Upon passage of the Affordable Care Act (ACA)—and its subsequent implementation delays—medical providers realized healthcare reform would bring major changes to the health insurance landscape. Yet, many did not consider the true magnitude of these changes. To date, results increase responsibilities and duties, accompanied by decreasing revenues.
Unfortunately, many private payers have adopted cost-savings measures for themselves that demand increasing documentation, placing more responsibility on medical providers and staffs. For example, requiring additional data supporting a diagnosis and treatment plan are more common.
These mandates are basic examples of “shifting” the work burden away from the payers to the consumers (physicians), much like banks do with ATMs, which place the responsibility on the bank’s customers to process their own transactions.
‘Medicine by Mandate’ Issues
Some of the issues fueled by healthcare reform and the ACA include the following new provider responsibilities.
- Transfer of many duties from payers to physicians and practice staff;
- Longer time to input patient data into electronic health records (EHRs);
- Spending more computer time at the expense of face-to-face time seeing patients; and
- Payers requesting more and more data from attending physicians to verify the quality of providers’ diagnosis and treatment efforts.
These and other less significant issues change the way physicians must operate their practices and maintain former revenue streams. Practice managers also face more complex operational challenges.
Providers and practice managers must devise answers to the following questions.
- How to efficiently capture the additional patient data necessary to verify quality care?
- How to allocate the additional staff time needed to input more patient data?
- How to ensure the practice is using the most efficient software and IT systems to produce satisfactory and secure EHRs?
- How to maintain high quality care, while satisfying new data demands of payers?
- How to avoid claim reimbursement delays or denials by providing the documentation CMS and private payers want?
The answers to these questions are vital to overcoming the ‘medicine by mandate’ issues that meaningful use and ACA regulations demand. Here are some suggestions to meet and manage these new potentially negative mandates.
Overcoming Healthcare Reform Issues
Physicians are still in charge of determining the diagnosis and treatment of patient problems, but healthcare reform mandates affect at least two important considerations.
- Delivering high quality care within the provisions of the law (ACA) and payer (CMS and private) requirements; and
- Maintaining or increasing timely revenues while submitting accurate documentation to ensure former income levels.
Evaluate these suggestions to overcome new challenges:
- Accept that ‘medicine by mandate’ is a reality, for better or worse. Instead of fighting these new rules, consider them a new challenge to the practice of medicine to be managed.
- Create policies that satisfy regulations without adding significant operating costs. Thorough staff training and procedures to ensure documentation accuracy, such as a double check of claims before submission are two methods of maintaining timely reimbursements.
- Implement cost-controls to maintain profit margins. Providers must use creativity to keep practice operating expenses in-line without sacrificing quality patient care. During your evaluation, consider using a top third-party billing and medical documentation firm, such as M-Scribe Technologies, to manage this critical function while delivering cost-certain controls.
- Focus on procedures that allow you to continue delivering quality care. No one knows your practice as well as you. Implement streamlined procedures that maximize patient contact and minimize additional expenses.
- Use the most effective IT solutions to save staff time, while maximizing accuracy of claims. If you determine your claim software is unacceptable or requires major staff time commitments to input EHR data, consider investing in more modern IT systems.
Depending on the ‘environment’ of your practice, you should summon up the height of your creativity to overcome these challenges. It appears they are here to stay, demanding efficient long-term solutions. Treat ‘medicine by mandate’ as another potential roadblock to be circumvented by designing methods to manage these additional responsibilities.