Despite the delay in implementation of 26.5 percent cut in Medicare family practitioners payment, AAFP continues to call on Congress for a repeal of the sustainable growth rate (SGR) formula. This is understandable because the deferment means a temporal relief for family practitioners and if SGR is around, given that it assesses growth solely from a financial standpoint, payment cuts introduced without taking medical and human factors into account will continue to recur.
Though, this cut which is framing the political discourse around primary healthcare in the US is a recent phenomenon (the cut was scheduled for implementation on 1st January, 2013), if we go about a year back and take the case of Dr. Hammond, we will see financial problems have been ailing family physicians for some time now.
Dr. Hammond is an independent family physician with a clinic in Denver who ramped up his in-house IT operations and staff to make his practice and services more holistic, such that with his increased staff strength and upgraded IT his practice is able to cover the entire need of a modern-day healthcare operations starting from keeping in touch with patients to track their health and progress to maintaining electronic data. It’s the most ideal practice to have, isn’t it?
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Though, Dr. Hammond and many family practitioners across the US have upgraded their family physician practices to meet the modern needs of healthcare (like outreach and coordination), the fact remains that these enhancements are not reimbursed under traditional insurance contracts making profitability difficult. This together with new payment reforms which encourage healthcare providers to come together is making independent family practitioners a dying breed in the US. Whether this is good or bad for US healthcare is debatable, but a close look at Dr. Hammond’s operations would reveal that it includes lot of things that are not part of core physician practice (like IT data maintenance) and could be kept out to keep the operations thin, nimble and cost-effective.
And as family practitioners wake up to the prospect of frequent cuts in Medicare family physician payments, there problems seem to be getting enough and counting. However, to upgrade their operations, thwart the effects of Medicare cuts and also to gear up for the innovative payment model, many family practices have been joining Accountable Care Organizations (ACOs) or setting them up.
But transitioning to ACOs from their traditional mode of practice may not be easy as it involves negotiating pay schedules, negotiating payer contracts etc. Also, it requires monitoring and analyzing information, like eligibility for Medicare, medical outcomes, Medicaid and private insurance, and clinical compliance and reimbursement requirements to name a few. Family practitioners in addition to the Medicare cut challenges will have to ensure ICD-10, HIPAA 5010 compliant billing and coding along with EHR and PQRS.
Medicalbillerandcoders.com, the largest consortium of billers and coders across US, has also been helping various healthcare providers with billing and coding services for over a decade now. MBC’s Revenue Management Consulting services can help family practitioners by assessing their in-house revenue management cycle and ensure sound coordination between various components of healthcare, facilitating smooth flow of medical data for ACO operations and otherwise.
We also identify gaps in your process blocking areas of revenue leakage and identifying areas of staff training. Additionally, we can help train your staff to replace applications where required and handle new billing and coding challenges like EHR, PQRS, and ICD-10, and HIPAA 5010 compliance so that they can make error-free insurance claims.
FAQs
1. What are the current challenges facing family practitioners in the US?
Family practitioners face significant challenges, including delayed Medicare payments, ongoing cuts to reimbursements, and the transition to new payment models like Accountable Care Organizations (ACOs).
2. What is the Sustainable Growth Rate (SGR) formula?
The SGR formula is a method used to control spending on Medicare services, which has led to payment cuts for physicians without considering the broader impacts on healthcare delivery.
3. How do Medicare cuts impact family physician practices?
Medicare cuts can lead to reduced revenue for family practices, making it difficult for them to maintain profitability and invest in necessary technology and services.
4. What steps have some family practitioners taken to address these challenges?
Some family practitioners, like Dr. Hammond, have upgraded their IT systems and staff to enhance patient care and streamline operations, but these improvements often go unreimbursed.
5. What are Accountable Care Organizations (ACOs)?
ACOs are groups of healthcare providers who come together to provide coordinated care to patients, aiming to improve quality while reducing costs. Transitioning to this model can be complex for family practices.
