A key factor in the patient-centered movement gaining traction is the Affordable Care Act and its intention to improve population health and reduce healthcare costs in the United States. This is expected to be accomplished through improved patient satisfaction, coordination of care and better clinical outcomes. The Patient-Centered Medical Home (PCMH) is viewed as a path to accomplish this and CMS is offering financial incentives to primary care practices that become recognized as a PCMH. The idea of PCMH was developed through a consortium of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. Together they developed joint principles for the PCMH including the provision that each patient would have their personal physician and their care would be directed by the practice, ensuring care was coordinated and/or integrated as deemed appropriate with an expected level of quality, safety and enhanced access, as well as establishing appropriate payment for these efforts. There is national growth in practices achieving recognition as a PCMH with the front-runner of recognition programs being offered by the National Committee for Quality Assurance. In 2011 NCQA’s standards increased to include guidance on developing chronic care management programs, enhancing patient engagement and improving patient outreach, and aligning with EHR and the new healthcare Meaningful Use criteria. NCQA’s program promotes goals to: Improve the patient experience Recognize clinicians’ efforts Provide confidence for purchaser: value for money spent on quality care CMS led the pack with financial incentives for the PCMH, but other payers have also emerged with bonus and payment systems that recognize the PCMH, improved outcomes and patient satisfaction In 2013 NCQA announced the Patient-Centered Specialty Practice recognition program. The development of this program was motivated by the discovery of reporting discrepancies between referring physicians and specialist. The PCSP program is designed to improve communication and access. Yes, there’s a lot of buzz about the focus on being patient-centered and improving the patient experience, but the programs are only growing in importance. If you haven’t already done so, it’s time to get information, make the commitment
Even this late in the year -- when we typically assume many patients will have met their deductibles -- we are hearing from practices that some patients seem to be delaying or avoiding care because of concerns about costs. This is not limited to the ACA plans, which tend to have high deductibles, especially on the 'bronze' end. Even patients with corporate plans are now facing enough out-of-pocket responsibility that it affects their decision-making. Some patients who may have had a trivial deductible in past years now have one with real teeth-- one that is less likely to be fulfilled unless a major illness or injury happens during the year. As a result, some practices aren't seeing the expected influx of patients who want to get needed care before the end of the year -- and some physicians and practice managers are concerned about the well-being of both their patients and their practices as a result. Patient caution and awareness of cost may be a good thing in some cases (if it helps patients become more judicious about using optional services, and or encourages more engagement with providers and health plans). That's certainly one of the goals of high deductibles. But the problem is, in some cases high deductibles might also discourage patients from getting care that they really need. And, of course, it certainly doesn't help your practice to establish and maintain a relationship with patients when they're afraid to come in for a visit(!). It can be frustrating to know how to respond, since physicians and practice managers can't do anything to change the terms of the health plans their patients are on. What's more, if you've been watching this blog, you already know that it's very important to stay within the lines of your payer contracts (e.g., selective discounting or waiving of co-insurance is likely verboten). There are a few things you can do, though -- and it's a good idea to take a look at some of these things now, because the deductible reset (January 1) is right around the corner. Preventive care: If you are
Hospitals are acquiring or partnering with medical practices at break-neck speed and for good reason. It makes sense to align with physicians in a changing marketplace. It will strengthen the hospital’s position for both bargaining power and marketing their brand. Physicians on the other hand, fear the unknown and are often uncertain about the strategies they should take to protect or improve their future. If you are approached about the possibility of joining forces with a hospital do you know what you would do? Here are some things for you to think about. The first step in consider partnering with a hospital is to clarify the opportunity by gathering information. Examine your own motivations. What is it you hope to gain and is it realistic? At the same time, it’s important to understand the hospital’s agenda and determine if, in fact, their motivations are clearly aligned with yours. Remember all successful relationships are built on trust. You can avoid a head-on collision if you ask the difficult questions and get honest answers upfront. At the same time, you must we willing to be open in your communication by discussing what you want and hope to gain, and what concerns you may have. Whether it’s about their motivations, their leaders or how they want to structure the contract. If it doesn’t feel right, it probably isn’t going to work unless you resolve the issues that make you uncomfortable with the deal. It is only through honoring your differences and negotiating in earnest that you can work toward common goals that align motivations and lead to success. In order to share your future you must develop trust and common goals, and build a vision that everyone stands behind. Check out my free mini-webinar on working with hospitals and systems without losing yourself, presented by the AOA -- part of the Power Up series.
It’s not too soon to think about the holidays and how you are going to honor staff for everything they’ve done to get you through the year. Will it be the typical holiday party and a gift exchange or do you plan on giving Christmas bonuses – which can be troublesome? I say this because most practice leaders just aren’t sure how to handle bonuses. I mean, really, maybe staff has just come to expect a bonus and don’t even realize it is intended as a reward or gift of gratitude. Maybe Andrea doesn’t understand why Heather, who has been with you less than a year got the same amount she did. Sometimes staff are actually disappointed – expecting more and feeling the bonus is paltry. It is not that unusual for staff to assume the practice can afford much more. This is unfortunate for the practice that struggles to maintain a reasonable profit during these difficult times. Is it time to change how you manage holiday giving how you recognize staff? Do you need to deal with the mindset of staff and get aligned? Is it time to educate the staff that it isn’t business as usual and profits have been sliding or are being threatened by healthcare reform? And do you even know if you are paying staff appropriately in the first place? This all seems burdensome to deal with, but it is that time of year again. I suggest practice leaders get a jump start on addressing holiday bonus and recognition programs and analyze how they financially honor staff once and for all. Begin by getting a grasp on your current pay scale to make sure you are paying market rate for each position based on the qualifications and responsibilities that each job requires. This will ensure you attract and keep the best employees. If you want staff stability and longevity you must create and maintain a desirable workplace environment where staff is respected and treated fairly. Next, think about the value of the paid holidays you already provide for staff. Not all practices are equal here.
The culture of the medical practice is shifting dramatically: the way we think, the way we work and the way we care for our patients. It’s no longer simply about what’s the matter with the patient; it’s time to focus on what matters to the patient! The patient-centric practice is in the limelight and being fueled by the Affordable Care Act, which places more emphasis on the patient relationship. The ultimate goals are to: Improve compliance Reduce healthcare costs Obtaining better outcomes Achieve a higher level of patient satisfaction This is a major shift for many medical practices that have previously focused primarily on the tasks required to diagnose a patient’s condition and create a treatment plan with the assumption that patients would follow its orders. Think strategically when it comes to creating a patient-centered culture. Managers and physicians need to accept the responsibility to make the changes required to accomplish this and commit to success. How can you pose issues effectively and what obstacles must be overcome to get team buy-in to changing the way things are done? You start by building the change management team. Determine who will be the champion for this project and increase your odds for success and which team members will contribute to creating an effective plan that will be endorsed by staff. The champion needs to be someone that is trusted and respected by everyone and believes that the changes the practice makes will lead to greater success in strengthening the relationship between the patients and the practice. The change management team will be required to establish standards and method of accountability that involve everyone. No balking allowed and no sacred cows! The plan needs to be structured and supported by management. Once the plan is agreed upon and in place, the champion must sell the vision and be the role model that inspires organizational change by leading the efforts, keeping the communication open and celebrating steps of progress. Check out my free mini-webinar on this topic, presented by the American Osteopathic Association -- part of the Power Up Your Practice series.