What are value based care and pay for performance strategies for independent physicians?

The independent physician plays a key role in a patient’s health, but the independent practice often runs on a tight profit margin. Providing quality, value-based care while maintaining financial stability can be challenging for some smaller practices. The Centers for Medicare & Medicaid Services (CMS) encourages and rewards the move toward value-based care, but reimbursement can sometimes put a small, independent practice in a bind while waiting for that pay for performance.

CMS has recognized the value in the independent practice and wants to encourage smaller practice to remain independent. In fact, recent studies have shown that “small, physician-owned practices, while providing a greater level of personalization and responsiveness to patient needs, have lower average cost per patient, fewer preventable hospital admissions, and lower readmission rates than larger, independent- and hospital-owned practices.”

Independent physicians have several strategies available to them for providing value-based care and participating in pay for performance plans. Value-based care generally requires time beyond the office visit to manage chronic conditions or to follow up on care plans. Independent physicians may find that they are spending additional time communicating with patients or with other providers. This time is typically not covered by traditional billing codes.

However, CMS recently added ongoing care codes to reimburse independent physicians for that extra time. For example, code 99487 is assigned for treating medically complex patients with an increased reimbursement rate of $93.67. Population health management can add to the efficiency of treating patients with complex or chronic conditions.

Another strategy for the independent physician is to join an Accountable Care Organization (ACO). While the physician retains independence, joining the ACO enables the practice to take advantage of the power of the group. Independent physicians in ACOs may be able to participate in Medicare’s Shared Savings Programs, in addition to enjoying cost savings and collaboration with other members of the group.

CMS also recently launched the Small, Underserved, and Rural Support initiative to “provide free, customized technical assistance to clinicians in small practices.” The program offers program level support and practice level support for practices of 15 or fewer physicians, with priority given to those practices located in a rural area, in designated health professional shortage areas (HPSAs), or in designated medically underserved areas (MUAs).

Tyler Comstock
November 14, 2018

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What are the advantages of cloud-based EHRs for small and independent practices?

When accessing a patient’s medical record, it is critical for the independent physician to be able to rely on the security and availability of the patient data. Electronic health records (EHRs) or, electronic medical records (EMRs) as some prefer to call them, can provide that convenience and security. The question for a small and independent practice is whether to use a cloud-based EHR or a server-based EHR.

Cloud-based EHR systems, or cloud-based EMR systems, offer many advantages. The small and independent practice will enjoy savings on installation and maintenance both for the system and the IT department. The independent physician can be assured of automatic updates that allow for security compliance. Cloud-based EHR systems, or cloud-based EMR systems, also offer seamless features that make it easy for practices to expand and provide wide access for all users within the practice.

With a cloud-based EHR, data is stored on external servers and can be accessed with any device that has an internet connection. Tight security is integrated into the cloud-based system, to protect the patient’s electronic protected health information (ePHI). Many describe the security of cloud-based servers as “achieving HIPAA compliance with bank-level security and high-level encryption methods.”

Cloud-based EHR systems, or cloud-based EMR systems, solve many of the issues that practices may be worried about when choosing to adopt an EHR system. In server-based EHR systems, thousands of dollars may be spent on installing and implementing a server, hardware, and software. Regular maintenance and management from a local IT department is also needed. However, cloud-based systems are already established by a software-as-a-service (SAAS) provider, meaning the expense of money and time diminishes dramatically.

Today’s cloud-based EHR systems are “much more affordable and easier to install and maintain” for the independent physician. The costs of the cloud-based system are “much more attractive to smaller and independent medical practices not only because of lower upfront costs but due to a lack of IT staff and expertise in smaller practices.”

Tyler Comstock
November 12, 2018

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5 attributes that independent physicians share with successful entrepreneurs

Independent physicians are primarily focused on the healthcare outcomes of their patients. However, they also need to focus on running their practice as a business. Just as an entrepreneur must plan and manage a business effectively to be independent and self-sustaining, there are many smart business decisions for physicians to make as they successfully grow their practice. Fortunately, independent physicians share a number of attributes with those successful entrepreneurs.

A recent post in Passive Income MD outlined five attributes common to independent physicians and entrepreneurs:

Problem solving skills. In an independent practice, there are many smart business decisions for physicians to make to ensure their practice continues to be financially solvent. Entrepreneurs must continuously solve their daily business problems to be successful. Independent physicians, of course, must also use those entrepreneurial problem solving skills when diagnosing and treating their patients’ medical conditions.

Ability to stay calm and focused under pressure. Successful entrepreneurs do not panic under pressure; rather they remain calm and focus on the problem to determine the solution. Independent physicians face this same situation with each new diagnosis and each new medical crisis. They must also apply these skills to their financial strategies, remaining calm and focusing on the success of their practice.

Critical and abstract thinking skills. Being able to see the “big picture,” as well as the critical details of a situation, whether that be a patient’s medical condition or the business needs of the practice, is a trait shared by independent physicians and entrepreneurs.

Self-discipline. When working for an employer, rules are generally set for the employee. Start time, breaks, project deadlines, and priorities are all predetermined. Entrepreneurs must have the self-discipline to run a successful business while balancing the many distractions and temptations around them, depending only on themselves to focus on the needs of the business. The same is true for independent physicians, who must have the discipline to focus on the needs of their patients and their practice.

Knowledge acquisition, research, and a healthy understanding of risk. For an entrepreneurial venture to grow, the business person must stay on top of the latest information and maintain a knowledge base of relevant topics in the chosen field. The independent physician must remain current on the latest medical research, including procedures, diagnoses, and treatment. To thrive in a successful independent practice, the physician must also balance the risk and rewards of each medical and business decision.

Greg Miller
November 5, 2018

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Physician burnout rates lower for small, independent practices

Physicians who are overwhelmed with their workload and who do not enjoy a healthy work/life balance may soon burn out from the stress involved in practicing medicine. However, most independent physicians who have control over their workload, who take advantage of electronic health records (EHRs) for their independent primary care practice, and who run their own practices autonomously appear to have much lower burnout rates than those physicians who work as an employee for a larger organization.

A recent study published by the Journal of the American Board of Family Medicine (JABFM), funded through the Agency for Health Care and Quality’s EvidenceNOW initiative, and approved by the New York University School of Medicine Institutional Review Board, found a “remarkably low burnout rate (13.5%) among providers practicing in SIPs (small independent primary care practices) in NYC compared with the burnout rate among physicians in previous studies.”

The study involved 235 providers practicing in 174 small independent primary care practices in New York City. Most (66.9%) SIPs were solo provider practices and 46.5% were recognized as Primary Care Medical Homes (PCMHs).

Authors of the study speculated that small independent primary care practices “may have deeper relationships with their patients, which may lead to greater job satisfaction and less burnout among providers.” Other studies have shown physician burnout to be a major problem for larger organizations such as hospitals and other healthcare facilities. In fact, an NEJM Catalyst survey recently found that “83% of respondents — who are clinicians, clinical leaders, and health care executives — call physician burnout a ‘serious’ or ‘moderate’ problem in their organizations.”

Lower physician burnout in small, independent practices is most likely attributed to the autonomy those physicians enjoy in regard to their workload and work hours. The JABFM research study authors indicated that one explanation for their finding of the low burnout rate “could be the autonomy (ie, control of work environment) associated with owning one’s own practice as opposed to working in an integrated health system or Federally Qualified Health Center where providers are subject to greater administrative regulations.”

Nick Dealtry
October 31, 2018

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How to approach population health as a small, independent practice

The concept of population health was first defined in 2003 by David Kindig and Greg Stoddart who proposed the definition: “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” The researchers state that the field of population should include “health outcomes, patterns of health determinants, and policies and interventions that link these two.”

A response to a recent Healthcare IT News survey further defines population health as “identified by demographic differences, health needs such as chronic diseases or disabilities, or the health needs of the underserved.” Generally, for independent physicians, the challenge is to manage the health of their specific patient populations as a small practice.

Several options are available for the independent practice. Joining an Accountable Care Organization (ACO) enables small, independent physicians to share resources. ACOs are groups of independent physicians and other healthcare providers who coordinate to provide healthcare services to Medicare patients under the Centers for Medicare & Medicaid Services (CMS) value-based program. Practices within the ACO may have access to population tracking resources they would not normally be able to as a small independent practice.

Population health management requires patient data management. Maintaining patient information in electronic health records (EHRs) enables the independent physician to holistically evaluate the patient population with a longitudinal record that trends vitals and lab values over time. Elation’s Clinical First EHR, in particular, helps the independent physician quickly identify patients who aren’t meeting goals based on custom care management protocols, Meaningful Use objectives, or specific document tags, and easily schedule a follow-up appointment to address any potential gaps in care.

Follow-up, including managing a patient’s medications and ensuring the patient is following post-visit instructions, is a critical step in the independent physician’s approach to population health. Communicating with the patient on a regular basis, particularly being responsive to patient questions, is also a critical element in population health management. Understanding the specific needs of the patient population, including the need for ongoing support outside the office visit, can reduce costs and improve patient health outcomes.

Tyler Comstock
October 16, 2018

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Understanding value-based care compensation for independent practices

With the move toward value-based care, the Centers for Medicare & Medicaid Services (CMS) and many private payers have developed measures to determine compensation and incentives for independent practices. When the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was implemented, it eliminated the Sustainable Growth Rate (SGR) law which helped to determine physician payments and increases for Medicare services. Now CMS offers the Quality Payment Program (QPP) with two tracks.

Depending on their practice size, specialty, location, or patient population, independent physicians can choose to participate in the Merit-Based Incentive Payment System (MIPS) or the Alternative Payment Model (APM).

An independent physician may choose to participate in MIPS as an individual or as part of a Virtual Group. For those reporting as an individual, the payment adjustment will be based solely on their performance. Virtual Groups are groups of two or more practices made up of solo practitioners and groups of 10 or fewer eligible clinicians who join together “virtually” to participate in MIPS as a group for a performance year.

Within MIPS, a score is applied that determines the payment adjustment for the independent practice. The score is based on four performance categories: Quality, Promoting Interoperability, Improvement Activities, and Cost.

Many private payers are also adopting a value-based care compensation model for independent physicians. HFMA (Healthcare Financial Management Association) reports that in 2017, BlueCross BlueShield in Western New York “determined physician payment based on Healthcare Effectiveness Data and Information Set (HEDIS) compliance, with 27 measurements ranging from adolescent immunizations to colorectal cancer screening to osteoporosis management.”

In 2018, the insurer is “measuring physician performance based on HEDIS quality measures (80 percent) and cost of care (20 percent). Examples of cost-of-care measures include inpatient utilization, emergency department utilization, laboratory services, and specialist services.”

For CMS, MIPS ties payments to quality and cost-efficient care. The APM is a “payment approach that gives added incentive payments to provide high-quality and cost-efficient care.” In addition, independent physicians participating in the Advanced APM track of the Quality Payment Program may earn a 5 percent incentive for achieving threshold levels of payments or patients.

Nick Dealtry
October 8, 2018

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Things to consider before making a tech investment for an independent practice

Technology-enabled tools can be useful for an independent physician who wants to run a more efficient office, communicate with patients and other physicians electronically, and maintain accurate, real-time patient medical records. Technology-enabled tools can also be a significant investment, especially for a smaller practice.

Medical Economics interviewed physicians, healthcare technology experts, and financial consultants across the United States to learn more about their experiences and to seek their advice for the independent physician considering making that tech investment. A few of their responses include:

  • Form a team to evaluate needs. Involve staff in determining the type of tech investment that would benefit the practice most. The team will also be responsible for educating patients on the new technology and for establishing user protocol for the staff.
  • Be sure the investment will pay off within a reasonable amount of time. The best way to determine this is to write a business plan for the independent practice. Understanding the financial picture short and long-term will enable the physician to determine if the technology is a wise investment for the practice.
  • Look for available training and support for software implementation. At Elation Health, we realize that the staff at an independent practice has limited time. That’s why we designed our clinical first, cloud-based EHR to take less than an hour to learn. We’ll even migrate your previous patient data across for free. With Elation’s extraordinary 24/7 support, you’ll get help from our team of dedicated user success specialists within 30 minutes or less – 365 days a year.
  • Assess practice management software to ensure it offers the capabilities needed by the independent practice. At the very least it should be able to handle appointments and billing in a secure manner.
  • Identify the most useful tools for the needs of the practice, including the needs of the independent physician, the practice staff, and the patients. Ken Ferry, CEO of iCad, notes that “By implementing highly effective, state-of-the-art technologies that reduce cost to the healthcare system and simultaneously provide improved patient outcomes, physicians are on the right track to achieving unprecedented success in this new era of value-based care.”

Nick Dealtry
October 3, 2018

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What exactly does it mean to be an Independent Physician?

What is an Independent Physician?

An Independent Physician is a physician who owns a majority of their practice and has key decision-making rights for the practice. Some benefits of becoming an Independent Physician are:

  • The ability to practice medicine and run a practice, all on your own terms
  • Having full control over the management and financial health of the practice
  • Being able to grow and compete in the local market
  • The ability to make informed, strategic decisions
  • The ability to thrive through industry changes
  • Being connected and integrated with hospitals while still being independent

Why are they important?

At its core the work of healthcare is exceedingly personal and intimate. Patients trust healthcare professionals to provide a service that means a lot to them. Some of the work like checkups, are routine but often healthcare professionals serve their patients at times of great need and personal vulnerability. That’s why independent physicians are important, because they have more time to spend on patients to understand their needs and concerns, and in that time create strong relationships.

What makes an Independent Physician different from other doctors?

About 70% of Independent Physicians specialize in a certain aspect of healthcare and that specialized nature of their practice within the local healthcare community enables them to remain independent.

Independent physicians also have a freedom that other doctors who work in large organizations do not have. With their patients in mind, Independent Physicians are:

  • Free to work with all health systems
  • Free to offer all treatment choices
  • Free to refer patients anywhere that is necessary
  • Free to give patients all their medical options all the time.

An independent network of physicians provides patients the ability to select from a complete array of health professionals rather than being limited to a selection within one corporation. This means that their patients are able to get the very best care they might need.

Nick Dealtry
October 1, 2018

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The pros and cons of joining an independent Physician Association (IPA)

What is an IPA?

An independent physician association (IPA) is a business entity owned and organized by a network of independent physician practices for the purpose of reducing overhead costs or pursuing business ventures such as contracts with employers, accountable care organizations (ACO) or managed care organizations (MCOs).

IPAs contract with independent physicians and will then provide the services of the physicians to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis. An HMO or other managed care plan may contract with an IPA which in turn contracts with independent physicians to treat their members at a discounted fees or on a capitation basis. IPAs can also contract with hospital systems and Accountable Care Organizations.

Benefits of joining an IPA

Optimally functioning IPAs can offer many potential benefits, including:

  • Appropriate alignment of physicians’ financial incentives
  • Efficiencies in practice administration and management
  • Political influence within the medical and broader provider community
  • Peer support
  • Optimized facilities
  • Increased ability to negotiate favorable contracts with other entities such as MCOs, ACOs, radiology, laboratory, and hospital systems
  • Independence and local financial and care management control in managed care
  • Improved services including, extended hours, urgent care, outreach services for prevention, telephone triage, and follow-up expertise

Risks of joining an IPA

Physicians considering the development of, or participation in, an IPA should be aware of the potential risks which include:

  • Underfunded capitation revenue, with risk of significant losses and/or bankruptcy
  • The trend of payers to decrease their payments to the IPA
  • Conflicts of interest for the physician between financial gain and optimal care for the patient
  • Restrictions on collective bargaining by physicians from the Federal Trade Commission and Department of Justice
  • Significant separation between primary care physicians and contracted limited specialists

Roy Steiner
October 1, 2018

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Tech-savvy tips for running an independent practice

In the 21st century, independent physicians must run a tech-savvy practice to keep up with their tech-savvy patients. Today’s proliferation of technology does not just affect the younger population. Many Boomers and even older patients are using their electronic devices more frequently for more tasks. The ability to access and communicate with their healthcare provider is almost taken for granted among those patients who use technology on a regular basis.

The independent physician can run a tech-savvy practice by:

Encouraging patients to use technology for tracking their lifestyle choices. Apps that monitor activities such as sleep and physical exercise can help the patient and the independent physician understand areas that need to be improved for better health outcomes. There are a number of apps that allow connectivity between the patient and the healthcare provider, transmitting data that can be helpful in diagnoses and healthcare strategies for that patient.

Providing electronic communication tools for patients. When a question arises outside of typical office hours, patients want to be able to communicate with their healthcare provider in the most convenient way and that usually means electronic communication. Even during office hours, many patients prefer to send a secure message rather than make a phone call.

Offering telemedicine services. A study published by the American Hospital Association in 2015 revealed that 74 percent of U.S. consumers would use telehealth services. The numbers have increased in the years since, with more patients becoming comfortable with – and some actually preferring – telehealth.

Using electronic health records (EHRs) to track, manage, and coordinate the patient’s healthcare. EHRs offer independent physicians the ability to record visit notes, collaborate with other healthcare providers, and send and receive critical information about the patient in real time. An EHR solution embodies a technology platform that adds value to the interactions between physicians and their patients, allowing for trust, a more productive and effective environment, and improving the quality of care that patients are receiving.

Roy Steiner
October 1, 2018

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