Health care reform will bring about sweeping changes for physicians in 2014, when provisions in the Affordable Care Act – from insuring all Americans to rewarding providers for better care – go into effect. How physicians manage these changes will determine whether they can continue to be successful in the field.
U.S. News turned to experts to examine these changes and to help doctors prepare. Michael Nusimow, CEO and co-founder of drchrono.com, an iPad-based electronic health record system, and Bill Metaxas, a podiatrist who practices in San Francisco, offered insight and say doctors can expect three main changes: a shift from private practice to medical networks, a full integration of electronic health records and changes in the health care payment model.
Prepare for a shift from private practice to medical networks.
Since starting drchrono in 2009, Nusimow has noticed a trend of more and more doctors moving from private practices into larger practices or practices owned by large groups and large hospitals, he says. In the past, many new doctors just out of medical school would start their own practices, but now groups of three to five doctors work together and pool their resources to be more efficient, he says. More doctors are able to see more patients, group according to several specialties, and work together to improve their administration.
This shift is occurring because of changes to value-based health care models, in which health care providers have to demonstrate that their services resulted in better health for their patients. Unless they do so, under Obamacare, their Medicare and Medicaid payments will be severely reduced.
Prepare for a transformation to electronic medical records.
In addition to the shift to larger practices, the industry will have to master a new way of keeping records. The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the government's 2009 economic stimulus package, set the groundwork for health care reform. It provided $27 billion in Medicare and Medicaid incentive payments to go to doctors and hospitals that adopted electronic medical records under federally established guidelines. The legislation was passed to jump-start the transformation toward a more efficient and less expensive health care model.
To receive payments, doctors and hospitals must show the systems are being used to improve patient care. Doctors who began participating in the program can receive as much as $44,000 from Medicare and up to $63,750 from Medicaid. Doctors who chose to participate in the Medicare program after 2015 can also receive payments, but at a reduced rate.
Two-thirds of family doctors currently use electronic health care records, government data show. The ones who haven't shifted yet understand the investment in time and money that will be required, Nusimow says, and some of are trying to determine whether making the shift will pay off. Many of the systems currently being used have been written by old databases rendered obsolete by technology's movement to a cloud model, he says. Improving the usability of electronic health records can help prevent dangerous or even fatal mistakes.
Metaxas says most doctors are ready for electronic health records from the standpoint of security and patient privacy. The Health Insurance Portability and Accountability Act (HIPAA) gives patients a variety of privacy protections for personal health information obtained by medical providers. Leaked patient information can adversely affect a patient's career, expose their financial history, or put them at risk for identity theft.
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Prepare to change the way you collect payments from patients.
The Affordable Care Act requires all Americans to purchase health insurance, so doctors need to be prepared for an influx of patients.
"Doctors are going to have to become more savvy business people to be successful," Nusimow says. They will have to rethink how they charge their customers, and consider solutions such as having a patient's credit card information on file and making sure that patients understand they are responsible for whatever costs their insurance company will not cover. The Affordable Care Act puts more onus on the patient, he says. A system that incorporates electronic billing, in which a medical bill can be received and paid by credit card online, is much more cost efficient and effective way to collect balances.