The US healthcare industry is constantly at a state of reform, especially so from the time ICD-10 has been on the cards, i.e. from the year 2012. The original deadline was set for October, 01, 2013; however, it has been postponed yet again to October 01, 2015 now. Another major factor constituting the reform is the reimbursement trends from insurance companies and change in the payment schedule for physicians.
As the deadline to implement ICD-10 and the payment fee schedule 2015 approaches, solo physicians are contemplating to either sell off their practices or merge into a group practice to deal with the changes and the expected revenue loss. Reports are even rife of physicians considering premature retirement. Although a number of reasons can be attributed to the decision of US physicians going solo, the following are the predominant ones that are egging them to do so.
- ICD-10 and Compliance Reform Issues
The implementation of the new coding standard is causing apprehensions among the physicians but more so to the individual practitioners. The reason behind this is increase in work load that consists of administrative tasks, billing routine, paper work, etc. as cited in multiple reports.
- Less Individual Patient Time
The quality of service is expected to take a beating because the physicians are going to remain busy in the above mentioned chores and as a result they will have less time for each patient. Statistics reveal that usually physicians spend around only eight minutes with each patient. This is also a reason for reduced patient satisfaction.
- Payment Restructuring
The Medicare physician fee schedule (MPFS) is undergoing a major shift from the fee-for-service (FFS) model to value-based payments and bonuses for physician quality reporting system (PQRS). Moreover, to gain incentives from the Centers for Medicare & Medicaid Services (CMS) for Meaningful Use, physicians are really hard pressed for time to provide quality care as well as do the documentation.
- Increasing Pressure
Other factors like hiring skilled coders with increased salary rise, increase in the administrative tasks due to compliance issues by the CMS as well as insurance companies, working on patient collections, staff turnover rate, follow up for rejections and denials, etc. pose as challenges to medical practices’ performance.
- Recourse in Group Practice
So, taking recourse to form group practices or be a part of the Accountable Care Organizations (ACO) seems a natural course of action to survive the healthcare reforms. Expenses are shared and experts can be appointed for particular tasks, which is unlikely to happen in an individual practice due to monetary constraints.
Outsourcing medical billing ensures timely filing of claims and accuracy of charge entry. Expert and certified coders don’t come cheap and an outsourced billing partner can be of immense help for their expertise in various medical specialties. A smooth billing process goes a long way in ensuring steady revenue and more collections from alternate payment methods.
Hence, physicians are opting to give up their solo practices and fall back on expert medical billing services to save time, resources, money, enhance practice performance, dedicate more time towards patient care, and last but not the least, to have a systematic documentation process along with keeping up with the latest updates of the healthcare industry.