In 2017, physicians are facing certain challenges this year more so than others. From MACRA to prior authorization requirements, physicians now have more to deal with on their plate in addition to staying at the height of their industry career-wise. Here are some of those biggest challenges.
MACRA
A transformative healthcare event, unrivaled in probably about a decade, took effect January 1 but many physicians are unsure what the compliance requirements are. To review, MACRA stands for Medicare Access and CHIP Reauthorization Act. It was passed in 2015 as a sweeping way to fundamentally change the way our country evaluates and pays for healthcare. Essentially, it establishes a whole new method to pay physicians for caring for Medicare beneficiaries, including funding for technical assistance to providers, new development and testing measurements, new requirements for data sharing, and new federal advisory groups, according to the Network for Regional Healthcare Improvement. With the goal of restructuring U.S. healthcare, MACRA is based on two new reimbursement structures: the Merit Based Incentive Payments Systems (MIPS) and Alternative Payment Models (APMs).
Many physicians haven’t gotten on board yet. With a migration from volume to value, it’s necessary for physicians to get educated about the process now before they get buried by it.
Prior Authorizations
These requirements have increased quickly recently, with no signs of stopping. Prior authorizations can be the bane of many a physician’s existence, but the good news is there are many products and services available that can speed up the whole process. In addition, value-based payment models can cut down on how many drugs and procedures require approval before coverage kicks in from payers. Prior authorizations are necessary due to the higher costs and complications of medication. Technology like e-prescribing software can help through integration with electronic health record systems.
Negotiations
Negotiating with payers is necessary as more and more payers consolidate. As a result, physicians must face narrow provider networks and declining reimbursements. It can be frustrating to agree to one-sided contracts in order to keep up with their patient head count, but the prospect isn’t all grim. Physicians are advised to concentrate on the value and success they provide to their patients, outlining why the payer needs them to be on board. Come up with a pitch whereby you outline all the value your practice provides and how you’ve maintained quality consistently. It’s also not a bad idea to come up with a spreadsheet, updated weekly, that you can use to keep track of payer contracts, termination clauses, rate of payment speed and common codes for reimbursement rates. Now you have something concrete to reference when you feel the squeeze from payers.
Patient Frustration
Patients are understandably upset about rising healthcare costs. As a physician, you are often on the front line of these complaints, even though your hands are tied. You don’t set the prices yet you hear first-hand how frustrated your patients are with the system. With deductibles rising 40 percent last year alone and co-pays rising nearly 70 percent, patients are opting not to come into the office unless they have no other choice. They’re choosing not to fill prescriptions or they’re skipping important procedures due to the potential price tag involved. Educate your patients on cost and do some research on where they can get the same services or medications at a lower cost. Cross-analyze labs, pharmacies and even hospitals for the lowest prices on common services.
Maintaining Motivation
With all these compliance rules and regulations, it can be disheartening to keep up the good fight. You got into this career because of the joy you received from helping people. Dissatisfaction with strict compliance rules, as well as increased workloads and less time interacting with patients, can put a big damper on your job satisfaction. There are things you can do, though, to combat burnout, such as making changes in your work environment and engaging in stress reduction techniques in order to restore the work-life balance. One of the contributing factors to physician burnout has to do with dealing with the minutiae of administrative work. One solution is to outsource your medical billing services to a company like Medical Healthcare Solutions contact. We provide comprehensive medical billing, electronic health records and practice management services for physicians just like you. Call us today at 800-762-9800.
