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From the MGMA Conference: Five Strategies to Prepare for a New Healthcare System

Elyas Bakhtiari, for HealthLeaders Media, October 14, 2009

Although many of the healthcare reform details are still up in the air, there are a few changes to the healthcare system found in all bills under consideration—expanding coverage, bolstering primary care, and tracking quality data, for instance. Medical practices can and should start preparing early to strategically prepare for a transformed healthcare system, David Gans, vice president of innovation and research for the Medical Group Management Association, said at the MGMA's annual conference on Tuesday.

Gans advised medical practice managers to monitor the public discussions about healthcare reform and pay attention to the timelines included in proposed legislation. Beyond that, however, he suggested taking the following steps to prepare for some of the potential changes:

1. Evaluate payer mix and contracts. Pointing to Massachusetts as a case study, Gans predicted that a significant effort to expand the number of Americans with insurance would create virtually "unlimited demand" for physician services. On the one hand, that could lead to more physician shortages and pressure on practices. But it would also increase practices' leverage when negotiating contracts with insurers, he said.

Physicians will have more room to pick and choose the best contracts because of the high demand for their services. "You may have operating leverage you never had before," Gans told attendees.

2. Focus on copays and patient education. Many of the newly insured won't be familiar with the basic workings of health insurance—copays, premiums, and eligibility requirements. The onus will be on medical practices to educate new patients about their financial responsibilities when visiting a physician. Additionally, practices should evaluate new collection strategies and technologies in order to collect the revenue they are owed, Gans advised. Practice payment policies should be published in clear language for distribution to new patients, he said.

3. Evaluate new covered services. Healthcare legislation will likely require certain services to be covered in all insurance policies, such as imaging and screenings, radiation and chemotherapy, mental health, and substance abuse. Practices need to evaluate their current offerings to determine if the practice could provide additional covered services. In particular, healthcare reform could bring about a significant focus on preventative services, and many practices should be able to adapt to capture that reimbursement.

4. Consider pilot programs and medical homes. Although the percentages differ, each healthcare reform bill promises to increase payments to primary care and focus on chronic care and patient-centered treatment options. Medical groups should begin evaluating their potential to qualify as a patient-centered medical home or offer advanced chronic disease management and monitoring services, Gans said. They may also want to participate in Medicare pilot programs, as there are often financial bonuses for those who do.

5. Start collecting data. Comparative effectiveness may be the sleeping tiger of healthcare reform, Gans said. It is one of many ways that reform could increase the emphasis on health data collection, and practices should review their internal data collection, tracking, and reporting procedures now. Electronic health records help with this process, and practices may want to consider the timeline for taking advantage of the $44,000 available per-physician in federal dollars to encourage EHR adoption.


Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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