Top challenges for office-based physicians

“What will be the single biggest challenge for office-based physicians in the coming year, and how will that challenge be best addressed?”

Medical Practice Insider recently posed that question to four healthcare industry executives and we were intrigued to see terminology such as sticker shock, transparency and philosophy as part of the discussion.

It's not that pressing issues such as ICD-10, meaningful use and reimbursements are becoming any less important, but it's constructive to view the current environment through the lens of individuals driving health businesses.

As you'll find in the following responses, the healthcare landscape is shaping up to be very interesting.

Mitch Rothschild, CEO of online physician locator Vitals:

Mitch Rothschild

Sticker shock. We have sudden and rapid growth of high-deductible plans, such as the bronze plans individuals favor in public exchanges, and deductibles rising significantly in private exchanges. Most people are used to going to the doctor and having insurance pay for most of the care. Much more of the payment — and sometimes the entire bill — now comes out of pocket. People aren’t expecting that.

We’ll eventually have consumer acceptance, adjustment of expectations and an understanding of the realities of coverage. Until then, expect immense challenges in collections — and nonpayment from patients is wildly more challenging than nonpayment from plans. Office-based physicians will need to become skilled at minimizing sticker shock. The sooner, the better.

When healthcare consumers go to urgent care centers, they usually understand the cost upfront and pay on the spot. Office-based physicians aren’t there yet, but being able to tell the patient what the charges will be ahead of time will become central to streamlining payments and collections. Several newer companies like Availity assist with calculating consumer cost at the time of care and collecting the consumer’s portion, and they can be very helpful to office-based physicians.

Of course, it won’t be possible for office-based physicians to always tell patients what their out-of-pocket will be, as the only entities that really understand the price of care are the health plans, which are now starting to provide more information. Vitals provides cost-forecasting tools for this purpose, and consumers really are using them. Although health plan sites aren’t where consumers typically go for cost information, it would be a good thing if it became commonplace in the future.

Joseph Berardo, president and CEO of health plan administrator MagnaCare:

Joseph Berardo

The biggest challenge this year will be to leverage health data — to integrate the office EMR with the healthcare system so that the clinical perspective can drive population health. We can’t fully accomplish this in 2014, but we need to take major strides now.

If we can ultimately harness and securely share the patient information we capture at physicians’ offices and beyond — pharmacies, labs etc. — we can profile populations and understand which individuals would benefit from proactive interventions. We can identify diabetics and proactively ensure they are scheduled for appointments they would otherwise not make. We have all this great and truly vital data, but we keep it in silos for use in isolated applications when we should leverage it to create a coordinated system of care.

We need to close the loop on care. We need to extract data from the EMR system, course it through the larger system, and then share rich data back at the physician’s office. A major challenge is that we have multiple types of EMRs and no standard. We may ultimately need technologies that can sit above these disparate systems and provide the data orchestration, which will mean more open architectures.

It has to happen if we are to deliver quality care with the efficiency that consumers, and the population at large, need — and if office-based physicians are going to thrive in an era of performance-based medicine that is driven by public payers and, increasingly, private payers.

Puneet Maheshwari, CEO of appointment scheduling platform DocASAP:

Puneet Maheshwari

Increasing healthcare consumerism, the result of individuals’ increasing burden of healthcare cost and management, will be the foremost challenge during the coming year. We're experiencing one of the most dramatic shifts in patient behavior in decades, and medical offices will have to adapt to remain successful, profitable and relevant. As consumers incur more out-of-pocket cost and are made responsible for their wellbeing, they will expect more control, more transparency and service levels consistent with their expectations of other services for which they pay.

That will mean changes at the office level that encompass everything from care delivery to increasing transparency, improving operational processes and delivering world-class customer service. Office-based physicians will need to champion cultural and operational change for each and every member of their staff, including themselves.

This presents a huge opportunity for physicians to differentiate their practices within a highly fragmented and competitive industry. Those who do will attract and retain loyal, long-term patients, which in turn will lead to better healthcare for the population as a whole and long-term economic benefits for all stakeholders. Those who miss the opportunity or resist change will see significant drops in patient volume and corresponding revenue. It’s all a matter of looking at best practices in other service industries and adopting and adapting processes and metrics to meet the expectation of this new era in healthcare delivery.

Karen Henry, CMM, CMPE, chief operating officer of office-based American Comprehensive Healthcare Medical Group:

Our biggest challenge is navigating through the changing landscape of private-based healthcare. It sometimes seems as if the quintessential doctor’s office is on brink of extinction — there are so many changes occurring with private physician groups and hospitals, the diversity of ACO networks, MSOs that are marketing ACOs and more. Today, there are simply so many ways in which care is delivered.

The drivers behind this are all well-known to the office-based physician. The most important thing to accept it that it’s fast-paced and there’s an urgent need for independent medical practices and private physician groups to establish their identities and their brands with a scope of services that will keep them viable. That involves a challenge in philosophy. We’re used to sticking to what we know, and so many entities above and around us are shifting and diverting that business-as-usual is no longer practical.

Change needs to start with awareness. Practices need to get active, reach out to and connect with people at top payer groups, look at best practices and compare themselves to their peers. Now more than ever, it’s critical to know what other doctors’ offices that serve the same population are offering that you’re not. It’s getting more competitive and commercial, so it's essential to have the right people on your team.

Not doing anything means missed opportunities. Practices not up to a full rebranding effort should take immediate steps to examine business practices and improve on internal processes to thrive in the face of so many changes.

What's your response? Use the Comments section below to add your voice to this discussion.