Clichéd as it may sound US physicians are still struggling to get a strong hold on their financial health in the wake of the healthcare changes and implementation of the Affordable Care Act (ACA). 2015 is all set to transform the face of healthcare industry in terms of administrative tasks, documentation process, quality of care, ICD-10 and one of the major challenges, the Medicare pay cuts.
Running a medical facility center is not a matter of joke given the constant renewal of rules and regulations on the healthcare practitioners. Here are the top most challenges physicians will face this year to maintain a steady revenue cycle management (RCM) and an average turnover.
- ICD-10 Implementation
Topping the dreadful list that is giving physicians the jitters is the ICD-10 deadline, October 1st of this year. In spite of the relay race of delaying the implementation date thrice, majority of practitioners are still unprepared to switch to the new coding system.
According to a recent survey by the Workgroup for Electronic Data Interchange (WEDI), the percentage of providers’ readiness for ICD-10 has dipped from a little more than 50%, as reported in the same survey conducted in 2014 to just 33%. The Medical Group Management Association (MGMA) too reported that only about 80% of providers were only somewhat ready or haven’t started their preparations for the switch.
- High Cost Implications
Implementing ICD-10 will involve technical overhaul like software upgrades, hiring trained people to use them, certified coders (who are expected to ask for considerably higher remuneration), training expenses and resources for the existing staff, etc.
Small medical practices fear to be the worst hit in this transition as the American Medical association (AMA) estimates an expenditure amount of around $56,000 to $226,000.
- Administrative Burden
To ensure providers get paid, they have to file the claims in both the coding standards, ICD-9 as well as ICD-10. No doubt this is a time taking process but an equally crucial one if the practice wants to stay afloat amidst the pay and fee changes, Physician Quality Reporting System (PQRS), Meaningful Use (MU), etc. The average time of eight minutes per patient is likely to further decrease and physicians will carry an extra concern for looking after the patient satisfaction factor.
- High Deductible Health Plans
The increase in deductible amounts of health insurance policies will pose as yet another challenge for medical practices as the ACA health plans now come with a considerable hike in the deductibles. This will add to the burden of collecting co-pays from the patients and sending them timely reminders.
Technology will play an important role here if providers want to make it convenient for the patients to pay via electronic or online mediums. This tactic will be a two way beneficial process as along with providing convenience payment options, practices can also ensure their cash inflow is not stagnated.
- Incentive Plans vs. Penalties
Even though the Centers for Medicare and Medicaid (CMS) has introduced incentive programs for physicians following practices like PQRS to motivate them, non-participation will attract penalties, which leaves no option for the providers to ignore or spend lesser time non such administrative tasks.
Other challenges include transition from paper to going digital, merging the availability of patient records for better care provision across different medical facilities, maintenance of certification, rising operational costs, patient influx with lesser chances of getting timely payments, etc. The scenario of the healthcare industry looks quite pitiable as of now and providers really need to buck up with their preparations to cope with these hindrances to curb losses.