I write as I am crusing, according to our pilot, at 37,000 feet heading to Phoenix for work at the Region IX conference. Most of my family is flying on another flight back to RI after a brief but wonderful vacation in Florida. Picture perfect weather, wonderful memories, great food, and all too precious (and never enough) time spent with my wife and two of our four kids. Truly this sort of time is, for me, really why I work hard…what inspires me. What inspires you?
Chances are it’s not the Affordable Care Act, ICD-10 delay, dwindling grant funding, meaningful use deadlines, and the host of other challenges impacting the US healthcare system and CHCs in particular. In fact, most people don’t know about it and as a result, could care less. For CHCs and all those working to make CHCs more profitable, stable, and sustainable…these challenges matter and, in some odd way, inspire us.
Here are some quick thoughts about how you can capitalize (and maybe be inspired) to conquer the aforementioned challenges:
- ACA: One stop patient registration, preferably electronically, with your team directing your uninsured patients to the payer your CHC likes best. Which pays best and fastest? Which benefits are more robust and/or easier to explain to patients? Which plan has the best customer service…Hint: ask your patients what they think. Master front desk efficiency and accuracy and know which plans are ideal for your CHC. Your patients will ask you…be ready with the answer AND the registration process. It will positively impact your bottom line.
- ICD-10 Delay: I won’t belabor this further except to say…you have more time to do a more thorough job getting your ICD house in order. Yes, we all ponder if ICD-10 will ever happen. It will take an Act of Congress to revert back to ICD-9 so don’t plan on it going away. AND…as we’ve discussed before, improving your CHCs ICD coding now will benefit your CHC because:
- ICD-10 coding process is nearly identical to ICD-9 but with more codes. Learn optimal ICD-9 for smoother transition to ICD-10.
- Pay for Performance and/or Risk Adjusted Compensation is on its way. Sure you will still have to submit fee-for-service (FFS) claims but ICD will dramatically impact future reimbursement…You can count on it.
- ICD-9 is simply inadequate in terms of affording your CHC the opportunity to better demonstrate the breadth, complexity, and scope of medical (not to mention socio-economic) challenges managed by your team. Only ICD coding can prove this. Get better at this or continue to look, according to data, less challenged than most private practices.
- Dwindling Grant Funds: Can you imagine your CHC being financially independent from grant funding? What is the delta between your Cost/Encounter (CPE) and Payment/Encounter (PPE)? If you don’t know these data, you should. If your CHC team does not know these data, how can they work to make your CHC at worst a break-even business or, ideally, surplus (dare I say profit) drive? Find the data, share it with your team, and be inspired by the progress that can/will be made.
- Meaningful Use (MU): So tell me you at least have your MU1 achieved so that only MU2 remains as your most significant hurdle. I am not a MU expert BUT the diminishing compensation from Medicare FFS (Part B) is reality and don’t be surprised if other payers are soon to follow. It is highly probable that you have been live on your EHR for a while. Have you optimized your workflow among all specialties and focused on increased, quality patient engagement? Optimizing a truly functional EMR/EHR with quality patient engagement needs to become the norm. ASAP.
As always, these are just a few items that might keep you up at night. As they say, control the things you can control. These few items are tangible and very controllable. Make someone on your team accountable for each. Set goals, measure progress, and ready your CHC for the never-ending constant in the world of healthcare…Resistance is futile. Be inspired to help lead your CHC to be the best it can be.