Beyond the wild world of health policy: Medical practice leaders still up for complex challenges

The state of medical practice may seem more uncertain than ever to industry veterans and casual observers alike.

Rapid changes to technology, the job market for healthcare workers, regulatory demands and payer requirements make the job of practice leader increasingly complex. In addition to necessary funding and staffing, these new demands require increasing investments of time, an already scarce resource for many. For example, almost two out of three practice leaders polled by MGMA Stat in September 2017 said they rarely or never take a lunch break at work.

What comes next for practice leaders depends their own commitment to managing changes from a hard-to-predict legislative landscape; evolving relationships with payers; and the day-to-day operational concerns that affect an organization’s well-being and future.

Health policy: A study in chaos

While experts predicted major upheavals from a new administration in the White House, the resulting 12 months of debates and legislative misfirings surprised many, leaving an air of ambiguity for healthcare providers and consumers alike.

As Anders Gilberg, senior vice president, MGMA Government Affairs, Washington, D.C., noted during his “A View from Washington” general session at the MGMA 2017 Annual Conference, five major legislative efforts to repeal the Patient Protection and Affordable Care Act (ACA) have failed since President Donald Trump took office.

“Nobody saw this coming,” said John McDonough, professor, practice of public health, Harvard T.H. Chan School of Public Health, Boston, during a Sept. 27, 2017, forum on the future of healthcare policy. “You’d like to have some finality one way or another in terms of repeal and replace, and it looks like we’re not going to have that.”

Lanhee Chen, research fellow, Hoover Institution, and director, domestic policy studies, Stanford University, Calif., said that common ground for policy changes remains an elusive goal.

“I think that what this process illustrated … is just how much division there is — within even the conservative movement, the Republican Party — on issues of healthcare. There was not one bill that was going to satisfy all those players,” Chen said.

That inertia is not lost on practice leaders. An Oct. 10, 2017, MGMA Stat survey found that 89% of respondents had low confidence in Congress to fix U.S. healthcare.

Further complicating matters for understanding where legislators and policymakers are headed is the rapid pace with which the president’s stated positions on health policy shift. Consideration of a bipartisan effort to stabilize ACA-backed insurance exchanges after the failure of the Graham-Cassidy healthcare bill found Trump endorsing and subsequently denouncing the bill in the span of mere hours, causing what one author described as “presidential policy whiplash.”

“None of this is really predictable,” McDonough said.

Editor's note: This issue of MGMA Connection magazine went to printing in early December, prior to Congress' final vote on the Tax Cuts and Jobs Act of 2017, which included the effective repeal of the individual mandate provision of the ACA. A Congressional Budget Office estimate stated that allowing individuals to opt out of purchasing health insurance would boost the number of uninsured Americans by 13 million by 2027.

Compensation, staffing challenges

Beyond Washington, D.C., the world of the medical practice leader remains a challenge in handling how to get paid for care delivery and properly staffing practices.

Various payers continue to build quality incentives into contracts in a shift away from fee-for-service, and the trend is not limited to physician compensation. Executive-level compensation for hospitals and health systems also looks to be significantly tied to the ability to pivot to value-based care.

Kameron McQuay, CPA/ABV, CVA, director, Medical Practice Specialty Service Group, Blue & Co. LLC, Indianapolis, noted that practice leaders need to identify efficient ways to embrace a level of quality incentives in balance with the cost of gathering and managing the data for quality reporting.

“Let’s face it, quality and value [do] not equal reimbursement,” McQuay said.

In the short term, continuing to focus on higher productivity may be a solid strategy for practices that have been slow to embrace value-based contracts. Insights from the 2017 MGMA DataDive Provider Compensation surveydata show that physicians incentivized on productivity tend to have higher median work RVU production, which still constitutes the majority component of compensation.

While minimizing cost is a recurring challenge for practices, many data measures suggest that organizations that attempt to do more with less may only be doing less. As noted in recent issues of MGMA Connection magazine, high-productivity and high-revenue practices often had higher levels of nursing staff to support physicians and higher support staff levels to maximize patient flow.

Many practices that embrace that increased level of staffing for nonphysician providers (NPPs) may help address the ongoing struggle for having enough providers to meet increasing patient demands. One healthcare organization recently highlighted saw its panel size per physician of about 2,500 jump to 7,000 patients per team with a small increase in the NPP-physician ratio.

And those high-level financial and productivity considerations do not begin to scratch the surface of how practice leaders are confronting emerging issues, such as the public health emergency of opioid misuse and the growing number of sexual harassment claims made throughout American society, both of which pose serious liabilities for healthcare organizations.

This issue of MGMA Connection magazine continues the discussion for how practice leaders can tackle these challenges. Having a better understanding of how to select a suitable continuous quality improvement strategy, developing the skills needed for the future of healthcare administration and keeping the patient experience at the forefront  are just a few examples of how the practice leader of today can manage the current state of medical practice and lead an organization into the future.