While we are already well into 2017, the health care industry is still being affected by trends and events from last year. These trends from 2016 could pose new challenges for practices, but could also create revenue and patient-volume growth opportunities in 2017 and in the future.
It is important to highlight what a significant year 2016 was for both the country and for the health care industry, and to look at how changes that occurred last year—such as the installment of the Medicare Access and CHIP Reauthorization Act (MACRA), the presidential election, and growing consumerism in health care—will affect specialty practices in several ways this year.
Let’s explore three health care topics from 2016 that practices and other health organizations should keep a pulse on in 2017:
- MACRA
- The Election
- Growing Consumerism
MACRA
MACRA’s Quality Payment Program (QPP)—which includes the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM)—consolidated the Physician Quality Reporting System (PQRS), The Electronic Health Records Incentive Program or “Meaningful Use” and the Value-Based Payment Modifier Program into one set of requirements and one report.
MACRA, which passed with large bipartisan support, is likely not going anywhere. Currently, the U.S. House of Representatives' health care reform bill, the American Health Care Act (AHCA), does not reference MACRA, although modifications could be made in later drafts of the legislation. In addition, new U.S. Department of Health and Human Services (HHS) Secretary Tom Price, M.D. told senators in his confirmation hearing: “If confirmed, I commit to work closely with the CMS (Centers for Medicare and Medicaid Services) administrator to make sure we implement MACRA in a way that is easy to understand, minimizes burden and is fair to all affected providers.”
With MACRA’s inevitable QPP, CMS has offered “Pick-Your-Pace” options this year for MIPS participation. If physicians have previously completed Meaningful Use and PQRS measures successfully, then they can earn an incentive. If the practice continues the processes in place from previous reporting periods, physicians can report MIPS for a full year to receive maximum incentive potential, especially since reporting burdens are reduced. However, providers should keep in mind that incentives are not only based on the amount of data submitted, but are more so focused on performance.
The Election
A major impact to practices with the new presidential administration is the potential repeal and replacement of the Affordable Care Act (ACA) with, most likely, some form of the AHCA. If the bill becomes law, the Congressional Budget Office projects that by 2026, 24 million fewer Americans would be covered by ACHA than under ACA. A larger uninsured or underinsured population means practices will have to help more patients understand their financial responsibility and offer payment plan options for those with financial difficulties.
Another significant change that comes with the new presidential administration is Price as the new HHS secretary. Apart from being a former U.S. Representative from Georgia, Price is an orthopedic surgeon who ran his own clinic for nearly 20 years. It is still unknown at this point how Price’s experience as a specialty physician practice owner would affect practices, since so much of his attention is currently on AHCA passage. However, Price did earn endorsements from the American Medical Association, the American Academy of Dermatology, the Alliance of Specialty Medicine and the American Academy of Ophthalmology.
The trade organizations endorsing Price often note his continued advocacy to reduce time-consuming regulations and decrease government interference between physician and patient decisions. Decreasing regulatory burdens and improving care efficiency would likely allow practices to increase productivity and grow revenue in the coming years.
Growing Consumerism
Health care consumers, due to higher out-of-pocket costs and advances in information technology, are demanding greater convenience, price transparency and better service—often in the form of spending less time in the waiting area and more time with the physician. More than ever, patients are price shopping and demanding higher levels of service—tactics which are usually reserved for the consumer goods industry—to reduce their out-of-pocket costs and make their lives easier. The phenomenon, known as “consumerism,” has been a slowly growing issue in the health care space for several years now, and continued to gain momentum in 2016.
Health care consumerism is decreasing patients’ loyalty to practices and is resulting in them more frequently sharing and seeking opinions about quality of care through social media and business rating websites. It is essential for practices—especially those with large ratios of elective procedures—to maintain positive online reputations in order to encourage practice growth moving forward.
Similarly, an increase in cash-paying and high-deductible health plan patients paying more out-of-pocket requires practices to increase marketing and promotion efforts to attract and retain these populations. Front office staff will need to educate cash-paying and high-deductible health plan patients on exactly what portion of their bill they will be responsible for, and may need to offer budget-based care options, such as payments plans. By working with patients to accommodate their out-of-pocket costs, practices can improve their collections rates and proactively educate patients on their payment responsibility, further engaging them in their care while putting them at ease about finances.
From politics to price shopping, 2016 was a big year in the health care space. Organizations can look at these key trends and adjust their own practices and plans to align with the shifts in the market that will arise due to these industry-wide changes. Whatever developments lie ahead, focusing on increasing productivity and efficiency is a good strategy that will ultimately increase patient satisfaction and retention.
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