I follow the Moskva,
Down to Gorky Park,
Listening to the wind of change…
So sang the gods of sound Scorpions, about the fall of the Berlin Wall and other significant politico-economic changes that swept the world in the early 1990s. The healthcare industry in the United States is currently in the midst of such an upheaval. Unfortunately, however, many in the healthcare industry (chiefly the providers) may not be as optimistic about their futures, as Klaus Meine obviously was when he composed the legendary song. Let us look at some of these changes below.
PAYMENT REFORMS:
Medicare payments have been nearly static for a decade, while costs for caring patients has increased by more than 20% in the same time period. The rationale for such a status quo is of course the escalating costs of healthcare and the burden it imposes on the wobbly economy. Medicare/Medicaid spending, as a percentage of the GDP, has more than doubled since 1990s from around 2.5% to around 5%. This is expected to rise to ludicrous levels by 2050 to 13%, which of course could cause the economy to implode.
Thus the federal government/CMS has initiated the following, which it hopes will curb overspending as against the Sustainable Growth Rate or SGR.
a. Quality Measure Reporting.
b. Incentivizing the process of attainment of meaningful use.
c. Patient-Centric Medical Care.
d. Accountable Care Organization.
e. Exploring payment models other than fee-for-service.
WHY FEE-FOR-SERVICE IS NOT FAVORED ANYMORE:
It has been strongly felt that payment under this model is not proportional to value, and rather than focusing on patient welfare and quality of healthcare it rewards only those who rake the highest volume. Thus, there is no demand and consequently no market for the most efficient outcomes and cost-conscious healthcare. Such a state of affairs, it is believed, will only further increase the costs of healthcare, and we will always end up paying more for less.
What This Means For Your Clinic:
Although the fee-for-service is still the dominant billing payment model, it is expected to be replaced majorly (although not entirely) by other quality-centric models. And quality here means, not just raising the quality of clinical outcomes by a few notches, but in fact infusing quality consciousness across the board. Thus it encompasses everything from counseling patients to referral management to medical billing and medical coding, to HIPAA-compliant EHR usage etc. And ideally, each of these segments needs to be manned by experts in that particular line of work. Expecting your front-office desk to do all of these perfectly day-in and day-out is just wishful thinking.
USING OUTSOURCED VENDORS:
Thus, your clinic can prepare for these winds of changes in a top-down fashion; going through your providers first, down the food chain to the front-office personnel at the very bottom, who schedule appointments. Along the way it may not be a bad idea to outsource a process or two (like your medical billing or medical coding) to a medical billing specialist. This would aid you in keeping down costs, while trying to prepare your clinic for the battles ahead. So perhaps, some day, providers may also emulate the Scorpions and optimistically sing:
The future is in the air,
I can feel it everywhere,
I am blowing with the wind of change….
