The Administrative Viewpoint
By CINDY SANDERS
Published: March 7, 2018
Insights from Inside the Practice Environment
What keeps practice administrators up at night? The list is long as practices strive to deliver the highest quality of care while making enough money to keep the doors open and complying with a long, complex list of regulations.
MIPS remains a chief concern for many as practices move to the new quality payment program for Medicare enrollees. The Merit-based Incentive Payment System is the next evolution in the Centers for Medicare and Medicaid Services (CMS) move away from fee-for-service and towards a value-based system of care.
Joy Testa, practice manager for Nashville Family Foot Care, PLLC, said the physicians in her practice recognize the value in federal programs that shift the focus towards quality metrics. "We've always been on board for all of these processes, but it's a lot of work," she said. Ironically, she added the team has to keep watch to make sure keeping up with new regulations doesn't inadvertently wind up taking time away from patients.
Testa, who also serves as president of the Nashville Medical Group Management Association (NMGMA), said her practice reported for a 90-day period for 2017. "We've done two of the three portions," she said, adding the third portion on quality is in process through their clinical EMR system. "We won't have a payment reduction," she noted. With today's tight margins, she continued, "We want to be cognizant of the fact that we don't want to lose any revenue opportunities."
From the quality standpoint, Testa said the practice welcomes the clinical decision support embedded in their eClinicalWorks EMR system. For example, she noted, every diabetic patient should receive patient education so it's nice to have that extra reminder pop up on the dashboard. "These are things that are relevant to the patient and relevant to their care," she pointed out.
For Kathi Carney, CPC, CPMA, CPC-I, a billing and coding specialist and member of the NMGMA Board, payment issues stemming from prior authorizations and third party payers have become increasingly frequent. "In line with that has been the ever-changing payment structure," she noted. "How do you continue to make your practice thrive when reimbursement rates are going down and costs continue to increase? How do you stay on top of changing regulations and keep the staff informed?" she questioned.
Like Testa, she relies on the automation of an electronic health system to pull key data for reporting and said she couldn't imagine how difficult and time intensive it would be to capture required data without and EMR.
"There are a lot of choices to decide what works best for your practice," she pointed out. "Often, it requires a consultant to come in and drill down to see what's best."
Despite Carney's professional focus on the revenue cycle, she was quick to say that practices can't always worry solely about the money aspect but must strike a balance between patient experience and revenue. "Ultimately it comes back to your patient, patient care and patient experience ... but really it's all tied together," she said. "You want to be respectful of your patient's time, and it costs a lot more to be inefficient. The best patient care at the lowest cost ... that's the ultimate goal."
Another issue practice managers face is the sheer breadth of their job description. "Practice managers wear so many hats these days," said Testa. It's one of the reasons she finds organizations like NMGMA so valuable. With a motto of 'meet, learn, grow,' Testa said the organization delivers on all three.
"If you're having a rough day, you have someone to talk to who understands," she noted of the relationships built through the monthly meetings. The educational component is another huge factor for attendees. In upcoming meetings, NMGMA will welcome speakers from the Office of the Inspector General to discuss compliance issues and from Palmetto GBA, the state's new Medicare Administrative Contractor. Participation also helps practice managers grow their careers by earning continuing education credits towards board certification from the national organization.
"It's hard to get away from the office, especially when you have a small practice," Testa said from experience. "But once you are away and have a minute to yourself, you hear something useful and are able to bring that back to the practice. That's what stood out to me when I first started coming to NMGMA."
Carney agreed, saying it was important for administrators to become involved in their local and national specialty organizations, including NMGMA. "You have to keep your finger on the pulse somehow, and I think one of the best ways is to stay involved with your professional community