Ever since Sustainable Growth Rate (SGR) began overshooting budgeted Medicare spend, physicians have been under the constant threat of Medicare cut. While Congress’ intervention has delayed the inevitable thus far, it may be a little tougher this time – Centre for Medicare Services (CMS) has already indicated that its fee schedule for 2013 is designed to initiate 26.5% Medicare cut if the Congress fails to intervene before Jan. 1, 2013. While physicians may still be optimistic of a breakthrough in their favor, they still need to be prepared for any eventuality. And if 26.5 Medicare cut is indeed set in motion, it would have a debilitating effect on physicians’ clinical and operational efficiency – practices may not be able to support operational expenditure, leave alone the thought of ‘profit’.
Despite the looming fear, practices can still find ways to off-set the impact of Medicare cut – transition to new payment and delivery models will help meeting the primary objective of improving patient care as well as moving to a higher-performing Medicare program.
Accountable Care Organization (ACO) is one such care model, which will increasingly become mandatory for care providers in the Medicare network. ACO requires physicians to form a clinical network that can achieve optimum clinical efficiency at minimum cost to patients. ACO works on the formula that a clinical network with A-Z medical services can considerably bring down patients’ medical expenditure. While physicians in an ACO get to be recognized for high performance, they also stand to benefit from shared-savings. Moreover, being in an ACO is indeed helpful in building credibility among patients.
The provision of Affordable Care will also help physicians counter the impact of Medicare cut. The significant thing about this reform is that it extends Medicare to every uninsured citizen in U.S. With roughly one-third of population expected to be Medicare beneficiaries, physicians can look forward to off-set Medicare cut with operational volumes from Affordable Care provision. But transiting to these novel care models may be seemingly difficult for physicians who have been used to protective health care models. Amongst possible challenges, understanding fee schedule, negotiating and renewing payer contracts, being conversant with multiple payer policies, and striking beneficial deal with payers will be more important. Moreover, a proper mix of public-private payers is more than advisable.
And, amidst these Medicare-cut-generated challenges, mandatory EHR, PQRS, and ICD-10 & HIPPA 5010 compliant coding too will add to the burden, which may be far too much to bear for physicians. With the in-house staff incapacitated to take responsibility of this enormity, outsourced medical billing services seem to be the only way out. Medical billing companies – with experience and competence in stage-managing transformation to high-performance Medicare models, managing mandatory EHR, PQRS, and ICD-10 & HIPPA 5010 compliant coding on behalf of physicians who are essentially focused on clinical efficiency – could provide helping hand.
