As too many patients and their healthcare providers can tell you, with regard to quality healthcare, bigger doesn’t always mean better. With an increasing number of smaller practices being gobbled up by larger facilities, to the tune of  5,000 independent practices within just a year, how does a practice remain independent while increasing profitability? With the focus now from CMS and others on value-based care, a golden opportunity awaits independent providers to offer a more personalized, healthcare experience than what might be expected from a larger facility.

Making that approach a practice goal for the coming year is one good way to ensure that your independent practice continues to thrive, along with planning ahead for 2020. Follow the preparation tips below for more ways to keep control over your revenues and sustained growth as well as prepare for the CMS changes ahead.

Challenges to the smaller, independent practice

In addition to the threats of competition and possible absorption into large organizations with subsequent loss of autonomy, providers are facing reductions in reimbursement rates, including changing payment models and the costs of compliance with an ever-growing list of regulations. Such are the pressures to stay open that many smaller providers have been forced to ultimately close their practices or join forces with larger healthcare organizations, where the number of physicians in hospital employment grew by 14,000. 

Leverage the value-based concept to your best advantage

Some physicians are in fact bucking the trend toward joining healthcare conglomerates by setting up their own practices – or refocusing on what they already have – with emphasis on a more personalized value-based approach. When physicians Julia Martinez, MD and Patrick Samora, MD decided to break from their larger practice and form Family Medicine Partners of Santa Fe, New Mexico they made value-based care a centerpiece of their practice.

With the focus on providing excellent patient care, the new practice strives to ensure that physicians there are not overworked, as is the case in too many larger organizations, and that patients received standard care for all preventive services while treating acute illnesses and managing chronic care patients.

(Speaking of value-based care, Primary Care First, an initiative from CMS is rolling out on January 1 2020. Plan now if you haven’t already, for participation – we’ll cover this in more detail later here.)

Tools and processes for successful independent practices

Understand the changing rules and the practice’s responsibilities: Practices must stay current with the latest CMS and payer rules. To keep staff and clinicians updated, the Department of Human Resources offers training for practices with 15 or fewer clinicians on the Quality Payment Program.

Utilize technology to improve patient care, engagement and regulatory compliance: Electronic health records (EHR) and similar technological solutions can ease administrative burdens, including verifying insurance and coordinating care while improving workflow, as well as improve patient communications and feedback. To get the most out of technology, it is critical that systems and related tools be fully integrated for seamless workflow.

Set goals with input from the entire practice: This also includes front office and billing staff as well as providers and nurses to ensure that everyone is on board with the same focus and goals.                             

Preparing for the coming year: a checklist

Diversity is the key to the conversation – as previously stated, good planning needs input and ideas from everyone on the team form physicians to office staff.

Review the past year – how have things gone so far? What projects have done well and what needs to be finished by year’s end?

What business problems need to be solved and what steps need to be taken to do so? Some topics to consider:

• Workplace planning
• Hiring and personnel management
• Technology
• Growth and marketing strategies
• Financial management

What goals will guide the practice into the future? Document three main objectives and specific steps for solving current key issues.

Primary Care First formally launches on January 1, 2020 – is your practice ready?

Primary Care First (PCF) is a voluntary program consisting of five-year payment options to support and promote advanced primary care with rewarding quality and value in the delivery of care to Medicare beneficiaries in 26 regions through the US.  With this program, primary care physicians (PCPs) receive upfront payments per member per month (pmpm) for each patient in care and a flat visit-rate with performance-based adjustments.  Practices can apply monies to support patient access in and out of office, including adding care managers, or telehealth options.

While enrollment has already begun, PCF (not to be confused with Advanced Primary Care or Comprehensive Primary Care Plus) has a number of benchmarks that practices can use to determine if they’re ready to join.

• Is your practice currently qualified as a patient-centered medical home (PCMH)? If so, you’re already on track. If not, here are some other areas to address if considering joining:
• Having excellent understanding and documentation of Hierarchal Condition Codes (HCCs)
• Offering 24×7 access to care along with real-time electronic health record (EHR) access
• Use of powerful analytics to enable providers to accurately risk /stratify patients
• Having exceptional team-based care already in place
• Having a reliable process in place for patients and caregivers to give feedback

Partner with an experienced medical billing service to take charge of your revenue cycle

One of the things you can do now to get ready for the year ahead while focusing on the best processes and tools to use for growth and profitability includes partnering with an experienced medical billing and practice management service. Since 2002, M-Scribe has provided independent practices of a wide range of specialties with billing and related practice management assistance. Our claims personnel stay current on the latest changes in state, federal and payer regulations and policies, ensuring that your practice is fully and accurately reimbursed for services. Contact us at 770-666-0470 or by email for a confidential evaluation of your practice’s goals for growth and management.

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