of care over quantity of services.
While the Final Rule "aims to allow physicians to ease into the program without getting hit with negative payment adjustments right away," it also poses a number of challenges to clinicians.
According to a recent article by FierceHealthcare, there may be unintended consequences of MACRA.
- The merger of smaller practices into larger ones or encourage further acquisition of practices by hospitals and healthcare systems.
- Physicians may drop out of Medicare or choose to get out of medicine entirely. Doctors with only a few years left in their careers are retiring earlier, particularly those who don’t want to be employed by large systems.
- Too great a reliance on electronic health record vendors to report data through MACRA. If there are errors in the data, practices could see negative reimbursements.
Even with these unintended, possible consequences aside, the first performance year of MACRA begins January 1, 2017, and will place added stress on providers to score highly to avoid a negative payment adjustment come January 1, 2019.
6) HIPAA Compliance
As we near the end of 2016, physicians and practices must also be preparing for the next phase of HIPAA audits expected to take place in early 2017.
In OCR’s announcement on the HHS Health Information Privacy website, they said that “The 2016 Phase 2 HIPAA Audit Program will review the policies and procedures adopted and employed by covered entities and their business associates to meet selected standards and implementation specifications of the Privacy, Security, and Breach Notification Rules.”
The second round of HIPAA audits will measure the degree to which not only practices but also covered entities such as health care providers and insurance companies, in addition to their business partners and associates are in compliance with HIPAA rules and regulations.
In an article published earlier this year by HITECH Answers, Bob Grant with the Compliancy Group points out that the proposed budget makes it clear that HIPAA compliance audits are taking priority in 2017. The proposed budget of $1.15 trillion for the Department of Health and Human Services (HHS)—$43 million going to the Office for Civil Rights (OCR)—would "allow the OCR to increase its team of on-staff auditors in preparation for the next round of HIPAA compliance audits," according to Grant.
To thrive in 2017, physicians must continue to embrace change, technology, and pay particular attention to the changes taking place with healthcare reimbursement and policy. Utilize the resources at hand to understand MACRA and be prepared for HIPAA audits that could be coming to your practice in 2017. By meeting these challenges head on, you can ensure that your practice will thrive in the coming year.