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If you're able to predict the activity of Congress and the decision-making logic of the Supreme Court then you're probably in good shape for developing a strategy to prepare for the Affordable Care Act. In the absence of such knowledge, you may at the least want to focus on the following:

Navigating the Affordable Care Act Minefields

In the day-to-day chaos of running a healthcare practice or facility, it can be very easy to forget some of the basic building blocks of the business.

Quick Tips: Don't Neglect Your Fee Schedules!

For many private practices, selling to a large corporation or hospital may seem like the only answer to address the challenges of today’s health care market. According to the 

AMA 2022 Physician Practice Benchmark Survey

, many private practices turn to corporate medicine for help negotiating higher payment rates and managing regulatory and administrative requirements. But there is another way forward.

Innovative AI-powered technology is one factordisrupting the corporate takeover trend, making the private practice business model more feasible by enabling transparent costs, increasing instances of payment at the time of treatment, resolving accounts receivable, simplifying patient education and enhancing clinical documentation.

Financial challenges and regulations stifle private practices

Private practices increasingly find themselves squeezed between higher administrative costs and increases in unpaid medical bills. At the same time, they must comply with new laws and compliance regulations that make it harder than ever to collect balances due from patients.

Managing a practice encompasses many costs including 

, clinical integrations, patient engagement, payment processing and billing services. Each vendor carries set fees plus additional fees for normal use volumes, driving massive expenses – even for those marketed as "low cost."These expenses are compounded by rising costs for rent, insurance and medical equipment – making profitability evasive for private practices.

At the same time, there is an increasing threat of never receiving outstanding balances due to the 

 debt less than $500 from patients’ credit reports. States like 

 extended this, prohibiting inclusion of any medical debt information on credit reports. When patients are unwilling to pay what they owe, it strains the private practice’s budget – impacting cash flow and making it difficult to cover operational costs and payroll.On top of that, confusion and frustration regarding unpaid balances is a top source of negative reviews, which also causes lost patients.

Adding to these challenges is new legislation, such as the 

to ensure transparency in health care costs prior to treatment. The 

 include providing Advanced Explanation of Benefits (AEOB) for in-network visits and Good Faith Estimates (GFE) for self-pay patients. Many practices have not yet fully addressed the impact of these changes on their business.

AI-enabled technology boosts private practice profitability

Technology powered by the latest in AI and automation is key to enabling private practice owners to address these challenges. Infusing AI throughout each function optimizes the practice management system to help physicians save time, reduce costs and enhance profitability. Here are a few examples of the benefits of AI-enabled technology:

Eliminate the manual steps needed to gather data and the subsequent guesswork required provide cost transparency and accurate estimates before treatment as required by the No Surprises Act.

Increase frequency of complete payments by estimating patient liability before treatment, offering payment options, and making payment arrangements at time of treatment.

Resolve accounts receivable with analysis of outstanding patient balances and automated tasks to reduce accounts receivable.

Simplify patient education and improve the patient experience with easy-to-understand, personalized information explaining eligibility, fees and balances.

Enhance clinical documentation with advancements in charting to save physicians time and effort while maintaining compliance and data security.

Being a health care provider carries a heavy weight of responsibility for patient safety and security that also applies to the private practice’s technology selections. When considering non-EHR AI plug-ins, ensure they do not share information with centralized databases, which can impact HIPAA compliance. Instead, look for a secure, 

 system that does not rely on outside data sources or pass data to third parties.

At the same time, be wary of systems that use outside knowledge to write narratives, code procedures or diagnoses, or make patient plans. AI can be used to augment practice efficiency but should not completely replace information that the physician – the clinical expert – originates.

Consolidating vendors and streamlining systems is one way to simplify workflows and controls costs, but it is also important to consider the latest technological advances. Several technology innovators have applied AI to various practice workflows, offering new ways to save time and effort.

The ideal solution is an all-in-one practice management system that offers benefits across the entire patient interaction – from marketing to scheduling to onboarding to office visits to clinical documentation to billing and payment. The value of the system is further maximized when data is shared in an integrated loop across functions to increase efficiency, optimize revenue cycle management and improve work-life balance. The savings flow through to the bottom line and keep the private practice profitable.

Technology for patient care and office use is essential in today's medical practice. AI is a catalyst for changing the status quo with new advancements that help private practices thrive in today’s health care landscape. Without significant technological improvements, rising overhead costs and documentation pressures will continue driving many physicians to sell their private practices to corporations, or worse, leave the profession.

Jeremy Shiner is the founder and president of 

, aprovider of comprehensive practice management software and services designed exclusively for private practices.

Innovative AI-powered technology is one factor disrupting the corporate takeover trend

Topics

The role of AI in revitalizing private practice

Amid rapid health care industry consolidation, a challenging cost environment, and increasing patient needs and expectations, only truly nimble health care organizations will survive and thrive.

Medical groups focused on prepaid, value-based care are better positioned to innovate, develop, and invest in technologies to respond to patient needs and market dynamics. For example, value-based organizations that bet big on 

 and remote patient monitoring technologies prior to 2019 were able to continue seeing patients remotely during the COVID-19 pandemic. In contrast, fee-for-service health care systems — which are paid per office visit, treatment, and test — struggled. As a result, a movement is now underway in health care, from volume of care to value of care.

Value-based care organizations prioritize prevention through early detection and proactive treatment of health issues. Physicians and care teams work together to manage the overall health of individuals and populations. Financial incentives are tied to keeping the patients and communities they serve healthy. Every interaction, from telehealth, 

, to in-person visits, is an opportunity to address patient needs, including access to healthy foods and community-based resources. The guiding principle is evidence-based, quality care that is cost-efficient while 

U.S. Centers for Medicare & Medicaid Innovation

 issued an ambitious goal to shift 100% of Medicare beneficiaries into an accountable care insurance plan by 2030. Given that the number of Americans 65 years and older is projected to increase more than 40% to 82 million by 2050, that announcement signals a massive shift in strategy where a huge swath of Americans will receive some form of health care services tied to value arrangements.

the future of medicine, and everyone is trying to get it right. Based on our nearly 80 years of experience, here are four innovative strategies physician leaders can adopt to advance value-based care.

Embrace artificial intelligence (AI) to help physicians with administrative tasks and improve quality care. 

With AI, physicians can get comprehensive insights into patient health, experience, and health care utilization at the individual and population levels. For example, at Kaiser Permanente Northern California, computer vision algorithms were used to identify patients at risk for breast cancer quicker and more efficiently. Also, we are using new ambient AI scribe technology to help physicians write clinical visit notes, enabling more face time with patients and reducing physician time spent after-hours on administrative tasks.

Focus on optimal wellness by delivering the right care in the right venue, including care-at-home for an aging population. 

Value-based care models allow organizations to invest in people, technology, and services that support team-based care. We currently provide at-home services in six regions across the country, doubling our commitment to this care model from 2022. Patients have told us they love recovering at home. As of April 2024, more than 320 hospitals across 133 health systems in 37 states are authorized by the Centers for Medicare & Medicaid Services to offer acute hospital at home under a 

 expiring at the end of this year. To make these programs scalable, we support a five-year waiver extension. We also want these services to be included in traditional Medicare coverage so health systems can sustainably care for the increased number of older adults.

Solve the shortage of primary care physicians. 

Primary care physicians are the first line of defense against illness or injury. However, 30% of Americans currently do not have a primary care physician due to a shortage. Policymakers should consider measures that bring a new generation of talented and diverse physicians into medicine. Increasing the number of graduate medical education slots — proposed by the Resident Physician Shortage Reduction Act — would be a good start. Additional solutions include immigration policy reforms that remove obstacles for foreign-born physicians and significant investment in medical education and training. Permanente medical groups participate in community-based programs that spark interest in medicine among diverse students at a young age. They include Kaiser Permanente Southern California’s Hippocrates Circle Program and Kaiser Permanente Northern California’s Prep Medico and Medical Scholar’s Pathway.

Identify and address health disparities and emphasize prevention.

 Value-based care focuses on quality outcomes. This encourages physicians to provide equitable care by addressing the root causes of health inequities. This is preventive medicine at its best. Through an effort led by our National Equity, Inclusion, and Diversity and Quality departments, our outcomes reporting has brought greater visibility to health disparities and their impact on patients. We use insights from this reporting to create comprehensive plans to address disparities. For example, research published in 

 showed that a decade of enhanced screening for colorectal cancer with fecal immunochemical tests (FIT) essentially eliminated disparities between Black and White Kaiser Permanente members in Northern California and that organized screening improves colorectal cancer outcomes for all our members.

Innovation thrives in prepaid, value-based care systems, which have successfully demonstrated their ability to adapt to major market disruptions. During this time of rapid change and increasing uncertainty, health care organizations will need to shift to value-based care to better serve patients and remain competitive.

Maria Ansari, MD, FACC, is CEO and executive director, The Permanente Medical Group; president and CEO, Mid-Atlantic Permanente Medical Group; and co-CEO, The Permanente Federation.

Ramin Davidoff, MD, is executive medical director and chair of the board, Southern California Permanente Medical Group; chair of the board and chief executive officer, The Southeast Permanente Medical Group; chair of the board and chief executive officer, Hawaii Permanente Medical Group; and co-CEO, The Permanente Federation.

Value-based care is the future of medicine. Health care organizations must adapt technology, venues, primary care and prevention to survive and thrive.

Four strategies to advance value-based care

There is no doubt that American health care is in crisis. Tens of millions of Americans are in medical debt. Hundreds of thousands are injured or die each year from avoidable health care errors and hospital-acquired conditions. Insurers categorically deny patients the appropriate treatment and medications in a misguided approach called “prior authorizations.” Employers have been asleep at the wheel for decades, allowing the system to unnecessarily jack up the costs of health care.

The U.S. is the only developed nation in which life span is decreasing, and we have, by far, the worst disparities in health care and health outcomes. Burnout and demoralization amongst clinicians and staff now adversely impact nearly half of the American health care workforce.

If we are to solve the dire dilemma in American health care, it is clear that the approach will have to be radically different from those we’ve taken to date. Over the past decade I’ve been studying visionary leaders who are thinking and acting differently. There are replicable lessons we can learn from these divergent leaders – approaches that we can adapt and scale. Below are three foundational principles and three examples we can learn from to humanize healthcare.

If you’re not actively and intentionally 

, then you're fostering distrust. When people talk about trust, I ask (1) How are you defining it? (2) How are you measuring it? (3) How are you operationalizing it?

Address health inequities and disparities. 

The immediate goal is to eliminate inequities in health care and disparities in health outcomes. What we must do is replace all of the systemic ‘ism’s: racism, sexism, ageism, ableism, classicism – with humanism - and again, operationalize and systematize it.

The evidence is overwhelmingly clear. More preventive primary care in a community leads to greater health and lower costs. 

 is fundamental to achieving any effective and sustainable health care system. This also includes attending to the emotional, relational, and psychosocial aspects of an individual’s life.

There are several examples of these principles in action. Unbeknownst to most, the Veterans Administration (VA) has become one of the most innovative and transformative epicenters leading the way in humanizing health care delivery. It’s also the largest health care system in the US – with approximately 150 hospital centers, 1,400 ambulatory care centers, and over 400,000 employees providing care to over nine million veterans annually.

In 2016 the VA instituted a “Trust Index.” Quarterly, they send out a survey to measure veterans’ perception of the value being delivered to them by the VA. The survey has three statements – each measured on a five-point Likert scale – that address ease, effectiveness, and emotion, plus an overall trust statement.

Ease - “It was easy to get the care or service I needed.”

Effectiveness - ”I got the care or service I needed.”

Emotion - ”I felt like a valued customer.”

Overall trust - “I trust VA to fulfill our country’s commitment to veterans.”

The VA publicly reports their trust index results quarterly (

), breaking down results by gender, race and other demographics. This transparency clearly adds to the trust they’re building with their employees and patients.

When they first began the survey in 2016, they discovered that only 55% of veterans trusted the VA, which they felt was unacceptable. In response, they used the insights they gained from this and other surveys, and launched numerous patient-facing initiatives as well as efforts amongst clinicians and staff to improve trust. As of Q4 2023, their score had improved to over 79% – best in class compared to other public and private sector healthcare delivery systems in the U.S. Their goal is over 90%. In order to reach that percentage, they have already begun mapping out veteran patient journeys and creating personas that capture the pain points, challenges, and bright spots for veterans as they utilize the VA.

The VA has also launched a national Whole Health Initiative (

), which has been extensively studied. Its goal is to provide more holistic wellness care, complementing traditional clinical and social care. The program is based on decades of research demonstrating that non-clinical factors play a significant role in the health outcomes of individuals. These factors include issues such as housing, financial stability, employment, education, transportation, nutrition, sleep, stress, relationships, and neighborhood and environmental safety. What’s fascinating is that this program also addresses issues such as loneliness and an overall sense of purpose in one’s life – factors now known to contribute not only to emotional and mental health but also to physical health and longevity.

The VA Whole Health program is multi-faceted and operationally complex, but it boils down to two essential questions which, I believe, other organizations can adapt and apply immediately. First: “What is most important to you in your life right now?” And second: “What can you and we do to assist you in achieving or attaining what’s most important to you in your life?”

The final example comes from a provider organization called ChenMed, whose focus is to provide VIP care to older patients who have either Medicare Advantage or are dually eligible for Medicare and Medicaid. ChenMed has been recognized as one of the best provider organizations in the country, with demonstrably superior quality, safety, health outcomes and experience scores.

Dr. Faisel Syed is a practicing internal medicine physician and clinical leader at ChenMed. One day he noticed the way he and his team were describing some of their patients. For those who work within provider practices, you’ll be familiar with the term “walk-ins.” The term has a negative connotation because patients who walk in without an appointment disrupt the schedule. It’s a term that does not elicit a lot of warm, fuzzy feelings from providers or staff in a clinic setting.

Syed recognized that it was also a somewhat dehumanizing term, not in keeping with the overall mission and culture at ChenMed. He reminded himself, his colleagues, and his staff that these patients were calling or coming in for an immediate appointment because they had an urgent medical need. So he asked his staff to change the term “walk-in” to “person in need.” It was nothing more than that, but that subtle shift changed everything for the team. It established a renewed sense of empathy, compassion, and kindness.

I applaud anyone who is asking themselves, “What can I do to humanize health care?” I would suggest that rather than trying to boil the ocean, start small. Start by talking about it. Start by asking questions that challenge the status quo and the incrementalism that has taken over healthcare delivery. Start by sharing examples of humanism in your practice and organization. Start by making your workplace more humane for clinicians and staff. Start by noticing the words you use.

The most important thing is not to allow the system to overwhelm, dismiss or demoralize us. Each of us is a leader – no matter what our role is – and we all need to be leading a humanistic transformation in American health care delivery.

) is a health care executive, author and nationally-recognized thought leader. His second book,

Beyond The Walls: Megatrends, Movements, and Market Disruptors Transforming American Healthcare

If we are to solve the dire dilemma in American health care, our approach will have to be radically different from those we’ve taken to date.

Brian J. Bourke, MBA

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