Kevin N. Fine, MHA

a major shortage of primary care physicians

 will sweep across the United States. By 2025, the number of physicians needed will fall short by 46,000 to 90,000, according to a 

 from the Association of American Medical Colleges.

Combating the impending physician shortage

	A number of factors contribute to the shortage. First, primary care physicians (PCPs) typically earn less than specialists. As a result, fewer medical students are pursuing careers in general practice. According to 

 of the highest-paying occupations and median base salaries in the U.S., physicians make an average of $220,000 a year. Four types of specialists-cardiologists, radiologists, anesthesiologists and surgeons-top the list with median base salaries of $356,000, $355,000, $350,000 and $338,000, respectively.

	Second, some PCPs have not embraced technology advancements to satisfy the modern patient’s needs and expectations. Other types of healthcare providers, however, have started offering patients convenient services like virtual visits to reduce travel and waiting times. Consequently, some patients have chosen specialists and other types of healthcare providers offering robust telemedicine and virtual visit options instead of primary care physicians for their healthcare needs. This, in turn, affects PCPs’ opportunities to grow their practices and boost revenue.

	As a primary care physician, how will you adapt your practice 

to meet new and increasing patient demands

 while addressing business challenges brought on by the impending shortage? With value-based approaches taking over traditional fee-for-service payment models, how can you deliver quality care to patients in condensed periods of time?

	To run your practice efficiently and stay competitive, you should strive to provide patients with convenient services, think creatively when developing new organizational structures and build strong relationships with insurance providers and payers. As always, keep your goals and bottom line in mind when evaluating new strategies to optimize your practice. 

Evolve your healthcare delivery channels to match patient expectations

	Patients expect convenience. In this technology-driven world, the expectation of immediacy is a reality. Don’t drive your patients away to other physicians, urgent care centers or emergency rooms because your next available appointment is a month away. Consider modernizing your delivery of care with services such as virtual visits delivered through a patient portal or app to attend to patients when they need you.

Top 11 gripes physicians have with patients

	PCPs spend an average of 14 to 16 minutes on in-office patient visits, according to 

. However, telemedicine platforms can cut patient visits down to an average of two minutes. 

 will not replace in-person care, but they can effectively supplement care and boost patient satisfaction rates.

	While third-party software products come with a price tag, technology investments can help your practice to stay competitive instead of falling behind. 

	You do the math. With services like telemedicine, Skype consultations and giving patients the option to schedule appointments online or through apps, you free up your time and resources to help more patients. You’ll also have more time to develop strategies to build a smarter and more streamlined practice.

 It's time a real investment is made in primary care

	Nonetheless, the growing role of technology in the delivery of care introduces cybersecurity concerns. More than 

27 million patient records were compromised in reported healthcare data breaches in 2016

, so establishing a strong cyber security program is crucial. Restricting access to protected health information, implementing firewalls and training employees on IT security best practices can help protect your patients’ health information.

Think creatively when approaching your practice’s organizational structure

	When was the last time you examined your practice’s office locations and hours? Taking a closer look at patient needs, emerging market trends and more can reveal opportunities to assist more patients and increase revenue.

 Consider establishing your own urgent care center so your practice can take care of patients in critical times of need instead of losing their business to competing healthcare providers.

 Research market trends and population changes across surrounding areas. Opening office locations in underserved areas experiencing population growth asserts your presence before other practices follow suit. Also take a look at demographics and see how you can tailor your new office’s design and services to meet particular needs. For example, older patients may respond well to quiet, comfortable seating areas in the waiting room while younger patients might prefer phone charging stations.

Physicians need to be like the Ritz-Carlton to improve healthcare

 Take a look at appointment patterns. Do most of your patients prefer appointments later in the day or earlier in the morning? Should you offer weekend hours? What about extending services later in the evening, when people are out of work? Instead of becoming complacent with standard office hours, test new hours and see how patients respond. Tailoring hours by office location will better serve patients while maximizing your staff’s time and resources.

Collaborate with payers and explore alternative reimbursement models

	More and more reimbursement contracts call for value-based payment arrangements, causing the traditional fee-for-service model to dwindle. You will be held accountable for the cost and quality of care rather than the number of patients you serve. Have you proactively prepared for this reimbursement shift?

Consider risk-based alternative arrangements. 

Arrangements like capitation and ACOs can increase revenue and drive more value in the payer-provider relationship. Collaborating with payers and sharing risk with other doctors and hospitals can help you work more effectively and succeed within today’s dynamic healthcare environment.

Partner with payers and sign up for a narrow network.

 Payers want to steer their members to doctors who provide value-based care and practice good medicine. The smaller the network, the more opportunities they have to strengthen relationships with providers. Physicians may want to consider partnering with payers as one of a few providers within a narrow network, which tend to carry lower premiums for patients.

A call for physicians to denounce third parties once and for all

Understand your success in value-based care.

 Adopting analytic models and methodologies ahead of time will help you comprehend various types of data needed to determine your success in value-based care.

	Transforming traditional approaches to patient care can help your primary care practice endure the physician shortage, in addition to creating opportunities for new types of business. Running an efficient and competitive practice can enable you to not only meet emerging patient expectations, but to enhance profitability as well.

, is a director of healthcare advisory services in the Miami office of Kaufman Rossin, one of the 

Articles

In the next few years, a major shortage of primary care physicians will sweep across the United States. By 2025, the number of physicians needed will fall short by 46,000 to 90,000, according to a recent study from the Association of American Medical Colleges.

How can physicians combat industry shortages and meet patient demands?

	More than 800,000 physician practices got a 

Centers for Medicare & Medicaid Services (CMS)

 in May. But practitioners shouldn’t breathe easy just yet.

 Top 8 things doctors need to know about 2018 MACRA proposed rule

	The break is only for certain providers and it only applies for 2017, which was slated to be a transition year anyway. Physicians who want to avoid future penalties should start preparing now to comply with MACRA and MIPS reporting requirements in 2018 and beyond.

	To aid in the transition, CMS had previously announced reduced reporting requirements in 2017 for physicians and healthcare organizations participating in 

the Merit-based Incentive Payment System (MIPS).

 Those who fail to collect and report a minimum amount of performance data this year could face a 4% negative payment adjustment on reimbursements in 2019 - with that penalty amount set to increase in future years.

	Under the latest exemptions, physicians with $30,000 or less in Medicare charges and 100 or fewer unique Medicare patients per year, as well as those who are new to Medicare in 2017, will not be evaluated under MIPS this year, and should have received a letter from CMS stating such. If you are now exempt, count yourself lucky.

Physicians, healthcare industry react to 2018 MACRA proposed rule

However, that still leaves close to 419,000 clinicians who are supposed to submit MIPS data for 2017. Those eligible providers are not just physicians-also included are some nurse practitioners, physician assistants, clinical nurse specialists and certified registered nurse anesthetists.

	Understanding the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is not complicated. It was designed to streamline value-based programs, including Meaningful Use, Physician Quality Reporting System and Value Modifier.  

: the Merit-based Incentive Payment System (MIPS) and the advanced Alternative Payment Model (APM). Most physician practices are expected to use MIPS to comply.

Next: Avoiding negative Medicare payment adjustments

	To avoid negative Medicare payment adjustments under MIPS, non-exempt clinicians need to choose one of the following reporting options for 2017:

If you report all of the required measures for a minimum of a continuous 90-day period, you may be eligible for a positive payment adjustment, depending on your performance results.

If you submit performance data on one quality measure, more than one improvement activity or more than the required measures in the advancing care information category for a minimum of a continuous 90-day period, you may have a neutral adjustment or earn a positive payment adjustment-depending on your results.

If you report a minimum amount of data for 2017 (e.g., one quality measure, one activity in the improvement activities category), you can avoid a negative payment adjustment, but you will not be eligible for a performance bonus.

	In addition, if you will be reporting this year, you need to decide if you will be reporting as an individual or as a group. For more information, visit the 

	Whether or not your practice is choosing to report this year, you still need to get your data in order so you will be prepared to meet future compliance requirements. If you don’t already have a proactive documentation management process in place, you should consider establishing one now.

Slow and steady won't win MACRA race for physicians

	Having accurate performance data is key to meeting the reporting requirements for MACRA. The quality of your electronic health records (EHR) and practice management (PM) systems as well as the knowledge of your staff in using those systems will affect your ability to report performance data accurately and timely.

	If your systems are not working for your practice in the way that you had envisioned, assess whether it is a system problem or a training problem. Most physician practices are underutilizing their EHR system and therefore not maximizing the value of their technology investment.

	Physicians, clinical staff and administrative staff should receive formal training on the capabilities of the EHR system. Take the time now to contact your vendor and schedule any training that you need to prepare for future reporting requirements.

	If you determine that your current system may no longer be a good fit or offer the full capabilities you desire, compare the options on the market against your practice’s needs, and engage a qualified healthcare consultant to assist with the selection process, if needed. 

	Under the MACRA final rule issued in October 2016, providers could have started collecting performance data as early as January 1, 2017. However, non-exempt providers have until the start of the fourth quarter of 2017 (October 2) to begin collecting data. The more data you report, the higher your chances of qualifying for a positive adjustment.

Quiz: How much do you really know about MACRA?

	March 31, 2018, is the deadline for non-exempt physician practices to submit 2017 performance data to the 

, regardless of which reporting option you choose.

	CMS is making it relatively easy for healthcare providers to meet the initial reporting requirements and avoid a negative payment adjustment in 2019-as long as you don’t wait too long to act. Start planning now to collect the performance data you need and to develop a MACRA reporting plan that works best for your organization.

, MHA, is a director of healthcare advisory services in the Miami office of Kaufman Rossin, one of the 

Top 100 CPA and advisory firms in the U.S.

More than 800,000 physician practices got a temporary pass on MACRA compliance from the Centers for Medicare & Medicaid Services (CMS) in May. But practitioners shouldn’t breathe easy just yet. 

Author | Kevin N. Fine, MHA

Articles

How can physicians combat industry shortages and meet patient demands?

Looking ahead at MACRA/MIPS reporting for physicians