The Business Imperatives of High Performance Practices

In the face of rapidly changing fiscal and regulatory conditions, physician practices must plan forcefully for the future. They need to focus management attention on the business areas of highest priority and set goals for their improvement.

The greatest imperative is to strengthen the practice’s financial competencies, but it’s also essential to engage patients, upgrade clinical systems, improve interconnectivity and enhance data analytics. This article discusses strategies for achieving these goals, while a sidebar looks at a survey in which physicians rank their highest business imperatives.

In the face of rapidly changing fiscal and regulatory conditions, physician practices must plan forcefully for the future. They need to focus management attention on the business areas of highest priority and set goals for their improvement.

The greatest imperative is to strengthen the practice’s financial competencies. Your goals should be to maintain and increase profitability; to collect full, prompt and accurate payments from insurers and patients; and to prepare your practice for risk-based payer contracts and other new reimbursement models. And, although the deadline is a year away, forward-looking practices are preparing for the transition to ICD-10 diagnosis coding.

Successful practices achieve these goals using several strategies. First, they’re enhancing their contract audit and recovery processes to maximize compliance with payer contract terms. They’ve developed a central financial infrastructure that’s optimized for current payment modalities yet adaptable to the new models on the horizon, such as bundled payments, value-based payments, pay-for-performance, ACOs and patient-centered medical homes.

These practices have worked aggressively to reduce the incidence of denied claims, the number of days of billings and claims still in accounts receivable, and the number of claims processing errors (at both the practice and payer ends). Many of them also are carrying out benchmarking against other practices to identify operational areas where performance can be improved.

In an age of growing patient empowerment, well-run practices have seen much value in engaging more fully with their consumer-patients. They’re accomplishing this through a few broad goals — with the most important being to significantly increase each patient’s involvement in maintaining his or her health, including compliance with clinical directives.

On top of that, practices should take steps to enhance the clinical experience, health education, and satisfaction levels of patients and their families. Several strategies contribute to these goals, including:

• Enabling patients to access their medical records,
• Allowing them to upload data from home medical devices, and
• Using online self-service tools to schedule visits, renew prescriptions, review lab results, check in for visits, and make payments electronically.

Practices are also helping patients take more direct responsibility for their own care management.

Modern medical practice requires that physicians upgrade their clinical systems. The objective should be giving providers the right clinical tools at the right time and making sure they’re stable, flexible and user-friendly. This is part of a practicewide commitment to demonstrate the “meaningful use” of EHR technology.

Strategies that will lead to fulfillment of these objectives include automating clinical workflows and achieving meaningful use for all physicians. Moreover, such strategies should demonstrate success in raising patient outcomes, providing clinicians with evidence-based guidelines, and making preparations for the ICD-10 transition.

The trend toward integration and collaboration requires providers to take steps in improving interconnectivity and care coordination. To help lower costs, the best practices are pursuing these objectives across the full continuum of care, taking such steps as:

• Adopting patient-centered care plans,
• Streamlining care transitions,
• Applying evidence-based protocols, and
• Improving resource utilization, resulting in lower costs.

A key strategy in accomplishing all this is the rollout of interoperable EHR systems among coordinating providers.

The delivery of health care is particularly amenable to improvement through the application of data analytics and the insights they reveal. Through the measurement of clinical outcomes, it’s possible to determine the best treatment options for patients. A side benefit is the reduction of unnecessary variation in care delivered.

Another valuable application of quantitative study is management of entire populations of patients, rather than individuals. This is a necessary skill for those participating in ACOs. To achieve these ends, practices are gathering knowledge about reimbursements, accounts receivable, physician and staff productivity, and process efficiency. From this information, they’re able to identify bottlenecks in patient flow and revenue cycles, and then introduce transformational system improvements.