What a tremendous task it is to weed through government requirements and adjust to new payment models that shift more risk to providers. Plus, now we are preparing for the impact of the new ICD-10 coding. This common, but important, duty is the role of the administrator in connecting the dots between processes and high-quality care.

I was at fund raiser recently and talked with the CEO of a major bank in Memphis. He commented, “I don’t see how physicians and hospitals can be prepared for all the changes going on. I thought we had it tough regarding the Dodd- Frank bill and the overreach of regulatory requirement. The requirements you have in healthcare keep moving and I don’t see how the medical industry and your stakeholders can meet all the new regulations which keep changing and be expected to make one of the biggest changes in the history of healthcare.”

Which posed the question: Does healthcare reform represent incremental change or a fundamental shift?

I would say both. Parts require incremental change (which is difficult with the speed of change in our industry) and also a major fundamental shift. But the different forms of integration suggest it is more of a fundamental change that demands new types of collaboration. You can see that the challenges facing medical practices and hospital/IDS challenges are very similar and speak to a need for more collaboration.

Top 10 independent medical practice challenges

1. Participating in the CMS EHR meaningful use incentive program.
2. Dealing with rising operating costs.
3. Preparing for the transition to ICD-10 diagnosis coding.
4. Preparing for value-based payments (shared savings, capitation/global payments, quality outcomes).
5. Preparing for reimbursement models that place a greater share of financial risk on the practice.
6. Managing current practice planning and strategy (which is a moving target) and being proactive in future planning and strategy (which is difficult with a moving target.)
7. Collecting patient-due balances (self-pay, high deductibles and HSAs instead of quality improvements and costs savings.) We face the challenge of not being able to respond to improvement and changes when the high costs of self-pay and high deductibles force many patients to put off care until the health of the patient has become critical thus requiring more costs and not being able to meet quality criterion.
8. Participating in quality reporting programs. (Interoperability is still a significant challenge and I do not see this changing much for the next few years.)
9. Understanding payers’ criteria for physician performance ratings and their effect to provider networks and tiering.
10. Collecting and reporting non-standardized health plan/government quality measures.

Top 10 hospital/IDS challenges

1. Preparing for value-based payments (shared savings, capitation/global payments, quality/outcomes).
2. Dealing with rising operating costs.
3. Preparing for reimbursement models that place a greater share of financial risk on the providers.
4. Managing physicians’ expectations of their compensation levels.
5. Recruiting physicians and non-physician providers.
6. Managing finances and change with uncertainty with changes going on in the insurance industry.
7. Understanding the total cost of an episode of care.
8. Preparing for the transition to ICD-10.
9. Adapting the physician compensation model to incentivize quality, productivity and/or outcomes.
10. Engaging patients to improve outcomes.

Practice professionals keep a close eye on the business aspects of care delivery to ensure the financial viability of their groups, but still greatly attempt to ensure the delivery of high- quality patient care. The two are inextricably tied. Despite multifaceted barriers, practice professionals continue to experiment with new methods to keep patients healthier and disrupt the progression of disease. The common theme of this article is improving patient outcomes by ensuring that every piece of the practice puzzle aligns to deliver on the desired promises.

Bill Appling, FACMPE, ACHE, is founder and president of J William Appling, LLC.  He is a national speaker, presenter and a published author.  He serves as an adjunct professor at the University of Memphis and is on the boards of Hope House and Life Blood.  For more information contact Bill at j.william.appling@outlook.com.