With Better Management System, Smaller Practices Can Transition to Value-Based Care

Originally Published on Medium

The government has been rewarding healthcare institutions for providing better service to Medicare patients and penalizing providers who fail to implement new care-management programs.

The Physician Quality Reporting System, as it’s called, is an effort by policymakers to ensure better care for certain patient populations by reimbursing doctors based on patient satisfaction and positive outcomes, rather than basing reimbursement solely on the number of these patients treated.

It’s a commendable idea because it incentivizes doctors to focus on quality instead of quantity as they deliver care. Unfortunately, the system is not working.

Nearly a half-million doctors are choosing to be penalized by the government because complying with new value-based care models is simply too expensive, too time-consuming and too much of a drain on resources. It turns out that paying the fine is less burdensome than implementing new policies for many healthcare providers.

This was not the result that anyone wanted.

The burden of implementing new quality measures falls disproportionately hard on independent physicians because their resources are already strained. In fact, independent practices have been closing their doors in greater numbers, because staying in business as an independent enterprise is simply too expensive.

All care providers—from the large health networks to the clinic staffed by a single doctor—must contend with hours of data entry just to show compliance with state and federal regulators, maintain the relevant certifications and collect copays and deductibles.

Larger health systems have the budget and the staffing to handle these administrative and regulatory burdens, but smaller, independent practices do not. Too often, it is the doctor who must handle this administration when he or she should be focusing on patient care. For this reason, smaller practices must struggle harder to implement new systems and to pay fines.

It takes advanced practice management to track patient care, which is necessary as medical practices show regulators that they are implementing a higher standard of care for Medicare patients. While larger health networks have adequate management systems, independent providers have been using fragmented, software-based solutions for practice management. This solution is falling short, and independent doctors are at higher risk of being fined by the government.

The providers who do comply with new value-based care models—mostly the larger health networks—are rewarded for successfully making the transition. The government pays out the reward to those institutions with fines it collects from providers who find it too difficult to comply. This means, in many cases, it will be financially strapped smaller practices who will be funding rewards for larger health networks, many of which are already doing well financially. The program was never meant to work this way.

Rather than accepting the fines, smaller, independent practices should implement software systems that make data collection from patients simpler and easier. Their practice-management systems should be connected to one another, to larger providers, and to the government. This will ease the burden of complying with new rules.

Smaller practices are already under fierce financial pressure, and should not be penalized for failing to do what larger networks are in a far better position to do.

It’s time for independent providers to demand more from their practice management systems. These systems should combine sophisticated software with human expertise to save time, save money and help with the move to value-based care.

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