Practice Management: Overwhelmed Yet?

By SONDA EUNUS, MHA, CMPE, CPB

Orlando Medical News is pleased to present this first in a series of answers to questions from readers dealing with issues faced by practice managers in our health care community.

We encourage readers to send questions they face in everyday practice. Use the subject Practice Management Challenges to editor@orlandomedicalnews.com

Questions selected for inclusion in the August edition will receive a complimentary 300 x 600 pixel ad with animated gif on our website.

How will MACRA impact my practice?

MACRA (Medicare Access and Chip Reauthorization Act) reporting started on January 1st, 2017, and even though we are already halfway through the year, many Medicare providers and practices are still not familiar with its requirements and stipulations. Additionally, some providers do not understand the urgency of getting on board with the quality measures because they erroneously believe that MACRA does not come into effect until 2019. This confusion stems from the fact that the first significant Medicare payment adjustments for quality measures will take effect in 2019 - but the reporting and measurement of quality measures has already been in effect since the beginning of 2017. Until 2019, providers will receive a 0.5% annual increase in Medicare reimbursement, and will then need to choose one of the two available payment tracks under MACRA.

The Merit-Based Incentive Payment System (MIPS) is one of the payment tracks, and will be the one that most providers will qualify for--at least in the first few years. This payment model will be closer to the Fee-for-Service model, but will take into account quality as well as patient volume. Quality will be measured by resource utilization, EHR use, and clinical improvement practices, on top of the traditional quality measures that providers were reporting on under PQRS, Meaningful Use, and Physician Value Based Modifier. All of these programs will be replaced by MIPS. Each year, payment adjustments will be made based on the provider's performance. These adjustments can range from +9% to -9% by 2022. Under MIPS, the payment increases made to high-scoring providers will be offset by the payment decreases to low-scoring providers. Furthermore, the best-performing providers will also receive additional payment adjustments.

The second payment track under MACRA is the Alternative Payment Model (APM) track. This option is riskier for providers because they are taking on greater financial risk and responsibility for the overall well-being of their patients. However, this increased risk is also rewarded by a 5% annual lump sum bonus in reimbursement. Not all providers will be able to qualify for the APM track, as they must hit a threshold for the percentage of total revenue that they receive from qualifying APMs.

Smaller physician practices are exempt from MACRA reporting. The original threshold for exemption was less than $30,000 in Medicare revenue, or fewer than 100 Medicare patients. However, since the reporting process is so complex and time-consuming, there is a new rule that was proposed by CMS on June 20th which will move the threshold to $90,000 or less in Medicare revenue, or fewer than 200 Medicare patients. This will exclude approximately 834,000 clinicians from MACRA quality reporting.

All Medicare providers should educate themselves on MACRA and its two payment tracks, and allocate time and resources to quality measure reporting in order to avoid penalties in the near future.

What practice specialties are best suited for providing telemedicine?

Technology is transforming the way that health care has traditionally been delivered, and telehealth is a hot topic that many practice managers are curious about. Telehealth, or e-visits, are becoming increasingly popular due to their flexibility and efficiency, both for the patient and the healthcare provider. Patients appreciate not having to take off work, travel, and sit in the waiting room and wait for their doctor's appointment, and enjoy the ease of access to healthcare services that telehealth provides in general. Additionally, these services are now being reimbursed by both private and government payers, and can be a great source of additional revenue for healthcare providers. Many employers are now providing telehealth insurance benefits to their employees in order to reduce expenses, and it has been forecasted that 90% of employers plan to cover telemedicine services by 2018.

One of the leading specialties currently offering telehealth is psychiatry and mental health counseling. Many patients who may benefit from regular counseling sessions may not be able to fit these sessions into their schedule. Telehealth makes it possible because these patients can attend their sessions from their living room, and still obtain the same professional care that they would at the clinic. Dermatology is another specialty that has found telehealth services to be very useful, as have many others including infectious diseases and pain management. There has been a remarkably low number of malpractice claims related to telehealth so far, although these statistics may change as the volume of telehealth visits increase. Providers interested in providing telehealth services must ensure that their malpractice insurance policy covers the provision of such services. Furthermore, some specialties such as cardiovascular disease, chronic disease management, and oncology carry a higher risk of negative patient outcomes from telehealth services, and may find it safer to stick to traditional visits.

Sonda Eunus, Founder & CEO of Leading Management Solutions has a background in managing a multi-location pediatric primary care practice, and truly enjoys medical practice management. She holds a Master of Healthcare Management, and a BA in Psychology. She enjoys sharing her work experience and knowledge of the healthcare field through her consulting work and her writing. She founded Leading Management Solutions, a healthcare management consulting firm, out of her desire to assist medical practice managers and physician owners in the successful management of their practices, by providing services that she herself needed while managing her practice. Along with a team of experienced and knowledgeable consultants, Sonda aims to make Leading Management Solutions a one-stop shop for medical practices by offering a variety of needed services that add great value to any healthcare organization. She can be reached at sonda@lmshealthpro.com