Medical Economics details a list of challenges that primary care providers will be facing for the upcoming year.
15 Challenges for Primary Care Providers
A recent article from Medical Economics detailed the top 15 challenges that primary care providers will face in the coming year.
Challenge 1: ICD-10 implementation
According to a survey from the Medical Group Management Association (MGMA), 79% of practices had not yet started implementation or were only somewhat ready. This delay can cost practices more money in training and preparation. The new coding system also comes at a high cost. The American Medical Association (AMA) estimates that small practices may spend between $56,639 and $226,2015 for the implementation of a new coding system. Practices will have to send both ICD-9 and ICD-10 claims during the transition period in order to ensure payment. This dual coding process can be time consuming and resource intensive. It may also be a difficult task to complete with their current health information system or practice management system.
Challenge 2: HIPAA
Keeping patient information secure has become increasingly complicated. HIPAA regulations are violated more often than one would suspect. When patients and staff have access to social media and mobile devices, it becomes harder to keep track of electronic communication within the practice. Practices need to consider this technology a threat to patient security and take the necessary steps to limit their violations. Fines for HIPAA violations can start at $100 and can go as high as $50,000.
Challenge 3: Meaningful Use 2
Starting in 2015, eligible professionals (EPs) will see a 1% decrease (up to 5%) in Medicare reimbursements for every year that they fail to meet meaningful use requirements. EPs have until the end of February 2015 to attest for MU2. The Centers for Medicare and Medicaid Services (CMS) has already changed the rules several times and may continue to do so, leading to further complications, as practices constantly have to adjust to the latest updates.
Challenge 4: Getting paid
Under the ACA, penalties for physicians who don’t participate in the Physician Quality Reporting System (PQRS) or aren’t considered successful participants for the 2013 program year will face a 1.5 % penalty in Medicare payments in 2015 and 2% thereafter. Medicare has proposed that physicians not participating in PQRS in 2014 should face penalties in 2016. While claim denials have been decreasing, some experts believe that the implementation of the ACA will lead to an increase in denied claims. Physicians are taking the necessary steps to avoid losing money from these denials. Practices are discovering that they need to involve themselves in every detail in order to submit a clean claim. Some physicians have even opted out of accepting insurance altogether in order to avoid the hassles of healthcare reform.
Challenge 5: Maintenance of certification (MOC)
The American Board of Internal Medicine (ABIM) has faced substantial backlash over MOC’s cost and time requirements. For family physicians, the application fee alone can be anywhere between $1,300 and $1,500. While the ABIM and other MOC proponents say that the program is necessary, some primary care physicians argue that the test material often doesn’t apply to typical proceedings in their specialty.
Challenge 6: Collecting co-pays and deductibles
Patients who sign up for plans under the ACA have a 90-day window to pay premiums. The AMA warns that physicians can get stuck with bills from enrollees who take advantage of medical services but then fail to pay premiums. Many ACA plans have higher deductibles and co-pays than other plans, resulting in a possible increase in the provider collection burden. Physicians also face challenges from government agencies such as Medicaid. Medicaid generally performs worse than Medicare and commercial health plans on days in accounts receivable, denial rates, electronic remittance advice transparency, and other key metrics.
Challenge 7: Administrative burdens
In the Practice Profitability Index, the percentage of physicians who spend more than one day per week on paperwork increased from 58% in 2013 to 70% in 2014. This trend is leading to a decrease in physicians’ on-the-job happiness. Prior authorizations are a major source of burden, as more payers are requiring prior authorizations for drugs and procedures. A 2012 Kaiser study estimated that physicians spend more than 868 million hours annually on prior authorization activities.
Challenge 8: Rising operational costs
In this constantly changing system, more practices are struggling to maintain their financial state. More than 84% of physicians have said that their practices are doing the same or worse financially than a year ago, according to the 2014 Medical Economics Physician Practice Survey. Personnel costs are most likely going to keep rising and competition with hospitals for employees has driven up wages. The Clinical Advisor discovered that the average salary among nurse practitioners was $94.881 for 2014. In 2011, by comparison, the average nurse practitioners’ salaries were between $75,556 and $90,114.
Challenge 9: Pay for performance
Beginning next year, practices that didn’t report PQRS data in 2013 will have 1.5% of their Medicare reimbursements deducted. That amount will increase to 2% in 2016. Under CMS’ Value-based Modifier Program, Medicare reimbursements for group practices consisting of 100 or more EPs by 2013 will decrease by an additional 1%. The adjustments will extend to practices with EPs of 10 or more in 2016 and then to all EPs in 2017. Public and private payers continue to look for alternatives to fee-for service medicine such as shared savings programs. Under such programs, providers create an ACO and contract with a payer to provide quality care to a designated patient population while meeting agreed-upon quality and cost benchmarks. Unfortunately, independent practitioners that participate in alternatives to the fee-for-service payment model often pay more money up front.
Challenge 10: Independence vs. employment
For some physicians, joining a large hospital system can offer protection from the rising administrative burdens of staying independent. Unfortunately, joining a hospital system isn’t a cure-all for the many challenges that physicians have to face. After the expiration of their initial contract, some physicians chose to return to private practices as their compensation from hospitals became less attractive.
Challenge 11: Payers dictating healthcare
In a RAND study released by the AMA in 2013, being able to provide quality care was a major influence on physician satisfaction. Factors that prevented this, such as payers’ refusal to cover necessary services, led to a decline in physician satisfaction. Payers are also maintaining their control through prior authorizations and tightened provider networks. This move toward narrow networks means more physicians are being evaluated.
Challenge 12: Patients dictating healthcare
Government programs such as the PQRS, as well as the growth of websites for evaluating doctors, have increased the need to keep patients satisfied. Unfortunately, this need can affect medical decision making for primary care physicians. Physicians are judged by their performance, so they often modify their practice patterns in order to be more productive and improve their scores. In many practices, medicine is devolving into a metrics-centered business.
Challenge 13: Keeping pace with technology
The cost and complexity of using computers increases substantially when a practice adds an EHR. The support and maintenance of these systems can be very expensive. Practices must either pay their EHR vendor an annual maintenance fee or pay for each new upgrade. Since many smaller practices cannot afford an IT department or even a staff member dedicated to IT, they’ll often hire a local computer service company to support their EHRs. While these firms can be skilled at maintaining computer networks, they don’t necessarily understand the complexities of EHR software or how to perform the security assessments required by meaningful use.
Challenge 14: Staff retention
While maintaining staff is critical to success, recruiting and retaining continues to be a challenge for many practices. Staff turnover can drain both practice revenue and resources. As some practices face shrinking revenue under fee-for-service models, they may look into reducing their staff size. Successful practice managers need to address workplace issues and make sure that pay remains competitive.
Challenge 15: Avoiding liability
A 2014 report from Aon Risk Solutions projects the loss rate for physician professional liability to be $6,230 per class 1 physician for incidents occurring in 2015. This is up from $6,030 in 2014.The 2015 projected loss rate for hospital general liability is $125 per occupied bed versus $119 in 2014. The average general liability claim is expected to be $38,000 for claims occurring in 2015. While the expanded market may increase claims, premium prices have been stable for several years. The median level of annual premiums paid by family/general practitioners in 2013 was $11,900, unchanged from the prior two years. Since 2009, median annual premiums for family/general physicians have dropped by 5.8%. Premiums for internal medicine practitioners have come down by 11.7%. As a way to avoid potential liability, some physicians are choosing to practice defensive medicine. These physicians are ordering more diagnostic procedures than may be necessary in order to avoid potential lawsuits.
Author: Lauren Daniels