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Charles Dickens could have been talking about the health care environment in the coming years when he wrote, "It was the best of times, it was the worst of times." When Physician’s Managed Care Report asked a group of experts what doctors could expect in 2001 and beyond, we got a mixed bag of answers, both positive and negative.
The good news for physicians: As the baby boomer population ages, you’re going to have a steady supply of new patients. The bad news: You’re going to have to have to see more patients and work harder to keep them happy.
On a positive note, there’s a whole world of new technology out there to help physician practices increase efficiency, improve patient care, and achieve quicker turnaround on accounts receivables. (For more information on computer technology, see "The future is now for technology in the office," in this issue.)
With the increase in government and managed care regulations and demands from patients, however, you’re going to need it. (For a look at HIPAA and ICD-10 changes, see "Record and coding system changes are coming fast," in this issue.)
On the other hand, there is a glimmer of light at the end of the tunnel as payers and government officials begin to recognize that increasingly complex rules and regulations do nothing to improve health care for Americans.
Some people call what’s happening in health care the hamster effect — the faster a practitioner runs, the faster the wheel spins. No one is optimistic that the situation is going to change.
"Based on the trends over the last several years, physicians are going to be asked to work harder and be more productive to stay even with inflation," comments William F. Jessee, MD, president and chief executive officer the Medical Group Management Association (MGMA), based in Englewood, CO. (For suggestions on how your practice can survive this trend, see "Six tips for survival in the coming years," in this issue.)
One reason is a larger supply of patients as baby boomers age, creating a bigger demand on the health care system. "Age is the single biggest factor in determining the use of health care. As the population ages, the demand for health care will increase. Physicians are not going to have to worry about having enough patients," says Randall Killian, MS, MBA, executive vice president of the National Association of Managed Care Physicians in Glen Allen, VA.
That’s good news on one hand, but it means that doctors are going to have to figure out how to see more patients, points out John Knapp, JD, a health law attorney with Cozen and O’Connor in Philadelphia. "This may include everything from faster through-put to extending hours or making the hours more convenient for patients," Knapp adds.
A cause for concern is that when people start running too fast, they trip and fall down, Jessee adds. So far, that hasn’t happened with America’s physicians, Jessee says.
"But at the pace some primary care physicians are running people through the office, patients may say stop, or the doctors may mistakes because they are too rushed," he adds.
Physicians also can expect to see a dramatic shift in the type of patient they see. Today’s older generation, for the most part, will listen to what they are told, will wait patiently for an appointment, and tend to be loyal to their long-time physicians.
Not so with the next generation of commercial patients and retirees, who are more demanding, more focused on outcomes, and who insist on good customer service from their doctors, says William J. DeMarco, president of DeMarco & Associates, Inc., Rockford, IL. (For information on dealing with baby boomers, see "Physicians need skills for boomer demand," in this issue.)
"Physicians can’t see every patient for as long as they like. They’re going to have to get a certain number of people through the office. They can’t triple-schedule patients any more. People aren’t going to put up with long waits. Even the retirees realize that their time is valuable, too," he says.
Physicians who want to prosper in the future will become focused on customer service and making their practices user-friendly, Killian adds. Health care financing is going to get more complex and in the coming years, physicians will continue to have to deal with more plans with different rules and different procedures. This will add to the cost of overhead for the practice without any real return.
"It’s getting harder and harder for physicians to collect the money they earn in office-based practices," Jessee says. He cites studies that show that Medicare rejects 26% of physician office claims because they are incomplete or for some other reason. About 40% of those claims are never resubmitted.
"If you assume they are legitimate claims, physicians are leaving a huge amount of money on the table because it’s such a big hassle and so expensive to resubmit the claims," he adds. It costs about $6 to submit a claim. If you’re going to get only $10 and you have to submit it twice, you are going to lose money, Jessee says.
But one bright spot is a willingness among providers and government agencies to at least talk about reducing the administrative burdens on physicians. The MGMA has talked with health plans about the possibility of using standardized paperwork and rules, such as the same credentialing form or a single set of rules for prior authorization.
"These kinds of things alone could strip out a lot of unnecessary duplication for physicians. Nothing has happened yet but a year ago there wasn’t even any dialogue," Jessee says. But now, the Medicare Payment Advisory Commission has launched an initiative to simplify its administrative structure. Also, the Senate budget committee has requested that the General Accounting Office study administrative structures of government programs and their impact on medical practice.
"At least we are getting some people to pay attention," Jessee says.