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.
Quality-based reporting is now a requirement for all qualifying physicians
As of January 1, 2018, participation in the Quality Payment Program (QPP) is a requirement for any physicians who qualify under the Merit-based Incentive Payment System (MIPS) or as an Alternative Payment Model (APM). Unlike previous years, where physicians could choose whether to submit reporting information, all physicians that qualify for MIPS or as an APM will be required to report on quality, improvement activities, advancing care information, and cost. Otherwise, practices will face a negative payment adjustment in 2020.
Unfortunately, only 40 percent of health organizations have begun incorporating value-based initiatives.2 To be sure your practice is prepared for 2018 reporting requirements, physicians need to identify target reporting criteria and determine whether the practice has the necessary data collection capabilities.
If your practice is lacking the proper software for quality reporting, you may need to consider upgrading your electronic health records (EHR) or evaluating add-on capabilities, which can capture this information from your current EHR. For practices without an EHR, Qualified Registries are also available for MIPS data submission. Some registries accept manually entered data or spreadsheets, and they will report the information directly the Centers for Medicare and Medicaid Services (CMS).3 “Test” reporting paces are still an option in 2018, but it is crucial that practices begin collecting all necessary data to prepare for full reporting.
In addition to preparing for 2018 reporting, any physicians who participated in MIPS during 2017 must submit performance data by March 31, 2018.4 Failing to submit before the deadline can result in a 4 percent negative payment adjustment for 2019.
Increased emphasis will be placed on reducing care variation
Unwarranted variation in care can cause mistreatment and unnecessary healthcare spending across Common Diagnosis-Related Groups (DRGs).5 However, variation can be avoided by establishing improved protocols for consistent care. A survey of CFOs indicated that variation reduction could amount to approximately 40 percent of health organizations cost savings opportunities.6
Practices should look for methods of establishing care delivery systems that reduce variation. By focusing on consistency throughout the continuum of care, practices can sustain greater operational efficiency with lower overall cost. To begin the process of creating a high-performing healthcare delivery system, organizations should work with clinical leaders and stakeholders to evaluate cost data and identify areas with the greatest cost variation. Practices can then develop initiatives to target clinical and cost outliers with coordinated, actionable benchmarks for an improvement team.
Physicians will continue searching for ways to mitigate burnout
With value-based care’s increasing pressure to track metrics and reporting requirements, providers will be looking for opportunities to decrease administrative burdens. To increase physician productivity, providers need to incorporate methods of delegating and reassigning non-clinical tasks. Reducing administrative requirements will decrease physician stress and free up more time for direct patient care.
Innovative provider-centric solutions, such as a scribe or virtual transcription service, will enable physicians to capitalize on patient-provider interactions. Using a scribe to document patient encounters can reduce required charting time by approximately 60 percent, saving physicians one to two hours of data entry each day. Yet since there is not a standard certification program for scribes, there is still a potential for errors that could leave the physician liable.7
Lines of communication will be increasingly streamlined
Patient portals were originally designed to achieve Meaningful Use requirements, and they enhanced the cultural trend for patients to be more involved in their personal healthcare and health records.8 However, portals are not doing enough to engage with patients.9
There will be a shift toward text messaging workflows, progressive web apps, and other mobile health applications to increase patient engagement. Text messaging workflows offer a range of capabilities and resources: providers can easily share voice, video, and imagery; clinics can decrease no-shows by sending appointment reminders directly to patients’ cell phones; and patients can provide wellness updates while communicating directly with providers and nurses.
To implement a text-based system, identify areas of weakness within your practice where faster text messaging could offer an improved workflow. Then look for HIPAA-compliant platforms that will provide easy-to-use resources for your practice. If the software is simple and straightforward, physicians will be more willing to integrate the app into their personal workflows, thereby increasing its effectiveness. You can also look for software that integrates with your existing EHR or scheduling systems.10
Practices will increasingly seek the expertise of analysts to gain population health insights from patient data
Leveraging big data helps practices identify trends in population health. Real-time data can be collected from remote monitoring devices and leveraged to predict patient health trends. This current data can also be used for dynamic risk stratification, which would allow patients to be re-stratified following their procedures to receive the best care for their recovery needs.
The trends gleaned from claims, EHR and other health data, coupled with remote monitoring, can be used to target high-need, high-cost patients and develop improved strategies for care coordination. High risk patients account for the largest portion of healthcare spending, and if practices could reduce unnecessary utilization by 20 percent en masse, they could receive an approximate 74 percent reduction in unnecessary care for the high-risk, high-cost group.11 To coordinate care for patients with high utilization, practices must implement strategies for assigning care coordinators to high-risk patients. These coordinators must establish open lines of communication to prevent unnecessary emergency room visits, ensure proper medication reconciliation, and manage treatments and disease. Improving the continuum of care for high-usage patients lowers the overall cost of care for the entire population.
Payers are looking for new avenues for expansion
Following the failed mergers between multiple major payers in 2017, payers will be looking for other cross-sector opportunities for consolidation. Instead of limiting mergers to private payers, health insurers are beginning to acquire medical groups, clinics, pharmacies, and other facilities across the United States.12 Payers feel that consolidating companies should streamline administrative tasks, while allowing payers to offer more cost-effective health plans and affordable, convenient access to pharmacy and healthcare.13 Unfortunately, 57 percent of healthcare executives feel that consolidation will lead to higher overall healthcare costs.14
While payers are active in their efforts to restructure and allocate resources, providers should be doing the same in 2018. Independent practices should consider options for easing administrative and financial cost burdens. Working with an outside practice partner can provide administrative relief, increase performance success, and enable physicians to focus more time on patient encounters.
To download a summary of all ten trends, please click here or use the button at the bottom of this blog.
More private payers will offer Medicare Advantage plans
Medicare Advantage (MA) is a federal program subsidized by the Centers for Medicare and Medicaid Services (CMS). It allows those eligible for Medicare to enroll in MA plans with private payers that offer comparable coverage to standard Medicare plans. Payers find Medicare Advantage attractive because it is a stable market with a steady stream of eligible candidates, and CMS pays the cost of MA plans upfront, providing consistent, reliable reimbursements.15
To attract more Medicare beneficiaries, payers will look to strengthen their consumer engagement and marketing strategies. Only 11 percent of MA health plan enrollees feel they have full communication regarding their health plan benefits, so increasing customer satisfaction through member engagement is an opportunity to attract a larger consumer base. 61 percent of payers feel that improving member engagement will increase the payer’s competitiveness in the market and secure longstanding relationships with enrollees.16
Consumers will drive payers and providers to offer cost, quality, and outcome information
A recent study found that the number of High Deductible Health Plans (HDHPs) and other Consumer Directed Healthcare (CDH) plans are expected to continually increase by 11 percent per year.17 As more consumers are faced with high deductibles and out-of-pocket expenses, they will look for price transparency and options to keep costs down.
The push for consumer-centric plans is growing from the increased demand for a retail experience, in which patients can “shop” for plans and providers while price-checking services. 63 percent of payers believe that the increased presence of HDHPs is encouraging consumers to pay greater attention to their personal cost of care, since the costs of visits and prescriptions are largely falling to the consumer.
Providers need to make cost data readily available to patients. To determine operational costs for visits and treatments, provider organizations must collect and analyze the total cost data for their patient populations. Analyzing cost data and metrics will offer opportunities to identify medical facilities and providers with lower-cost, quality care.18 Physicians can then refer patients to these facilities and specialists, while citing their competitive costs and quality care for certain treatments.
Additionally, practices must ensure patients understand that certain preventative care measures are covered under the ACA. With high deductible plans, more patients will avoid physician visits to keep costs down. To provide quality care for an entire patient population, providers must be sure that even healthy patients receive their required annual care, enabling the provider to meet applicable value-based metrics. Develop a strategy for reminding patients to schedule their annual appointments, and indicate the services they will be provided and the associated cost, if any.
Physician practices must collect payment from individuals, in addition to payers
High Deductible Health Plans (HDHPs) are causing patients to become major, unreliable payers in the healthcare market. In addition to billing payers directly, practices must now request payments from individuals. Yet billing a patient’s insurer and then invoicing the patient for the remaining cost can take 30 to 90 days, at which point a patient is significantly less likely to pay the balance owed.
Instead, practices must incorporate methods of directing staff to politely pursue balance collections during every patient interaction. Prior to each office visit or procedure, staff should research a patient’s insurance requirements and communicate the patient’s eligibility and estimated fees. Determine the patient’s plan specifics and ensure that the patient is prepared to pay their copay, deductible, or full fee if they are without insurance. Ascertain the services the patient will need during their visit, and then use potential diagnosis and services codes to generate fee estimates. Use the codes to establish how much will be billed to the payer and the remaining balance the patient will owe following the visit.19
To improve revenue cycle streams, require either full or partial payment in advance of care, as payer contracts allow. Then direct staff to hand patients an invoice for additional fees or services as they leave the office. Industry standards indicate that the likelihood of collecting patient fees decreases by approximately 50 percent for every 30 days the account ages, so it is crucial to collect payments as consistently as possible.20 Finally, establish clear policies and communicate them with your patients by providing written statements and posting the information in your waiting room, exam rooms, front desk, and on your website.
Telemedicine and virtual care will continue to expand
Consumers are continuing to press for more convenient access to providers, and virtual care allows physicians to easily interface with patients at remote locations. Virtual care provides patients access to physicians and specialists without traveling to a hospital or clinic, and it offers providers the potential to see a higher volume of patients at a lower cost per interaction. With more than 75 percent of health systems employing some form of virtual care in 2018, most consumers are likely to experience telehealth within the next year.21 Consumers will press hospitals and physicians to fully incorporate telemedicine into their continuum of care.
The Centers for Medicare and Medicaid Services (CMS) also issued the 2018 Physician Fee Schedule Final Rule in November. The final rule expands coverage for telehealth encounters and increases the number of billing codes available for telehealth services, which will widely increase its usability and popularity.22 To begin incorporating virtual care, practices must weigh the financial costs and benefits of purchasing telehealth technology. Since costs for telehealth software can be high, practices should compare the upfront costs to the cost savings opportunities and determine whether pursuing telemedicine is an advantageous choice this year.
In 2018, patients, payers, and providers will be working to make sense of the many changes that occurred in the healthcare industry last year. Though there is still uncertainty surrounding healthcare policy, independent practices must look for actionable methods of making financial and technological progress. Choose at least one of the above trends, and develop a plan for implementing a new solution for your practice.
1 Industry Top Trends in 2018: Health Care
2 Managed Care State of the Industry Survey 2017
3 Merit-Based Incentive Payment Program (MIPS): 2017 CMS-Approved Qualified Registries
4 Quality Payment Program
5 Reducing Unwarranted Variation in Healthcare Clears the Way for Outcomes Improvement
6 Are you really reducing care variation costs?
7 Is a scribe right for you?
8 Digital Tools Empower Patients, Enhance Engagement
9 8 healthcare marketing trends for 2018
10 HIPAA Compliant Texting
11 Focusing on High-Cost Patients - The Key to Addressing High Costs?
12 UnitedHealth is Buying a Major Doctor Group on the Heels of the CVS-Aetna Deal
13 Healthcare consolidation: What consumers need to know
14 Managed Care State of the Industry Survey 2017
15 Why payers are flocking to the Medicare Advantage market
16 Member Engagement, Medicare Advantage Growth Top 2018 Payer Trends
18 Managing the True Costs of Health Care: A Roadmap to Cost Analytics
19 Collecting from Patients Preparing for 2018 - Webinar: ZirMed, Elizabeth Woodcock
20 6 tips for improving your self-pay collections strategy
21 8 virtual health predictions for 2018
22 Telehealth Opportunities Worth Watching in 2018