Top Goals for Physicians to Implement In Their Facility

The changing political trends has affected the way physicians are implementing changes in their functioning at work, be it at clinics or hospitals. Keeping up with the times, is the need of the hour and hence never knowing which way the winds will blow, physicians should initiate certain goals that can help them ride the rough weather when it comes and sail through the smooth times.

So What Goals Can Physicians Implement?

Based on a recent online researcher Toluna’s healthcare panel of 500 physicians revealed that nearly 9 in 10 respondents ranked “achieving work-life balance” as their most or second most-important resolution for 2017. This was followed by 69 percent who ranked “staying up-to-date with technology,” and 58 percent ranked “taking advantage of more leadership and training opportunities”.

The latter two goals can help achieve the former and topmost goal of achieving a work-life balance. Let’s see how this can be achieved.

Taking Advantage of More Leadership and Training Opportunities:

Effective beginning January 2017, the Medicare Access and CHIP Re-authorization Act of 2015 (MACRA) was initiated to attempt to increase clinician engagement in value-based care by fundamentally changing how Medicare reimburses physicians for the care of its beneficiaries. New requirements imply that that reimbursement is tied in part to participation in the Merit-Based Incentive Payment System (MIPS), which encompasses physician quality reporting. Reporting on clinical quality measures itself is not new. MIPS help consolidate a number of more familiar Medicare initiatives, including the previous Physician Quality Reporting System (PQRS). And, after a period of data collection, analysis, and scoring, MIPS will begin exposing eligible physicians to potential payment adjustments totaling upwards of 4% and potentially as high as 9% of their overall Medicare Part B payments.

Many measures relevant for improving quality will have varying degrees of challenges and commitments. However, those submitted under MIPS may either be measures that possess such features or are instead the most common, accessible, and/or convenient to report. And if the Affordable Care Act is replaced by a new one, physicians will have to be able to integrate the old with the new strategies to keep the balance they are seeking.

What Would Be Required To Achieve The Above Goal In Their Facility?

By keeping abreast with all the new changes in rules & regulations, and updating oneself with knowledge shared among peers. Do physicians have the time for that plus attend to their patients? A recent study revealed that, “for every hour spent with patients, physicians spend two hours on electronic health records (EHR) and desk work”. So how would they be able to lead, train for new opportunities and keep the workflows and process streamlined at their facilities? The best answer to the above would be to outsource the “administrative and operational” functions to a third-party vendor, so that they can meet the MACRA goals of value -based care and simultaneously increase their reimbursements

Staying Current with Technology:

This not only involves keeping updated with the rules & regulations and the need to automate their workflows and processes and infrastructure, but also focus on medical equipment to better implement and update the facilities to cater to the patients. Moreover, many physicians have also taken to working the social media platforms to better communicate and implement strategies to reach out to their patients, the right information at the right time. Here physicians have to have time to be able to devote and inform their patients- schedule appointments, answer their queries, ensure eligibility and verification of their insurance, see that the staffs at their facilities are conversant with the updates and able to respond positively to the patients with changes in insurance demands and payment schedules, etc. All this requires infrastructure changes, software updates, and training.

Do physicians have that kind of investments to put in? Does the staff have up to date training and knowledge? Or are they stressed and curt with the patients? This in turn can cause loss of footfalls of patients and impact the value based care reimbursement cycle hitting hard the Revenue Cycle Management process. The solution, here to, would be to tie up with a partner who handles the infrastructure and administrative and functional processes like coding and billing, claims management process, audit reports etc., can help staff and physician concentrate on the main focus- having happy & satisfied patients- a much needed goal for an effective MACRA based reimbursement

Achieving Work-Life Balance

Once the above two goals are in place, physician can then definitely achieve a fairly balanced work-life system. And how does this then help physicians set goals that they can implement at their facility?

Once the “infrastructure” details and “administrative workflows & processes” are set up with vendors who have been researched thoroughly and the right queries asked with respect to the needs & requirements listed by physicians, then certain goals implemented within the facility can be put into place

  1. Train the staff with the help of the experts to handle the simple based queries of the patients walking in.
  1. Tighten up the process for verification and eligibility of insurance plans so that physicians do not lose out on reimbursements.
  1. Have coordinators appointed to work with the medical billing and coding expert third party vendors to verify and streamline the claims process.
  1. Put into place a well-coordinated team to handle the claims and follow up A/R process to handle rejected or denied claims.
  1. Implement stringent documentation so that the above can be implemented with ease.

Once the above 5 goals are implemented, this paves the way for the staff to have less on their hands and thereby handle patients with care and focus on their queries with more thoughtfulness. Focus on Value based care will definitely help towards implementing increase in the quality of care which brings in satisfied and happy customers.

Last But Not the Least, and Extremely Important: Stringent Documentation

Yes, trying to achieve your work-life balance is important, as once more in tune with oneself, delivery of care becomes much more important given the burn-out rates among physicians these days. However, two important goals that are extremely important in today’s world of changing rules & regulations, coupled with fraud and misuse and abuse of the systems, is the need for strict and stringent documentation. To achieve this very important goal, physicians need to train their staff on the consequences of fraud and abuse of the systems. No matter what changes in rules and regulations take place in the medical domain or in the medical coding and billing section, documentation is the core that will help commit less errors in coding & billing and will provide the much needed support as proof in claims management.

Once staff is aware of the pitfalls and monthly trainings with awards provided, this will boost the staff into higher productivity coupled with enhanced streamlined workflows & processes, and thereby dealing with patients will be much easier and thus handling more patient footfalls.

Summing Up the Goals

To Sum Up The Goals That Can Be Implemented:

  1. Streamlining the workflows and processes
  1. Training staff and putting in place coordinators
  1. Outsourcing sections/or the entire RCM process that requires adherence to the changing rules & regulations & thus lowering operational costs in follow-ups
  1. Putting into place a team to improve the quality of care for patients
  1. Stringent Documentation