The pressures on independent physicians can be staggering. In addition to the many trials and tribulations all entrepreneurs must face, physicians have some additional obstacles that are unique to their profession. In part one of our two-part series, we’ll focus on six key challenges facing physicians in the year ahead and opportunities to meet these challenges.
Bogged Down by Administration
Today, many physicians spend twice as much time per patient filling out paperwork compared to before the Affordable Care Act was passed. If time per patient was spent with the real-live patient then that would be considered a plus. Unfortunately, that additional time is spent in front of a computer. It’s becoming clear that mounting paperwork is keeping physicians from spending enough time with patients. In addition, mandatory and redundant file keeping has become so time-consuming that many practices have had to hire full-time compliance officers.
Prior authorizations are a major, and growing, source of physicians’ paperwork burden. More and more payers are requiring prior authorizations for more drugs and procedures as a way to hold down costs, improve treatment and ensure patient safety. But the feedback from physicians has been mixed, with many saying that prior authorizations are in fact, an obstacle to actually delivering the best care possible to their patients.
The law of unintended consequences is that actions of people—and especially of government—always have effects that are unanticipated or unintended. The Affordable Care Act, which requires physicians to fill out specific forms, document specific health patterns, and more—has had a negative impact on the day-to-day life of independent physicians.
Payers Setting the Rules
In health care, a payer generally refers to entities other than the patient that finance or reimburse the cost of health services. In most cases, this term refers to insurance carriers, other third-party payers, or health plan sponsors.
The payers have a role in the Affordable Care Act and their emphasis on cost-cutting is having some negative consequences for many other parties. It’s all good and fine to putting the spotlight on return on investment and scrutinizing costs while increasing care for patients. Needless to say, the rising emphasis on value-based payment models is increasing strain on the physician-patient relationship.
Physicians seem to be bearing an unfair share of the burden. Staying compliant in a fast-moving, digital world is critical and has become very expensive.
Another area of concern involves the increase in audits. Physicians have had to deal with a range of audits tied to meaningful use and other programs. Since the ACA, these audits have increased due to the fact that there is money on the table for the payers. The best thing a physician can do to ensure an audit goes well is to assume they will be audited and to prepare for it. Physicians require documentation from their vendors confirming the version of the EHR system they are using and they need to document everything.
It’s no secret that independent practice costs keep rising. Dealing with rising costs was noted as the single biggest daily challenge for physicians. So is this driving physicians to become employees? Yes and no. The 2015 Independent Physician Outlook Survey, which provides insight into that state of independence in the medical field from the physician perspective clearly showed that the majority of physicians desired continued independence.
Some of the increase in costs comes in the form of increasing rates for malpractice insurance and for directors and officers liability coverage. As well, there area higher health insurance costs with their own practice staff. As well, there are now more software and training costs that practices must shoulder.
The independent medical practices that thrive in the new healthcare environment will be the ones that take a proactive approach to manage these changes. In part two of our series, we’ll cover three remaining challenges for physicians and explore how medical practices are thriving on non-insurance based revenue.
It is not a stretch to anticipate that increases or decreases in inpatient encounter volume will likely be matched by similar trends in allegations of malpractice. As a way to avoid potential liability, some physicians report practicing a much more conservative approach to their treatment and diagnosis options. In other words, there may be a tendency to practice a kind of defensive medicine. For example, physicians may order more diagnostic procedures than might be necessary for an effort to protect themselves from potential future litigation.
Compliance issues are also a part of this mix. Staying compliant in a fast-moving, digital world can be both complicated and expensive. The ICD-10 compliance deadline is an additional burden. And it comes at a time when physicians are trying to meet several other federal technology requirements and risk penalties if they fail to do so.
With the necessity of electronic records, keeping patient information secure is growing more complicated. Many physicians are not aware of the requirement to complete and keep an updated security risk analysis. This is a requirement of both the Health Insurance Portability and Accountability Act and meaningful use.
The “Requirement” for Satisfaction
Government programs such as the Physician Quality Reporting System indirectly tie Medicare reimbursements to patient satisfaction scores. The problem for physicians is that the goal of patient satisfaction isn’t always aligned with the goal of providing the best care. And because physicians are being judged by their performance grade card, it’s in their best interest to protect their livelihood. This may cause physicians to modify their practice patterns, in an effort to improve their scores.
Doctors who say “no” to their patients, for example, who may be requesting unnecessary antibiotics, do so with the understanding that patient dissatisfaction could end up eventually affecting them in the form of a pay cut. That situation is inherently problematic.
Actually Getting Paid
Many private practices are choosing to opt-out of Obamacare entirely, citing reimbursement rates that are simply below acceptable standards. For those who are not opting out, they are finding themselves under constant pressure to get paid for the work they do.
If a patient in a subsidized plan falls behind on their premium payments, the Affordable Care Act requires insurers to cover their medical bills for 30 days. But for the next 60 days, insurers may hold off paying the claims — and ultimately, deny them if the patient doesn’t catch up on his premiums.
What does this mean to doctors? In this scenario, a doctor will not get paid for their services. If the insurer ends up canceling the policy after 90 days, doctors can bill patients directly but collecting that money is another challenge. For some medical specialties, treating patients who have fallen behind on their payments could end up being quite costly.
Non-Insurance Based Revenues
So how are some physicians adding popular in-demand procedures and treatments that are non-insurance based? Quite simply, they are bringing their marketable skills and expertise to an industry that is hungry for their talents – they are entering the consumer-driven aesthetics industry.
With non-insurance based revenues, they do not face the same administrative nightmares that have ballooned under the Affordable Care Act. And they are generating profits that far exceed their traditional practices. The numbers are impressive. By simply adding 10 Aesthetic & Weight Loss patients per month, a practice can earn in excess of $500,000 in non-insurance Revenue. That’s a staggering amount when compared with the financial and other pressures facing independent physicians.
Fortunately, there are industry experts that are able to help physicians transition to the lucrative aesthetics industry. One of the leading programs, the Aesthetic Medicine Symposium, has been structured and streamlined to not only provide physicians with hands-on training in the most popular and profitable procedures but also a financial and business foundation to be successful in this new economy.