MGMA: Preparing for Healthcares Future Now

The Medical Group Management Association's (MGMA) annual conference took place in Las Vegas in late October, gathering together thousands of healthcare administrators. Sessions covered a variety of topics, such as staffing considerations, the trends of practice integration and physician shortages, preparing for the expectations of accountable care organizations and patient-centered medical homes, as well as general health IT strategies. Here is a selection of session highlights.

Overnight EHR roll-outs aren't effective

If administrators are going to optimize EHRs to increase efficiency and the bottom line, they should consider more inclusivity in the implementation process, workflows and training time, according to a presentation by Ron Anderson of CHMB, Escondido, Ca., which provides technology and business services for healthcare providers.

When implementing an EHR, "think inclusively," he said. This means bringing all the stakeholders to the table—both internally (front office, back office and management) and externally (patients and outside resources, such as labs, device manufacturers, hospitals and business service vendors).

Anderson strongly recommended the use of patient portals and the use of voice recognition software, rather than transcription. "If a typical encounter requires 15 clicks or more from a physician, it's time to go to voice recognition," he said.

He also stressed the importance of training time, which often gets overlooked because of busy schedules. According to a 2011 MGMA survey, 39.9 percent of EHR users said they "severely under-allocated time for training."

If a consultant is hired and the implementation goes too smoothly, Anderson suggested that all the kinks are probably not worked out. "Overnight EHR/practice management big-bang roll-outs are very unlikely to produce good results or improved workflow, and there's no going back once the paper charts are gone."

Therefore, he encouraged a strategic approach that requires a great deal of time and effort prior to implementation to optimize workflow and garner some early wins, such as e-prescribing; lab or imaging orders; tasking; referral/consults; and letter generation.

Step 1, Clinical integration; Step 2, ACO

Accountable care organizations (ACOs) require cultural changes and clinical integration demands structured collaboration between physicians and the varied provider settings. All are necessary to reduce waste in the healthcare system, according to a presentation by Mark Shields, MD, MBA, senior medical director at Advocate Physician Partners (APP), a northern Illinois-based joint venture of physicians and a health system, Advocate Health Care. APP includes 1,100 primary care physicians, 2,700 specialists and 900 Advocate-employed physicians.

Federally recognized ACOs, which the U.S. Department of Health and Human Services will initiate by January 2012, means the provider groups accept responsibility for the cost and quality for a specific population, and must provide the data to be used to assess performance, according to Shields.

• Clinical integration, he noted, is the foundation for ACOs because it:
• Overcomes problems seen with the fee-for-service model, and incentivizes providers to drive improvement;
• Creates the business case for hospital and doctors to work for common goals; and
• Allows one approach for commercial and governmental payors.

Importantly, the clinical integration process needs registry data collection and a reporting system back to the providers. At Advocate, quarterly reports are created and disseminated for each physician and provider setting, and the financial incentives are tied to specific outcomes. In fact, data are collected from 43 separate files across 13 functional areas within Advocate. All the information is available online to "view and compare," so physicians can see how they compare with their physician peers, Shields noted.

No fix for U.S. doc shortage; start preparing now

The number of active patient care physicians, including MDs and DOs, per 100,000 people in the U.S. population was 213 in 2009, and of that group, 37.6 percent are greater than 55 years of age, reported presenter Jon Mayer, MSN, MBA, department administrator in the department of surgery at Medical College of Wisconsin (MCW) in Wauwatosa. "Specialty physicians are currently the largest number of active physicians, but that number also is expected to decrease," he added.

Based on supply-and-demand statistics and the aging population, the shortage of physicians in the U.S. is predicted to hit 91,500 by 2020, based on a June 2010 analysis from the Association of American Medical College's Center for Workforce Studies.

There are few options, according to Mayer, to address a decreasing supply of physicians yet increasing demands of patients:

• Keep the population healthy through preventive care, so not as much care is needed;
• Expand provider alternative staffing models; and
• Improve efficiency (i.e. throughput).  

MCW developed a post-graduate surgical physician assistant training program, which includes structured didactic learning and supervised clinical training, and resulted in significant surgical exposure but a shortened learning curve. The provider also is developing an acute care nurse practitioner fellowship.

MGMA Q&A: Physician Compensation in Flux

During the Medical Group Management Association (MGMA) conference in Las Vegas, CMIO sat down with Jeffrey B. Milburn, of MGMA’s Healthcare Consulting Group, to talk about the trends in physician compensation in the independent practice setting, the hospital and in the integrated delivery system model. How are the costs of running multispecialty independent practices and operating budgets impacting the bottom line of these practices? Milburn: If you look at a private practice, you take their net revenue, which is their collections and subtract their overhead expenses. That leaves the profit and usually profit is what the practice has available to pay physicians. If revenue collections are fairly static at best, and expenses tend to go up a couple percent or more every year through a simple increase in the cost of supplies and staffing expenses, then the component that suffers the most is dollars available for physician compensation. This can ultimately impact the ability to recruit and retain doctors or even lead to dissolution of a practice.   How are Medicare reimbursement cuts impacting practices?   Milburn: If there’s a cut to any reimbursement, it’s going to impact the bottom line. Some practices are trying to offset this by increasing their scope of services. In a typical practice, especially in primary care, they refer a lot of services out of the practice—lab, radiology and referrals to medical/surgical specialties. Thus, practices are re-evaluating what they can do for themselves, rather than sending the patient to another doctor. There’s a definite trend trying to increase the scope of services that a practice can accomplish at the primary care level. Is it profitable for physicians to become hospitalists? Milburn: The hospitalist is one of the fastest growing primary care specialties. They are frequently hired by hospital systems to provide coverage when community physicians aren’t available. Doctors who do not work for hospitals are less and less willing to take call or work nights without additional compensation. Because there’s so much demand and competition for hospitalists, the price that hospitals are willing to pay is increasing. Many hospitalists come out of internal medicine, family practice or pediatrics ranks. Often, hospitalist compensation is higher than for primary care level for these physicians. The higher compensation, in addition to an attractive work schedule, is helping to encourage physicians to become hospitalists.    Is it going to continue to be financially beneficial for physicians to join hospitals? Milburn: It’s going to be specialty specific. Over the past few years, cardiovascular surgeons and cardiologists found that they were the target of reduced reimbursement. They initially found hospital employment agreements appealing. Medicare and commercial payors are continuing to find ways to reduce reimbursement for other specialties. When hospitals hire doctors, the doctors usually get a two- or three-year compensation guarantee. However, at the end of that period, the hospitals will assess whether the physician compensation meets production expectations and fair market value regulations. Specifically, nonprofit hospitals can’t pay excess compensation to a physician. Therefore, this honeymoon period may not continue when hospitals are forced to recalibrate physician pay.