It will come as no surprise that in 2019, healthcare costs will continue to rise. At a projected 6 percent increase, this is consistent with the past five years, but it’s still an unsustainable trend long term.
To help manage costs for your patients and your practice as you begin the new year, we've compiled nine trends to keep in mind. Read on for a summary of these trends, or scroll to the bottom and click the button to read the full briefing.
independent physician practice
Greater access to quality care and lower costs are strong incentives
According to a recent report by the Association of Medical Colleges, we are in the calm before the proverbial storm relating to physician demand. The report states that the need for physicians will increase due to an aging population; however, the physician supply is expected to decrease. The projected physician shortfall will range from 40,800 to 104,900 by 2030. As if the strain of an older population wasn’t enough, the survey also projects ''more than one-third of all currently active physicians will be 65 or older within the next decade.”¹ That means a lot of doctors that are practicing medicine now will be retired in the next ten years. Some areas that are already feeling the strain are hiring Nurse Practitioners to fill in the gaps.
top of licensure,
Effectively managing a team involves properly delegating tasks, since no one has the knowledge and expertise to manage everything on their own. Create an atmosphere of problem-solving, and empower others to always work at the top of their licensure.
When non-clinical issues arise, they shouldn’t always be a physician's responsibility. Hiring an office manager to coordinate administrative issues allows physicians to focus on patients, rather than micromanaging staff.
top of credentials,
top of licensure
Retirement may be years away, but as an independent physician, there are many succession-related issues that need your consideration—and they shouldn’t be put on the back burner.
First, who will be your replacement? Will you select a successor from the talent within your practice or medical group, or will you undergo a search for an external successor? How and when will the transition occur? Finally, what steps will be taken to provide stability for your employees, patients, and referring physicians?
To ensure a successful transition, practices should develop succession plans for all leading physicians. Follow these 10 steps to formulate a strong plan for your practice.
Physicians must code diagnoses properly to succeed under Medicare & other value-based contracts
Each year, CMS sets cost benchmarks for every Medicare member, based on the patients’ diagnoses during the prior year. But what if the physician hasn’t reported their patients’ health information accurately or fully? The result is often benchmarks that are set low, and costs of care exceeding benchmarks.
The payer then thinks the provider spent too much on members’ care, and does not recognize or reward the value (high quality/lower cost) of the care provided by the physician.
That's why proper Medicare risk adjustment coding—entering diagnosis codes in the EMR and on claims and treating for each diagnosis —is essential. Providers who follow best practices for risk adjustment coding have a better chance of earning shared savings.
risk adjustment coding
With the growing complexity of the healthcare industry, practicing physicians are seeing an unavoidable rise in required reporting and administrative tasks. At the same time, the increasing financial burden of maintaining a viable practice weighs heavily on providers. These mounting pressures cause high levels of stress, frustration, and fatigue, leading to physician burnout.
CMS created the Star Ratings system in 2008 to help seniors compare quality and performance among Medicare Advantage (MA) Part C plans and Part D prescription drug plans (PDPs). Insurance companies also benefit, as a plan’s star rating influences patients and directly affects membership growth. In 2012, CMS upped the ante by linking premiums and bonus payments to each plan’s star rating. Roughly, each half-star change in a plan’s rating affects bonus revenue by 25-30%, with the most significant reductions occurring when a plan drops under 4 stars. In real dollars, a plan increasing their star rating from 3.5 to 4.0 would result in double the annual bonus payment (referred to as a “rebate percentage”). Bonus payments are substantial, with an average amount between $700 - $1,000 per patient per year.
Practice transformation is an ongoing process of developing a practice into a Patient-Centered Medical Home (PCMH)—a theoretical model of primary care delivery that is coordinated, team-based, and committed to achieving the Triple Aim of medicine.1 In today’s value-based healthcare environment, the Triple Aim guides practices to provide better care, achieve higher patient satisfaction, and lower healthcare costs per capita.
Patient-Centered Medical Home,
The number of High Deductible Health Plans (HDHPs) and Consumer-Directed Health Plans (CDHPs) in the market continues to increase as patients and employers look for lower monthly premiums and payers aim to place more financial risk on patients.
In 2016, the Kaiser Family Foundation reported that an average of 51 percent of workers were covered by a health plan with an annual deductible over $1,000 for single coverage. This group of individuals had increased by 22 percent since 2009, and this trend continues to rise.1 With high deductible plans, patients are often liable for the entire cost of the payer negotiated rate of their physician visit, and the high out-of-pocket expenses are driving them to make savvier healthcare decisions. Patients desire more financial transparency, access to healthcare costs, and increased communication from their provider. Yet despite patients’ increased financial awareness regarding their obligations, many are still unreliable payers in the market.
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Revenue Cycle Management,
2018 is expected to be another tumultuous year for the healthcare industry, even though industry growth is projected to remain mostly stable.1 With the repeal of the Affordable Care Act (ACA)’s individual mandate, uncertain policy efforts to strengthen state marketplaces, and ever-increasing insurance premiums, there will be a broad range of challenges facing the industry this year.
Yet for physicians and clinicians, the industry’s shifting tides will not be the center focus. Physicians will place increased emphasis on alleviating operational challenges, improving the quality of care for their patients, and tracking compliance with care plans to improve patient outcomes. These improvements are expected to aid in the decrease of overall healthcare spend, since industry trends in 2018 will focus on innovative ways to lower costs, increase quality, and reduce unnecessary utilization.
2018 healthcare trends,
quality payment program,
high deductible health plans