Showing posts with label specialty practices. Show all posts
Showing posts with label specialty practices. Show all posts

Thursday, August 22, 2024

Patient access myths specialty practices should ditch today

Aligning with national priorities and consumer demands, more than 25% of medical group leaders plan to prioritize patient access over every other technology initiative in their organization. Specialty practices, such as orthopedics, dermatology, ENT, and urology, have unique patient access needs compared to primary care and hospital/health system counterparts. They deal with a higher volume of specific procedures, detailed scheduling for complex provider preferences, and a greater diversity of appointment types.

Despite being early adopters of digital tools like telehealth, technology has not sufficiently eased the operational and patient access challenges faced by these practices. Research suggests that physicians in various specialty practices, including urology and orthopedics, are among the most burned-out in the United States, with wait times for new patient appointments averaging as high as 38 days. If specialty practices have been leaders in digital adoption, why do these problems persist?

The root cause lies in several pervasive patient access “myths” that no longer align with the realities of emerging patient and operational needs. Recognizing and debunking these myths is crucial for specialty practices to design effective strategies, improve patient access, and achieve the best ROI from digital tools.


3 myths that can hinder your practice


Myth #1—My practice management system’s current scheduling tools can suffice for now.


Practice management platforms are good for many things, but specialists have specific appointment and patient needs that status quo scheduling tools cannot meet. These generalized scheduling workflows often rely on staff to manage complex provider rules and preferences using offline resources like binders and spreadsheets.

The cost of believing it: Without automated rules and intelligent personalization, healthcare staff spends excessive time on patient calls, manually finding appointment slots and matching patients to providers. This process is error-prone, leads to unbalanced provider schedules, and results in longer wait times for the patient. Additionally, digital solutions can gather valuable data to provide insights on scheduling patterns, helping your practice to optimize processes and identify areas for improvement.


Myth #2—Another digital solution is too much right now. My patients don’t need another platform to manage.


While it’s understandable to avoid adding yet another password or app to patients’ lives, dismissing new technology based on past experiences with clunky, non-integrative tools can be a costly mistake. Organizations with this mentality miss opportunities to use today’s intelligent solutions, designed to integrate seamlessly, offering the convenience patients crave without the hassle of extra logins or complicated processes.

The cost of believing it: Sticking with outdated solutions puts your practice at a disadvantage, especially given challenges with staff turnover and rising patient demand for convenient care. By not embracing advanced digital tools, specialty practices risk falling behind competitors, who may provide more efficient, patient-friendly options. Modern solutions not only enhance patient experiences but also streamline operations, making life easier for both staff and patients.


Myth #3—Patients prefer human interaction over digital solutions.


It’s a common belief that patients value human interaction more than digital solutions for tasks like scheduling. While personal interaction is important, today’s patients also demand convenience and flexibility, such as 24/7 booking, which manual processes seldom provide.

The cost of believing it: By not offering digital scheduling options, practices risk alienating the majority of patients (89%) who prefer managing appointments online or via mobile apps. Without digital tools, practices may struggle with high no-show rates and underutilized slots, negatively impacting the bottom line. User-friendly, mobile-first scheduling and engagement meets patient demands for convenience, reduces no-show rates, and optimizes appointment slots.


A fresh start from outdated operations


To combat these long-held patient access beliefs, consider these three facts:
  • Nearly half of provider organizations list patient scheduling as their most important patient experience function. Many organizations rely on practice management systems, but staff still use analog tools like binders and spreadsheets to manage provider scheduling preferences. Tailored, intelligent scheduling platforms can vastly improve experiences for your staff, patients and organization.
  • Three out of four digital health vendors use APIs to integrate directly with EHRs, lessening the pain of onboarding digital tools.Advanced solutions enable patients to self-schedule appointments (including referrals), confirm insurance information, chat with representatives, or pay bills from their smartphones without logging in or referencing appointment data.
  • Nearly 100% of patients would use a self-scheduling service if offered. Organizations that hesitate to automate daily tasks like scheduling overlook benefits: freeing staff to focus on impactful work and providing patients with preferred access channels.

By understanding these myths and recognizing their costs, specialty practice leaders can expand patient access and equip their staff for long-term success.

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Thursday, February 8, 2024

How specialty medical practices can succeed in MIPS and value-based care

Now in its seventh year, the Merit-Based Incentive Payment System (MIPS) continues to create confusion, especially for specialists. The program can have a big impact on Medicare Part B reimbursements, using the MIPS composite performance score to determine if providers will receive a payment bonus, a payment penalty, or no payment adjustment at all. Adjustments are based on performance in four categories: quality, cost, promoting interoperability, and improvement activities.

The biggest challenge for providers is to report data for at least six quality measures for a minimum number of cases for each calendar year. This poses an additional challenge for specialty providers as most of the measures were designed around the most common point-of-service where Medicare participants receive treatment – primary care. Specialty providers often find themselves force-fitting measures to fit the specialized care they provide. In addition, the benchmarks used to score performance keep raising the bar each year, making it increasingly difficult to earn a high score.

MIPS is one of many government programs focused on improving quality with a focus on value-based care. Programs like MIPS seek to change provider behavior to ultimately improve patient outcomes with the most affordable costs – using penalties to drive that change. To reduce the burden of MIPS, it’s best to make the shift in behavior to support providers in delivering the best patient care – and making compliance with these programs a natural outcome of doing that well.

Specialty providers can take three steps now to succeed with MIPS while prioritizing caring for their patients.


Be proactive about MIPS


To comply, CMS requires a full year of data for a minimum number of patients. If you have not considered your plan for 2024, don’t delay. Your plan for 2024 should recognize that it will be the strictest in the history of the program, including changes to 60 quality measures. It’s imperative to become familiar now with the CMS MIPS final rule released in November. With a requirement to report on at least six clinical quality measures, start by understanding the measures and associated benchmarks that best fit your patient mix.

Note that some clinical quality measures are specialty specific, while other measures need to be selected based on the appropriateness for the care they deliver. Many specialty practices need to incorporate primary care measures into their standard practice to have enough measures. For example, an ophthalmologist who treats patients with complications of diabetes can incorporate the HbA1c lab results into their documentation and get credit for an outcomes-based quality measure. With these considerations in mind, identify at least six measures to target in 2024 that will benefit your patients, and optimize your MIPS score.


Make MIPS part of everyday practice


Each year, the benchmarks have grown tighter, so it is reasonable to expect that will continue. Moreover, the outcomes for providers have shifted from gaining incentives to avoiding penalties – now a minus 9% for Medicare Part B reimbursements. Therefore, it’s imperative that providers make MIPS compliance a team effort by integrating the measures and associated documentation within everyday patient care workflows right from the start of the year.

After identifying at least six quality measures, consider with all staff, from the front desk to the care team to billing and reimbursement, how best to incorporate each one into day-to-day care delivery and administrative processes. For example, when a patient checks in for care, establish a standard protocol for the front desk staff and medical assistants to update the medication list and document weight and blood pressure. You can leverage the required MIPS functionalities in your 2015 Edition Certified EHR to make sure that your clinical documentation will satisfy your MIPS efforts.

In addition, consider how to make ongoing patient engagement part of your standard practice. For example, invite patients to connect via the patient portal, provide patient educational materials, offer virtual visits as appropriate, and increase proactive outreach for follow-up and preventive care. All these actions improve care and patient engagement while improving scores on MIPS measures at the same time.


Keep an eye on what’s expected in 2024


Even as CMS tightens the MIPS program, they are also actively working to reduce the burden on providers. One avenue is the creation of MIPS Value Pathways (MVPs). These pathways are designed to make it easier for certain specialties, such as orthopedics and neurology, to manage their participation in MIPS. However, not all specialties have an MVP available yet. Providers in those specialties can work with their professional associations to lobby CMS to expand MVPs.

With all the changes and the potential impact on revenue, it’s important that providers stay informed. Many seek guidance from their EHR vendor and organizations that provide consulting expertise and technology tools to streamline compliance. In addition, providers should actively use the CMS’s Quality Payment Program website to stay up to date on MIPS.


Conclusion


For specialty providers, there is a balance to strike with the MIPS program. With upfront planning, providers can implement processes that improve patient care and quality outcomes – and successfully address MIPS performance measures. The data collected by CMS is intended to inform patient-centered best practices that will continually improve clinical and financial outcomes. The more we equip the system to make compliance with government programs a natural outcome of quality care delivery, the better the system will work for everyone, especially patients.


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