By Laurie Morgan, Consultant and Partner, Capko & Morgan
In small ways for several years, and in a big way for the past several months, ICD-10 preparation has diverted physician and practice manager attention. Now ICD-10 is here. Over the next several months, most practices will face new coding challenges and possibly strained cash flow as a result of the switchover. But by early 2016, normal patient flow and billing should be restored – or at least be visible on the horizon.
Hopefully, this will mean that doctors and practice managers will have more bandwidth available. Many strategic opportunities have emerged for practices in the past few years, but they’ve sometimes been crowded out by the urgency of ICD-10 conversion.
Here are just a few trends and opportunities we’ll be encouraging our clients to take a more focused look at in 2016 as the ICD-10 dust settles – and that may spell opportunity for your business, too.
Chronic Care Management (CCM), Patient-Centered Medical Homes (PCMH), and other new reimbursement models
Several programs that reward care coordination activities, including the CCM reimbursement program and the PCMH initiative, have been advanced by the Affordable Care Act (ACA). Many of these programs offer practices the opportunity to get paid more for offering the kind of services they want to offer (or already offer) anyway. For example, the CCM reimbursement code that the CMS introduced in January provides a path to reimbursement for the work that practice staff does to distribute information among providers and help keep patients on track with care plans. A properly established CCM workflow inside a practice has the potential not just to engage patients and generate more revenue every month, but also provide a growth path for employees and boost morale and retention.
EHRs in the spotlight
More practices will enter or complete Meaningful Use Stage 2 in 2016, a process that will require them to think about engaging patients more fully via technology. Those that have struggled with promoting their patient portals or getting electronic lab reporting to work reliably will see much more incentive to optimize with Stage 3 around the corner – especially in conjunction with CCM, PCMH, and other programs that reward better care coordination and communication. For some practices, this will require more willingness to dig into their EHR data, more training, more investment in add-ons and customizations – or all three. In some cases, it will be time to consider a new EHR – perhaps a third or fourth in some cases – with the stakes much higher to get it right this time.
Patient payment technologies
One of the most exciting areas of innovation in the practice management world is the proliferation of new technologies to help practices collect more effectively from patients. With patients assuming financial responsibility for a greater portion of the cost of services than ever before, these technologies can address a critical and growing practice need. Some of the tools that have recently emerged include out-of-pocket estimators, real-time eligibility and authorization checking, and mobile payment tools patients can use on their own devices. This latter category, in particular, can benefit practices by improving cash flow and allowing patients to connect and pay with the platforms that are most comfortable for them.
Some skeptical practices have been reluctant to even try some of these technologies – especially with the great unknown of the ICD-10 conversion. But these tools can help solve very thorny problems and deliver huge upside for practices. We hope and expect to see a dramatic increase in trial (and opportunity for these vendors) now that the timing of the ICD-10 conversion and its impact on practice workflow is no longer a looming question.