Implement medical practice change without going broke or insane

Over the last several years, new regulations have become law affecting how doctors practice medicine. First came the Meaningful Use program, pushing doctors to purchase and implement EHRs. Then came updates to those rules, threatening doctors with financial penalties not only if they failed to incorporate an EHR into practice, but if it was not used in a meaningful way based on submitted data metrics (as determined by government officials). 

Now, many practices and healthcare systems are scrambling to address the recently enacted MACRA laws (also known as Medicare’s Quality Payment Program). There is much discussion going on about how to avoid reimbursement reductions. It first comes down to how your practice is getting ready to take on the challenge.

Not all of us work for a hospital or large organization that has IT departments assigned specifically to that task. For many of us, especially in small and/or private practices, this is pretty much a do-it-yourself project.

Tips to incorporate new regulations

• Know the regulations.
Even lawmakers didn’t read the bill introducing MACRA they passed into law. But, we need to know as much as we can because this affects our careers and patients. A good example is the fact that my practice is exempted from Merit-based Incentive Payment System (MIPS) reporting because we don’t bill Medicare enough. This is something very good to know before you go crazy trying to create your data reports and evaluating if you are going to be positively or negatively adjusted. Since I know the exemption, I can skip this step and not face any financial penalty.

• Make it a team sport.
Physicians are busy seeing patients and no one has extra time to see what it all means. Discuss it with your staff and enlist their help. Many doctors find it difficult to delegate tasks to others; we like to do it all ourselves. But, this is a time to delegate if you want to stay sane.

• Ask others.
State medical societies are a great source of help. They have many resources to commit to the new regulations. Not only do they have advice they are eager to share, but in New Jersey, for example, they have organizations created around the new rules and will come to your practice and help with your data reporting; for free if you are a member. Other states likely have similar organizations.

• Make change your new routine.
For example, when implementing Meaningful Use, we were required to report email addresses and language spoken. Since, we knew our patients and knew that they spoke English or another language, we didn’t need to record it in the chart. But, since it is a required data metric, it is now our routine to ask every patient their primary language. You will miss many requirements if they is not asked and recorded in the chart.

• Educate your patients about the regulations.
Healthcare is becoming extremely complicated these days. Some of these new laws make it more complex in fact. Help patients understand these new rules and how it affects them.

• If it’s not working, drop it.
For many physicians in small practices, it is much easier to opt out of Medicare rather than implement these Draconian changes to their practice. And there is nothing wrong in doing this. We have to survive too. Just be sure to give patients enough advance notice.

• Speak up.
If you don’t agree with the need for the new laws or those being proposed in the halls of Congress, raise your voice. Most of us disagree with many of these regulations, but we are now forced to follow them because so many stood silent as they became law.

Whether or not we agree with the rules being manacled to us, when they become law we have no choice but to comply if we want to stay in business. The system seems to be pushing more and more doctors away from self-employment and into larger systems.

While these regulations make our practices more difficult, it is very important to stand strong against the forces driving us away from private practice. It is only when we succeed that the winds will again change and the force be diverted to other agendas.

Linda Girgis MD, FAAFP, is a dedicated board-certified family physician in private practice in South River, N.J., and its surrounding communities.