Best Practices

Future payments: Should practices begin to self-monitor?

Get ahead of a change that is surely coming.

By Derek Preece

While managing an ambulatory surgery center for a group of doctors in 1985, I heard from one of them: “I’m so glad my practice does not have to put up with all the governmental regulations the surgery center is subjected to.” Unfortunately, the time is long past when practices are free of governmental intrusions in their daily work.

For decades, doctors had to conform to Medicare’s billing rules. Now practices have the additional burden of complying with a slew of regulatory policies dictated by various governmental agencies. OSHA, HIPAA, e-prescribing, PQRS, EHR and its onerous “meaningful use,” requirements all take time and resources to implement and have a major affect on internal operations. Sadly, the governmental impact on practices is likely to grow in the future.

Fasten your seat belts

Given the ever-increasing percentage of the nation’s gross domestic product health care consumes and the expressed intent of governing bodies to rein in medical costs, it is almost certain that new attempts at controlling resources spent on medical services will be attempted. The Affordable Care Act designates a Center for Medicare and Medicaid Innovations and gives it a large budget to meet its mission to find and promote new payment methods and models of care. What these changes might entail over the next 10 years is unknown now, but judging by what has been discussed (and tested in some cases) it’s likely three areas will eventually affect ophthalmology payments:

• Clinical and surgical outcomes.

• Resource utilization.

• Patient perceptions.

It is hard to argue against any of these factors being important in a practice. Good clinical and surgical outcomes are the main purpose of treatment and rightly belong at the top of consideration for judging the success of any services. High utilization of medical resources without commensurate differences in results is hard to defend, and patient satisfaction is certainly part of a good medical experience. The guesswork lies in how to measure each of those factors without causing harm to patients and practices that fall outside of the norms.

Prepare for the future

Barring a radical change in the direction of health-care policies, these three measurements are likely to impact every ophthalmology practice in the next few years. This means practices currently have to answer an important strategic question: Do we get ahead of the curve by beginning to self-monitor those areas in an effort to prepare for when payment changes are implemented, or do we maintain the status quo?

Your answer to that question may determine the viability of your practice in the coming years. OM

Derek Preece is a principal and executive consultant with BSM Consulting, an internationally recognized health care consulting firm headquartered in Incline Village, Nevada and Scottsdale, Arizona. For more information about the author, BSM Consulting, or content/resources discussed in this article, please visit the BSM Café at www.BSMCafe.com