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Administrative Challenges? Here Are Practical Solutions for Independent Practices

Administrative burdens continue to top the list of challenges for independent physicians, according to an annual Medical Economics survey. The top five administrative challenges that readers report as being major issues for them and their independent practices are:

  • Prior authorizations

  • Staffing

  • Patient communications

  • Care management coding

  • Quality metric reporting

Prior Authorizations. The number of requests continues to increase even though third-party payers have made promises to reduce the requirements. A recent MGMA poll found that 70% of medical groups saw increased prior authorizations in the last year. Prior authorizations continue to cost providers time and money.

The biggest challenge for independent practices is not receiving a response from the payer, which results in staff spending more time in continued attempts to secure approval. They also cite a lack of automation in the prior authorization process as creating a burden for them and their clinical staff. Patient treatment suffers as well. In a study conducted by the University of Colorado, 93% of physicians reported care delays and 82% reported treatment abandonment cases resulting from prior authorization requirements.

Staffing. Healthcare has been facing challenges with finding and retaining quality staff, just as many other industries have over the past couple of years. Lack of staffing was reported as one of the toughest issues faced by independent physicians in 2022. Most providers reported shortages in all clinical staff roles. A survey conducted by The Physicians Foundation found that 73% of providers experienced significant or moderate shortages of registered nurses.

Patient Communication. Technology has improved many forms of communication. While some patients still prefer phone calls, others want more virtual options such as patient portals and messaging. The independent provider may be challenged with these patient expectations regarding their communications options. In a recent survey, 61% of the participants said they wanted healthcare to mimic the experience provided by a customer service app, and 79% said they wanted the ability to use technology to manage their overall health care experience.

Care Management Coding. Care management, including chronic care management and principal care management, comes with its own unique challenges for the independent practice. One challenge for the provider is encouraging patients to participate in care management with a primary care provider. A report from the Primary Care Collaborative and the American Academy of Family Physicians’ Robert Graham Center found that more Americans lack a consistent source of healthcare (most often primary care) despite the COVID-19 pandemic.

An additional challenge with care management is that it involves a significant amount of coding and documentation for providers to get reimbursed for their time. New codes were introduced in 2022 that could benefit patients and providers, but they require careful review and understanding to ensure they are used appropriately.

Quality metric reporting. Patients are interested in quality measures that give them information about a provider’s technical care and interpersonal skills. Technical quality can be measured by using clinical information that is found in databases and electronic health records (EHRs). Interpersonal quality is determined through patient surveys.

Depending on whether the physician is participating in a value-based reimbursement program, it may also be critical for that physician to maintain high-quality scores to realize additional revenue for the practice. Most importantly, physicians must ensure that quality metrics are making a difference in the lives of patients, as they focus on quality outcomes.