Physicians should be modernizing practice operations

For physician practices battered by more than a year of COVID-19 restrictions and lower patient revenue due to fewer patient visits, the time for decisive recovery action is now.

Emerging competitors threaten to siphon off patients who require routine care, leaving physician practices with sicker, higher-acuity patients more likely to be on Medicare or Medicaid. An August 2020 survey indicated that 2% of primary care practices had closed in the previous month. Another 2% were considering bankruptcy, and 10% were uncertain whether they’d remain solvent in the next month.

While physician work and revenue numbers have recovered somewhat this fall, year-over-year statistics remain lower, pointing to the need for significant change to devise a positive and profitable path forward.

Possibilities exist for closer collaboration among care providers to facilitate value-based care, but practices need to invest in new technologies to reap the benefits. Those technologies include a document management solution to tame the paperwork tsunami and the ability to receive admission, discharge, and transfer (ADT) event notifications from acute-care facilities. The latter became a requirement for hospitals as a Condition of Participation for serving for Medicare and Medicaid patients.

With vaccination efforts ramping up dramatically during the first months of 2021, the answer to the question of returning to near normalcy has become the more optimistic “when,” rather than the pessimistic “if.” Still, physicians face significant headwinds in the return to normalcy for their practices and their bottom lines.

Dramatic reduction in routine care, screenings

More than 40% of patients skipped medical care during the first five months of the pandemic, according to a recent survey. Often, the reason was a closed medical practice (63%), but another 57% feared exposing themselves to COVID-19. Moreover, 29% missed a preventive care visit, and 26% didn’t show for a general outpatient medical appointment. Between February and August, physician practices reported that revenue declined by one-third.

Service volumes for employed physicians dropped 5% from January-October 2020, compared to the previous year. Consequently, net revenue per physician fell 4.5% from January-October 2020, despite an uptick in productivity between July and October. Employed physicians represent just over one-half of all providers.

Physician practices were also impacted by a 6% drop in outpatient revenues for hospitals, where many outpatient tests and procedures are conducted. During the nationwide shutdown in March, ambulatory visits dropped by 60%, before rebounding at about 10% less than levels seen before the pandemic.

While the pandemic has upended nearly every industry, physician practices have been particularly hard-hit. Many already operate on razor-thin margins, with high fixed costs and an increasing number of Medicare patients whose reimbursements often don’t cover the cost of providing care. In addition to direct financial losses due to closures, practices that reopened faced lower volumes and higher costs for personal protective equipment.

Financial pressures likely to remain

According to an American Medical Association survey published during the early days of the pandemic, 97% of medical practices experienced a negative financial impact either directly or indirectly related to the pandemic.

Funding through the CARES Act Provider Relief Fund has provided a much-needed financial lifeline for many practices. If there’s a bright spot for physicians amid the global pandemic, it has to be the sharp uptick in telemedicine to maintain a revenue stream while in-person visits plummeted. Federal reimbursement certainly helped, but questions remain whether those payments will continue once the worst impacts of the pandemic lessen. Many digital competitors have entered the telehealth space that threaten to skim off the healthier, savvier patients who are comfortable using technology.

Every practice continues to grapple with an ever-increasing amount of paperwork related to insurance, claims, prescriptions, prior authorizations, referrals, patient portals, and alternative care arrangements as the industry moves away from fee-for-service toward value-based care. The burden is particularly acute on smaller practices.

Reducing the administrative burden on practices can increase throughput, making staff more productive and efficient. A small-scale study aimed at the Quadruple Aim—reducing costs while improving population health, patient satisfaction and team well-being—showed that small changes can have a large gain in productivity. The intervention group could offer 48% more patient appointment slots than the control groups.

Technology can reduce paperwork burden

Physician practices need the right technology to collaborate with other providers and become a hub in the care continuum. One still can find a physical fax machine in nearly every medical office. Ninety percent of healthcare organizations still use standalone fax machines as a communications source, sending and receiving patient data, referrals, and other data, including protected health information (PHI).

The physical fax machine can be a security weakness for organizations, especially if the machine is stationed in the front office in view of patients. Other perils include sending confidential data to the wrong number or failing to clear a machine’s memory should it need off-site repair or be discarded at the end of its useful life.

From a productivity standpoint, paper documents have to be collated, scanned, and attached to the correct patient record and data entered, a labor- and time-consuming process. A unified communications platform can bridge the gap between disparate technologies, including fax machines, which allows providers to send information in a HIPAA-compliant format that can become part of the patient record.

Cloud fax and Direct secure messaging can be used among clinical and financial IT systems to speed patient referrals, transmittal of continuity of care (C-CCD) documents, appointment information and much more. Physician practices can utilize the benefits of all fax infrastructure to the cloud, allowing staff to send and receive electronic faxes securely through email, a secure website or with an app. Users can triage electronic faxes, receive direct messages and even query through the Carequality exchange to find additional patient encounters, all from a common dashboard. Documents can be uploaded to a physician’s EHR inbox, creating a smooth integration into workflows.

Practices can benefit from new ADT regulations

Starting May 1, 2021, hospitals, psychiatric hospitals and critical access hospitals will be required to send electronic notices of admission, discharge, or transfer (ADT) to established healthcare providers. Absent of a unified EHR across the care continuum, where notices zip quickly and easily between hospitals and downstream providers, physician practices need their own solution to receive these notices, which can unlock the door to more collaborative care.

Winchester Hospital Independent Physicians Association is one integrated physician group that is helping their affiliated physicians connect across the care continuum by positioning itself for success way ahead of the May 1 compliance deadline. They are doing so with a technology solution that supports Direct-based ADT alerts but also details reports about the alerts, including the date, receiving physician and details about the type of message that was received.

The Massachusetts health system uses Epic, and the independent physician practices use a wide array of EHRs. Practices with compatible EHRs receive ADT alerts within the system, while others can access an online portal that provides physicians the information they need regarding discharged patients. The ultimate goal for both health system and physicians is to provide a more seamless, continuity of care experience for shared patients.

_{About the Author}

_{Bevey Miner serves as Health IT Strategy/Chief Marketing Officer, J2 Global Cloud Services}