Ready or not: 3 big changes coming for primary care physicians

April 7, 2021
Pooja Goel

Pooja Goel is Managing Director at Virgo Investment Group where she oversees healthcare. She is responsible for creating portfolio investment strategy and seeking new opportunities for partnerships.

Even before the pandemic, primary care was complicated. Now it’s even more so.

Even before the pandemic, primary care was complicated. Now it’s even more so as Covid-19 upends old practices, ushers in new ones and accelerates changes that were already in the works.

Tectonic shifts are underway for practitioners, including a push toward timely intervention and demand for remote patient monitoring. While all practices face an evolution-or-die dilemma, undertaking big change is harder for smaller firms which often lack the staffing, budgets, even expertise to meet the latest demands from patients and payers.

Still, whether they are large or small, PCPs must take necessary steps to survive and thrive. How do they know what to prioritize? Here are three trends that should be top-of mind for all practitioners, plus some solutions to help them manage their way through.

1) Timely intervention

Traditionally, primary care took a passive approach to treatment: PCPs waited for patients to present with symptoms and complaints. That model is fast becoming obsolete.

Increasingly, PCPs have – or will have – access to technology that indicates what’s happening with a patient even before the patient feels something amiss. Providers will be expected to prescribe remote monitoring equipment such as glucometers, pulse oximeters, and digital blood pressure cuffs to keep track of patients between visits.

Data will reveal when a patient’s condition is worsening; it’ll also prepare doctors better for less-frequent, in-person visits. Patients, who have already shown their willingness to supplement their care with digital tools, will increasingly demand the service. It will save lives and reduce costs.

But doctors already have tremendous responsibilities; managing this data can send already-burdened PCPs into burnout mode. They, or their practices, will need to invest in new staff or hire a vendor to help provide touchpoints for patients between visits.

Reimbursement is equally challenging, but help is coming. CMS has recently introduced new remote patient monitoring codes and allowed clinical staff to operate monitoring equipment under the “general supervision” of the billing provider. With the right technology and staff, primary care physicians can increase their Medicare revenues up to 20-30 percent by taking advantage of these programs.

Challenges aside, remote monitoring practices can improve care dramatically. To stay relevant, PCPs will need to embrace and onboard these new methods.

2) Think like an … actuary?

It’s time to consider another approach to patient panels: The risk score. This has been a successful tool for health plans to drive for better outcomes. But now it’s possible to apply risk scores to even more populations, allowing PCPs to participate in potentially huge shared savings.

There’s also a new economic incentive to use them broadly.

An exciting CMS initiative — one of the most exciting moves the agency has made in years — will make risk scores even more financially beneficial. The agency is launching a new direct contracting model this spring. Once the five-year pilot begins in April, most Medicare patients won’t have to switch to a Medicare Advantage plan to see their preferred primary care physician. This is a boon for seniors who hate to relinquish control over choosing their providers. At the same time, this new model gives PCPs the incentive to provide more preventative care to their patients, knowing it will finally be reimbursed.

So far, CMS has enrolled 51 direct contracting entities (DCEs), including physician practices and other healthcare organizations. More DCEs are lining up.

For PCPs to take advantage of incremental practice revenue, they’ll have to create the risk score of their patient panels — a new skill for many practices. Though providers know which of their patients is sicker than another, a risk score will indicate how likely that patient is to end up in a hospital. PCPs will need to know not only when to make timely interventions; they'll also need to understand the economic impact their intervention will produce.

But if they want to participate in the potentially huge shared savings, they’ll need to create their own risk score or find a service that can.

3) Big changes in workday routines

Telehealth visits soared in 2020. While we may see in-office visits creep up again as the threat of COVID-19 declines, patients are now accustomed to the convenience of remote treatment for minor acute problems. Their habits have been changed permanently.

Post-pandemic, a provider who had been documenting just one electronic medical record, has much more to juggle. Fewer patients will come into the clinic. That will cut routing time between waiting room and exam room. As a result, the ability — and expectation — to book more visits per hour will rise. PCPs will be logging in and out of multiple systems, telehealth portals, EMRs and chronic condition management systems.

If PCPs are providing remote patient monitoring, they’ll need to work with the vendor of this system. How does your office manage that workflow? How will you measure productivity? While CMS has helpfully cut some documentation demands, providers have some tough decisions to make: Is all this hassle worth the technology, staffing, overhead and time demands?

Yes, but …

There’s no question PCPs have some adjustments to make. The independent PCP model will become increasingly stretched by demands for timely intervention, actuarial thinking and workday changes. To ignore these changes is to leave reimbursement on the table.

Can PCPs do it alone? Yes, but those unwilling to make necessary investments in infrastructure and overhead should think hard about other options. For practitioners who planned to retire in about five years or so, they might consider sunsetting sooner. For others, it could mean selling, joining a network or becoming employed by a group. An acquisition is another option. Practitioners should consider tapping a management service organization to hire staff, fill schedules and take care of other moving parts — freeing the physician to focus on patient care.

All three changes offer new financial opportunities for primary care practices. But to take advantage of them, PCPs need more robust technology stacks, more staff, more case managers, more vendors. The solutions are clear: either invest heavily in the business or consider finding a partner.

Pooja Goel is Managing Director at Virgo Investment Group where she oversees healthcare. She is responsible for creating portfolio investment strategy and seeking new opportunities for partnerships.