Being a procedure-based specialist in the era of primary care. Now what?

Since the passage of the Affordable Care Act in 2010, the healthcare industry has cast its spotlight squarely on primary care, asking questions about medical homes, care coordination, chronic disease prevention, population health and how to manage increased demand.

These issues have and will continue to be ones we explore in FiercePracticeManagement, but today let's turn our attention to specialty practices. In particular, what the post-reform world will look like to procedure-based physician practices.

In a system that's increasingly looking to contain costs, the idea is that primary care medical homes will more proactively manage patients' health, lessening the need to call in the big guns--highly paid specialists. What's more, the scrutiny on what tests and procedures are necessary to perform is higher than ever, as indicated by the release of the new Choosing Wisely list for surgeons, which now includes anesthesiologists.

Whether or not you agree with these changes, the spirit behind them is well-intentioned. Wouldn't it be wonderful if you never had to place a stent in a drive-through-clogged artery again? Sure, in the same way that an end to confusing and controversial healthcare regulations would be great for me.

Realistically, I don't think there's any concern that in our lifetimes the industry will solve all the problems we get paid to fix. After a long day, fries are just too delicious.

Nonetheless, specialty practices will need to take a hard look at what they offer their marketplaces. You do more than perform assembly line body-part repairs. You are the experts in your field. You help solve the cases nobody else can figure out. You offer hope at the end of an often bumpy and scary road for patients faced with serious conditions.

But to ensure you continue to get the opportunities to provide these life-changing services, it's critical that you outshine your competitors in the following ways:

  • Patient experience. How well you wow or disappoint patients is not only a theme in how patients pick doctors, but also in referral patterns. "One of the worst outcomes of a referral is to have a patient return from a specialist to a primary physician and say, 'That was a terrible experience,'" noted a recent article from Medical Practice Insider. "Not only does this look bad for the physician, it means that doctor is unlikely to refer your practice ever again." Your expertise is top-notch. Make sure that's reflected in the service side of your practice as well.
  • Ease of referrals. "Don't play phone tag with another doctor or a potential patient; have systems in place to handle referrals quickly and efficiently," MPI advised. "It is often best for specialists to leave slots open specifically for same-day referrals." In addition, consider the tips recommended by New Orleans urologist Neil Baum, M.D. I've heard him speak many times about the importance of creating a user-friendly referral letter and following up with primary care physicians. He summarizes many of these ideas in a recent article for OBG Management.
  • Expertise. As we've reported previously, many patients, even if they recognize the buzzword, don't understand what it means to be board-certified in a specialty. Educate them. In the physician biographies on your website and brochures, spell out what each doctor's specialized training means from a patient perspective.
  • Compliance. Physician self-referral is under more scrutiny than ever. Even if everything you do is perfectly legal under today's rules, make sure whatever fancy equipment you happen to own is the most appropriate for your patient to use. Ensure your documentation is thorough and accurate--a best practice anyway, but also particularly important with the coming transition to ICD-10 coding.

This is not an exhaustive list, and I'd love to hear more of your ideas for how specialists can adapt to this shifting landscape. For all of the elements you can't control, for sources of revenue that may feel lost, I encourage you to look at the opportunities. Think about what you can offer that works with the new dynamic and how you can work with, rather than lament, the changes. As always, please share your ideas with us and your peers in the comments. - Deb (@PracticeMgt)