MGMA COO: Staffing Shortage 'Issue One, Two, and Three for Practices'

For physician practices, potential decreases in telehealth reimbursement and other financial challenges loom on the horizon.

Workforce shortages are the primary challenge facing physician practices as the country emerges from the emergency phase of the coronavirus pandemic, the chief operating officer of the Medical Group Management Association (MGMA) says.

Staffing shortages are impacting the entire healthcare sector. Nurse vacancies are forcing hospitals to close beds and doctors are in high demand at health systems, hospitals, and physician practices.

"Practices are still struggling with staffing—that is issue one, two, and three for practices," MGMA COO Ron Holder, MHA, told HealthLeaders during the organization's conference this week in Boston. "It is hard to find medical assistants, nurses, front-desk staff, and revenue cycle staff. The economy being what it is and inflation being what it is, there are positions that are competing for some entry-level staff in practices that were not competing for that staff before. It is challenging."

Some practices are regretting staff decisions made during the pandemic, he said. "When the pandemic hit, the first thing they did was get rid of medical assistants and other staff. That is hanging around their neck now."

Practices can pursue several strategies to address workforce shortages, Holder said. "They can do some innovative things with regards to working with local programs to support nursing such as students and medical assistants at local colleges. They can help pay off student loans to get medical assistants and nurses to join their practice. They can offer flexible work schedules—flexibility in work schedules is highly desirable now."

Practices can also try job sharing, he said. "There can be two people in the job market who are medical assistants who only want to work 20 hours per week. If you can match up the schedules, you can cover a full-time position, with two bodies instead of one."

Challenges beyond staffing shortages

"There are a couple of challenges that are on the horizon that could be as big of a factor as staffing. The public health emergency for COVID-19 is set to expire this month. Although we believe it will be extended, whenever the public health emergency is lifted, it will present a challenge to physician practices," Holder said.

When the public health emergency is lifted, providing telehealth services could be harder for physician practices, he said. Before the pandemic, telehealth services were reimbursed at a lower rate than in-office visits, but Medicare and other payers established reimbursement parity for telehealth services during the pandemic.

"When the public health emergency ends, there likely will be a period when reimbursement parity for telehealth services will go away," Holder said. "The smart practices have figured out how to adjust their overhead and adjust their cost structures, so that when the payments for telehealth go back down, they will be able to continue telehealth services. If a practice has been doing their telehealth services in an expensive brick-and-mortar site in a nice part of town, when the reimbursement for telehealth drops, they will be losing money. Other practices have figured out how to do telehealth from home, for example."

Practices are also facing financial challenges, he said. "There are also Medicare reimbursement cuts that are set to go into effect at the end of this calendar year, layered with inflation at 9% to 10%. There is no way for practices to make up 9% to 10% in revenue because there is no inflation factor on physician reimbursement like there is in some other aspects of healthcare. So, they are paying for services that have been increased because of inflation, but they have limited ways to increase their revenue."

Opportunity knocks

Value-based care represents an opportunity for physician practices in the new phase of the pandemic, Holder said.

"Practices need to figure out a way to invest in value-based care and make value-based reimbursement work. As the pandemic ends, we are going to see continued progress toward value-based care that took a pause during the pandemic. For example, if you are in primary care, you need to figure out how to put an infrastructure in place such as having a mental health professional on your staff or social workers to address social determinants of health. The goal will be to keep patients out of the hospital, which is often the most expensive part of care."

Payers are likely to step up their value-based care efforts, he said. "Medicare and Medicaid are one part of value-based care, but you are seeing more of the commercial insurers that are moving in that direction. Insurers are going to be pushing more risk on the practices. So, if you can figure out how to manage risk for your patient population, you are going to be OK. If you cannot manage risk, that may be a danger zone for your practice."