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a company that specializes in strategic healthcare initiatives such as mergers and acquisitions, management services organizations, private equity, succession planning, physician partnerships, and strategic planning. He can be reached at 

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While analyzing the competition is an essential component of your strategy, most medical practices don't conduct this type of analysis systematically enough.

Are you working on a 2025 strategy?

Ryne Natzke is Chief Revenue Officer at TrustCommerce, a Sphere Company.

Practices have tools at their disposal that can help alleviate some of the problems that women face with health care affordability and access. 

How digital tools can alleviate health care access and affordability issues for women

Your monthly collection of insights from the Physicians Practice Pearls writers is available now!

Physicians Practice digital edition: Best states to practice

Nance Goldstein, MDc, ACC, PhD, partners with physicians as a leadership coach to find ways through today’s tough times and enjoy medicine more.

Her evidence-based work enables physicians to sail through the challenges of influencing others to deliver excellent care. Her clients learn simple, quick ways to lead high quality, thriving care groups – one conversation at a time. She’s an Affiliate Faculty at AriadneLabs (Brigham & Womens Hospital and Harvard’s Chan School of Public Health), as well as a scholar at Brandeis University WSRC. 

https://www.linkedin.com/in/nancegoldstein/

, curates recent research and stories of physicians making medical practice better – leadership that honors their purpose 

 improves their experience of practicing.

Her podcast offers conversations with seasoned women MDs talking about how they navigated the competing demands of practice, family and the rest of life.

She’d like to hear what troubles you in your practice. Email her: 

De-escalating situations and emotions can settle disagreements between staff members.

Messy Moments: Dial down the drama

Healthcare Policy | Physicians Practice offers medical practice news, expert insights on concerns physicians & medical practices face every day.

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 Podcast. In this podcast, we'll aim to bring you some of the most interesting, influential guests in the healthcare industry. If you have any ideas for podcast guests or topics, shoot us an email at 

Between the repeal of the Independent Payment Advisory Board (IPAB) and changes to the Quality Payment Program, it's fair to say the Bipartisan Budget Act of 2018 is a health care bill tucked inside of a budget bill.
In fact, Jennifer McLaughlin, senior associate director of government affairs for the Medical Group Management Association (MGMA), says there is a "laundry list" of items that affects the health care landscape included in the budget agreement (which passed the Senate by a vote of 71–28 and the House of Representatives, 240–186). While the organization is still going over the list, the changes to IPAB and the QPP (better known as MACRA – the Medicare Access and CHIP Reauthorization Act) are the biggest two.

In regards to MACRA, there were "small changes" that have the potential to make a big difference, McLaughlin says. In the QPP's Merit-based Incentive Payment System (MIPS), the Cost category continues to be a source of confusion for physician practices, she notes, because there hasn't been a ton of discourse coming from CMS about how it will be measured over time. The bill gives CMS more time to clarify, test, and develop episode-based cost measures.

"This bill gives the secretary of HHS three additional years before they have to move to full implementation of [Cost]. It also did away with what would have been a new scoring element for Cost in 2018, which was year-over-year improvement," says McLaughlin. The bill ensured that Cost would stay at 10 percent of physicians MIPS score through 2021. Originally, it was slated to go to 30 percent in 2019.

Later in the podcast, McLaughlin talks about the other major changes the Budget Act will enact on physician practices, which includes "the one negative [aspect] of an otherwise favorable bill." She also talks about the major legislative issues MGMA will be focusing on in the near future.

If you have any comments on this article email 

The Budget Act that passed Congress recently included "small changes" to MACRA with the potential to make a big difference, says one expert.

Analyzing Budget Act's Impact on MACRA 

Welcome to the Physicians Practice Pearls Podcast. In this podcast, we'll aim to bring you some of the most interesting, influential guests in the healthcare industry. If you have any ideas for podcast guests or topics, shoot us an email at 

The 2018 reporting year for the CMS Quality Payment Program (QPP) has arrived.

Some categories in the QPP's Merit-based Incentive Payment System (MIPS) pathway are based on full-year reporting, which means physicians eligible for the program cannot hold off on compliance any longer. They must understand the intricacies of this year's requirements, says American Medical Association President, David O. Barbe, MD. For instance, this year, the cost category of MIPS counts, unlike last year.

"[Cost] was 0 percent [of the total MIPS score] in 2017. It's now 10 percent in 2018…that was taken from the quality category, which has gone from 60 percent of the MIPS score to 50 percent," Barbe, who is also a family physician in Mountain Grove, Mo., says on the podcast. While MIPS doesn't have the "pick your pace" flexibility available last year, he says it should be an obtainable plateau for small practices.

"There are opportunities for small practices, including the opportunity to form virtual groups, five bonus points for groups with 15 eligible providers or fewer….there's also favorable scoring in the quality category for small practices."

There are other accommodations for small practices, including the fact that CMS expanded the low-volume threshold for exclusion from MIPS reporting to groups with less than $90,000 in Part B allowed charges or fewer than 200 Part B beneficiaries. All this, Barbe says, makes MACRA ''about as favorable as it can be for small practices."

Later in the podcast, Barbe talks about why it's not a good idea to cut the MIPS program and start over, as the Medicare Payment Advisory Commission has 

. "We believe it's way too soon to abandon the program altogether. We still see opportunities for improvement and will work with CMS on those…but we're not ready to declare this a program that can't work or won't work for doctors or patients," he says.

In this podcast, AMA President David O. Barbe, MD talks about the accommodations that CMS has made towards small practices in MACRA.

AMA Pres: MACRA Has Been Made Favorable for Small Practices

 podcast. In this podcast, we'll bring you some of the most interesting and influential guests in healthcare. If you have any ideas for podcast guests or topics, email us at 

In the ever-changing world of health policy, physician practices must move forward with value-based care as a strategic focal point. That was the wisdom of Ingrid Lund, PhD, practice manager for the physician practice roundtable at Washington D.C.-based research company, The Advisory Board Company, on this week's 

Lund was joined by her colleague Eric Cragun, senior director for health policy at Advisory Board, to discuss the GOP's ongoing efforts to repeal and replace the Affordable Care Act (ACA) and how practices can map their future without knowing what will happen with sweeping health policy legislation. "Certainly whatever the GOP does, whatever their next move on healthcare reform is, it will impact providers in some way, but I think we can agree there are some safer bets and ways to move strategy forward even though we're in this point of uncertainty," Lund said.

In particular, Lund said that "value-based care is here to stay" and the bi-partisan Medicare Access and CHIP Reauthorization Act (MACRA) isn't going anywhere. She advised practices to continue to prepare for this major shift and respond to the strategic implications of MACRA, including the push toward risk-based payment models. Another "safe bet," according to Lund, is to "double down on your consumerism strategy" thanks to the rise of health savings ac

"Thinking about strategies to improve patient loyalty is absolutely a good bet. Think about how patients find you in the first place - your website or other means, how easily they can get in for an appointment, how accessible you are, and … what that actual experience is like," Lund said.

Earlier in the podcast, Cragun talked about lessons learned from the Republicans' failure to pass the American Health Care Act. "It became pretty obvious that Republicans are not a monolith on health care issues. They may agree at a general level in the opposition to the ACA, but they differ on the specifics on how to [replace it]," he said.

Another lesson, Cragun offered, is that while the ACA as a whole may not be the most popular piece of legislation, there are certain individual policies that have support - such as the Medicaid expansion. "To keep those in place requires possibly keeping less popular parts of the ACA," he said. "It's in those tradeoffs where there is some political risks for Republicans."

At the end of the podcast, Cragun and Lund both offered their opinion on areas of potential health policy that could have a positive effect on physician practices.

No one can accurately predict what will happen with the ACA, but that doesn't mean physicians can't chart a path forward.

Amid ACA Uncertainty, Value-based Care Will Survive

Patients aren't blameless in the current state of health care in America.

Patients share  the blame

Don't run afoul of these new privacy and civil rights rules.

Triple play: HHS issues three new final rules

A U.S. Senator discusses the future of cybersecurity in health care.

"Lives are at stake" - Cybersecurity in healthcare

A 1.68% reversal of the 3.37% Medicare payment cut does not go far enough

Doctors groups say spending bill isn't enough

Recounting the steps that have brought healthcare to this state.

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Anders Gilberg, senior vice president of government affairs for MGMA, discusses what the midterm elections could mean for healthcare policy this year.

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