Prepare Your Practice for a New Healthcare Model

A proactive approach to change is necessary.

By Amy Jennings and Jeff Wasserman

Like all medical specialties, ophthalmology will be affected significantly by changes to healthcare over the next several years. No matter the results of the recent Supreme Court decision on the Patient Protection and Affordable Care Act (ACA) or the November presidential and congressional elections, it is clear that American healthcare is now in the midst of a major transition.

The concept of accountability will now take center stage in evaluating care delivery, accompanied by reimbursement models such as the patient-centered medical home and the accountable care organization (ACO). In practical terms, this new emphasis will require ophthalmology practices to put systems in place to provide and demonstrate:

► Better patient care outcomes.
► Improved quality of care.
► Greater accessibility and patient satisfaction.
► Enhanced cost management.

Ophthalmologists increasingly will be reimbursed on their ability to meet these goals. Providers may even be asked to share financial risk within a more coordinated care continuum.

In a marked departure from the past fee-for-service environment, attention is now turning toward care collaboration as a means to enable illness prevention and population wellness. Primary-care providers will assume a larger role in managing care, which will create a ripple effect that changes the way specialists organize and staff their practices, develop relationships with their peers and accommodate patient needs.

Here, we will offer guidance on how ophthalmology practices can best prosper under the healthcare system that is now emerging. To benefit from this new model, both physicians and staff will have to embrace change rather than fight it.

Get Ready for Changing Operations

Ophthalmology has operated as a unique specialty over the past several decades. Unlike many other specialties, care is provided largely in office-based settings, with surgeries typically performed in the office, a freestanding ambulatory surgery center or an outpatient center attached to a hospital. In addition, it has the distinction of catering primarily to an older population that will only continue to grow — and to demand services — as the baby boomer generation ages. By contrast, the current trend among younger and healthier patients is to first seek care from optometrists who offer a full range of ancillary services.

With healthcare reform will come opportunities for ophthalmologists to recruit a new patient demographic, many of whom will be newly insured, and expand their practices. However, access to these patients will require ophthalmologists to become much more involved in organizational and patient care networks than in the past.

Develop Peer Relationships

As most ophthalmologists have no doubt noticed, peer relationships within health care already are starting to change. Physicians and other care providers understand the need to work together to better manage patient care. New reimbursement models are further challenging providers not only to work together, but also to be represented at the negotiating table.

In this changing atmosphere, ophthalmologists will need to begin developing stronger affiliations with colleagues and other practices in order to effectively contract for patients — as well as to gain access to needed infrastructure such as electronic medical record (EMR) technology. Those who wish to remain independent may find that it is no longer a practical strategy for survival. A more viable option may be to join a network, an independent practice association (IPA) or an ACO.

The emphasis on demonstrating outcomes, quality and cost savings will necessitate collegial cooperation. Communication among providers and staff — and with primary-care providers — will be more important than ever in the coming years.

Reconsider Staff Responsibilities

In ophthalmology, office work flow and patient accessibility is often dependent on mid-level providers and technicians. These staff members are critical to maintaining productivity, managing office efficiencies and assuring cost-effective care. In short, they have a great impact on the overall patient experience.

Going forward, patient satisfaction will have to become a larger part of the focus for ophthalmology staff. Practices most attuned to the overarching goals of healthcare reform recognize that the roles and responsibilities of many staff positions may change. In addition to technical skill, for instance, staff may need to be excellent communicators and offer exemplary customer service. They may be required to accommodate patient convenience by working flexible hours.

Technical and administrative staff alike should be held responsible for accommodating these demands. In fact, like the overall practice, staff compensation may need to be linked to performance in these important areas.

In addition, a successful transition into the future will demand staff members who are willing and able to adapt to EMR technology and accept additional responsibilities. Staff must be familiar with not only how an EMR system works, but also how to efficiently move patients from one point of care to the next — both within the practice and among external points of care.

Assess Practice Infrastructure

But EMR systems are just the beginning. The EMR will need to link with other practices in whatever kind of provider network the practice has joined. With readily available data, however, will come a new level of accountability.

The expectation of healthcare reform is that tools such as the EMR will enable practices to better meet quality benchmarks and manage patient-care data. Patient safety and operational efficiency will be at the forefront of measurement and reporting activity. Patients and networks alike are likely to have a wide choice of providers, and they will choose partners based upon parameters such as clinical outcomes, timely communications, the ability to share data, ease of access, cost and overall patient satisfaction. The faster an ophthalmology practice can offer transparency regarding these parameters, the better its prospects for the future.

Focus on the Patient

The ACA established that almost all patients will have health insurance, which means a large number of patients who previously did not have access to ophthalmic care will obtain it. Many practices will be competing to capture new patient populations, as well as the skilled healthcare professionals to serve them.

As the focus of patient care shifts to promote disease prevention, many patients previously denied or unable to afford care will seek screenings for such conditions as diabetic retinopathy and glaucoma. One thing is certain: The ability of a provider to demonstrate value will greatly influence where patients go for care. Forward-thinking ophthalmology practices must consider how they can best demonstrate the delivery of high quality, efficient and cost-effective services.

Those involved in ophthalmic care will be required to develop new care models that expand beyond the boundaries of the traditional practice. Medical teams that take full advantage of the skills and efficiencies of mid-level providers, medical assistants and other professionals may be required. Outreach that extends to working with patients and families will become prevalent. The best preparation for the uncertainties of healthcare reform is a proactive approach to initiating change. OM