Rheumatology Practice Management
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Rheumatology Practice Management February 2014 Vol 2 No 1 — February 28, 2014
Iris W. Nichols
Founding Editor-in-Chief, Rheumatology Practice Management
Practice Administrator, Arthritis and Osteoporosis Consultants of the Carolinas
Charlotte, NC

Happy New Year. Every year around December 27 or 28 we start wishing everyone a happy new year. As we look into 2014, we are trying to determine just exactly what a “happy new year” means when we manage our business of delivering healthcare services.
The new year will bring new challenges, and with new challenges come new opportunities. When it comes to healthcare delivery, however, we face new challenges each day. Practice administrators must have the ability to address and strategically align their practice with these challenges, while delivering quality patient care.

The Challenges in 2014
There are many factors that will impact our business models in delivering rheumatology care in 2014. The question becomes, which challenge among the following factors will take the biggest toll on our practices this year? 

  1. Healthcare exchanges and high-deductible health plans:
    • There will be about 30 million newly insured Americans under the Affordable Care Act.
    • What will their insurance cards and benefits look like?
    • Will they be eligible for copay assistance programs if they are using biologic therapy?
    • There has been a 31% increase in high-deductible plans since 2012 (that is less than 2 years)
    • Relationships with our payers may become more complicated
    • Reimbursement may continue to decline.
  2. Bundled payments:
    • According to the Centers for Medicare & Medicaid Services, “Traditionally, Medicare makes separate payments to providers for each of the individual services they furnish to beneficiaries for a single illness or course of treatment. This approach can result in fragmented care with minimal coordination across providers and health care settings. Payment rewards the quantity of services offered by providers rather than the quality of care furnished. Research has shown that bundled payments can align incentives for providers—hospitals, post-acute care providers, physicians, and other practitioners—allowing them to work closely together across all specialties and settings.”1
    • Will we be informed before we experience these types of payment restrictions?
    • How will imposing of quality metrics play a critical role?

Implementation of ICD-10
The rollout of the International Classification of Diseases, Tenth Revision (ICD-10), will require input from all practice staff members.

Advances in information technology and changes in HIPAA laws.
Patients and physicians have concerns about privacy and security. There is a consensus that although patients are excited about the ability to have their personal health information (PHI) at their fingertips, the concern is about a potential privacy breach. Will my PHI be misused? There are risks as well as benefits surrounding the participation in the health information exchange. Through office-supplied education tools, we will ensure our patients that we take their concerns seriously. At the same time, the electronic health record (EHR) system and its implementation is filled with promises of concise documentation, data-sharing, and reimbursement increases, but  it also presents frustration—with major concerns about interoperability between systems, and with the amount of physician time that is involved with data entry.

Changes Affecting Rheumatology Practices
All of these factors will result in office flow and policy changes. There may be positions created for financial counselors, and more staff allocated to prior authorizations. There will be critical policy changes associated with a more aggressive approach to collections at time of service that will include not only copays but also deductibles and coinsurance.

The ICD-10 implementation will affect all office staff. Anyone who “touches” a diagnosis code will be a critical part of this implementation. Information technol­ogy changes surrounding the newly defined electronic HIPAA (Health Insurance Portability and Account­ability Act) requirements and continued EHR implementation will require dedicated staff.

Although these challenges sound dire, opportunities abound. We have opportunities to exercise leadership and advance our mission of innovative thinking, strategic planning, and alignment within our specialty, for the purpose of improving the access to care for our patient population. In this new year we may need to refresh our services to patients, reassess our use of technology, revise our collection processes, remind each other to better monitor population health, and engage patients in new ways.

Reference

  1. Centers for Medicare & Medicaid Services. Bundled Payments for Care Improvement Initiative. September 30, 2013. www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2013-Fact-Sheets-Items/2013-01-31.html. Accessed January 29, 2014.

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