3 actions your practice should take to prepare for healthcare reform

It's been just over a year since the Supreme Court decided to uphold most of the Affordable Care Act as constitutional, and implementation deadlines are fast approaching. Nonetheless, knowledge of how the law will work is still shaky at best among the public, while the healthcare industry works hard to prepare amid unanswered questions.

Despite the lingering unknowns, here are several actions you can take now to get your practice ready for the transition:

Appoint a healthcare reform guru. Patients' questions about healthcare reform have already contributed to a 25 percent to 50 percent increase in phone calls to practices over the past five years, according to Mary Pat Whaley, president of Manage my Practice; and there's no telling how much precious physician facetime is spent discussing the law rather than patient health. While everyone in your practice should be making an effort to understand the law, try designating one person to serve as the practice expert. Provide this person the time and resources to become educated about the law and consider paying him or her a little extra to take on the role. Make this person your go-to resource for all issues related to healthcre reform, whether the questions come from patients, staff or physicians. Since most healthcare reform-related questions from patients won't be urgent, train staff to take a message and have your reform guru call the patient back with information. He or she could designate a time of day to return these calls, and perhaps a weekly check-in with colleagues to go over points they need to know and address any questions.

Learn how coverage terms affect your practice. Although states' health insurance exchanges are supposed to be open for business on October 1, most doctors participating in a recent survey from LocumTenens.com said they are "not at all familiar" with how a number of important aspects of those exchanges will work, CNBC reported. One piece that will affect physicians' bottom lines directly, according to Shane Jackson, president and COO of LocumTenens.com, is a rule of the exchange that patienta can go up to three months without paying premiums and still not get their coverage formally dropped by an insurers. However, insurers aren't required to pay claims that patients incur during the second or third month premiums go unpaid, either, meaning that doctors' reimbursement for such care could be significantly delayed or not paid at all. Until now, practices have had their hands full just holding patients accountable for balances owed directly to the practice. Keeping tabs on whether patients are paid up with insurers represents an entirely new challenge that offices will have to address.

Make expanded access part of your strategy. A recent article in the Worcester Telegram & Gazette provides a nice overview of steps that Massachusetts practices have taken to expand access since implementing its own insurance mandate in 2006. Key elements of the updates made by Reliant Medical Group and others include the following:

  • Expanding clinicians' roles to the top of their licenses. Reliant hired seven more advanced-practice clinicians, such as nurse practitioners and physician assistants, who provide primary care under a physician's supervision, according to the newspaper. It also employs nurses and medical assistants to serve as "health coaches" who work with Reliant's database to contact high-risk patients with chronic diseases, including depression, who may be overdue for an appointment or need a check-in on medication. 
  • The use of group medical appointments for patients with like conditions. "There are a surprising number of patients who enjoy it [groups]," said Dr. Michael Kelleher, Reliant Medical Group's medical director for quality and patient safety and interim chief medical officer. "Patients learn from each other. They offer each other tips." 
  • The 'access promise.'  UMass Memorial Medical Center has made a commitment to make sure 80 percent of patient visits, including appointments for specialties such as OB-GYN, cardiology, surgery, gastroenterology and pediatrics, are handled within 48 hours at 70 percent of its clinics. The caveat is that patients may not be able to request a specific physician. But Jay Cyr, senior vice president of operations, said that patients have been pleasantly surprised with being offered such quick appointments, and often prefer to be seen within a week to make work or childcare arrangements.

How prepared do you feel your practice is to handle an influx of patients and new regulations? Are you confident about any aspects of the transition? - Deb (@PracticeMgt)