Unlike past years when physicians' concerns focused mostly on scenarios that might occur in an evolving U.S. health system, 2014 will call for doctors to address the new realities of practicing medicine under the Affordable Care Act.
While elements of uncertainty still exist--including the fate of the sustainable growth rate, how patient panels will shift under enrollment in health exchanges, and the long-term success of new practice and payment models, to name a few--practices can count on entering a period of increased market flux.
As noted by the Physician Foundation's 2014 Watch List, for example, patients enrolled in health exchanges with narrower networks may need to switch doctors--putting practices in the position of not only losing some of their patients but needing to find the bandwidth to get new patients established. While some of these patients will simply transfer from one source of care to another--a move that will require ramp-up time for new doctors to get to know them--others will receive routine care for the first time. They may suffer from more than one chronic condition and need to catch up on a great deal of preventive care.
The good news here is that these changes offer physicians and practices an opportunity to make a real difference in patients' lives--if organizations have the right processes and planning in place to keep their businesses healthy.
But to truly take care of patients, practices can't limit their scope to addressing medical needs alone. Patients need support, empathy and clear information not just regarding their health, but also their access to care and how they will afford it. If you think you're confused and overwhelmed by the ins and outs of a system you work within every day, imagine how your patients feel. Most likely, they will turn to you for information.
While it will be your job to educate patients about your practice policies, including the need to pay copays upfront, you don't have to take on 100 percent of the burden of explaining to patients how their insurance coverage works, according to practice-management consultant, speaker, and author Elizabeth Woodcock. Be polite in acknowledging patients' concerns, she told FiercePracticeManagement, but "do your homework" so you can send patients to more appropriate sources of information. For instance, have ready a supply of 3 x 5 index cards listing contact information for patient navigators in your community. When employees hand these cards to patients, they might also suggest patients talk to their employers' benefits officers to learn more, Woodcock suggested.
In addition, don't think the Affordable Care Act is something you can "opt out" of, she said. "The vast majority of practices are going to be in the exchange products whether they want to or not," Woodcock said, "because they already participate in the Blues, Kaiser, Coventry, etc., and the majority of those plans are simply adding the health plans on to the existing participation agreement. There is no check box where you say I want in or I want out," she said. "It's a myth that there's somewhere on the CMS website you go to to participate."
Fortunately, Woodcock noted, practices have so far reported that the reimbursement for their exchange products has generally been in line with payers' other products in the marketplace. "That's good news that we're not seeing these products come out and saying, 'we're only going to pay you 50 percent of Meidcaid' or what have you. In general, the fee schedules have been consistent with other products in the marketplace," she said.
Now that we've moved out of the hypothetical and into the reality of healthcare reform, what has been your practice's experience? What are your goals and concerns for guiding your practice into 2014? I look forward to learning your thoughts. - Deb (@PracticeMgt)