Looking toward tomorrow
Volume-based staffing has the potential to increase practice revenue — but there may be limits to its abilities. "Reimbursements have gone down and the only real way to increase your overall revenue has been to work harder and try and take more market share from competitors, but that's ultimately a losing business plan," says Todd Sagin, national medical director of HG Healthcare Consultants in Laverock, Pa. "The trouble that practices have today is that they have had limited ways to increase their margins."
Value-based reimbursements — which reward practices for achieving higher quality care at lower cost — could enable your staff to "get off the treadmill," he says. In other words, it could provide incentives for spending more time with patients, rather than performing service after service as quickly as possible.
This is something Trinity is exploring, notes Swan. It recently began participating in a Patient-Centered Medical Home, and though it isn't very far along in the process, she is optimistic about the approach. "Our primary reimbursement right now still is fee-for-service, but we definitely are moving into this other payer avenue with our payers as far as the patient-centered model of care, and it's really working out really well and our patients love it and our physicians love it," says Swan.
While switching to value sounds great, there's a catch. It's a long process, and for many practices, it's an expensive one, says Van House. "Everybody agrees that better patient care, better metrics in and around quality, more patient satisfaction is a good thing," he says. "The trick, however, is that it requires … more overhead."
That overhead includes, in many cases, additional staff members, he says. That's because improving quality requires more patient outreach, monitoring, and follow-up, says Sagin. Patient navigators, he notes, are a great addition to practices hoping to participate in new models of care.
These staff members help patients follow through with their instructions for follow-up care, such as helping them make appointments with specialists, making sure they obtain their prescriptions, ensuring they understand how to take their medications, ensuring they get recommended diagnostic testing, and answering their questions. The credentials of a navigator vary; for instance the role could be filled by a registered nurse, a trained case manager, or a health educator. In fact, Trinity employs care coordinators and nurse navigators to assist with patient outreach, says Swan. In addition to working in practices, navigators sometimes work for insurance companies, ACOs, IPAs, etc., says Sagin.
Physician assistants (PAs) and nurse practitioners are also great additions to practices hoping to improve care coordination, says Baker. They can help practices "deal with the issue of volume and continue with the quality of care," he says.
Still, if a practice is on its own in paying for these additional staff members, participating in value-based reimbursements will be a challenge. "Most practices don't have a margin to support that kind of additional staffing," says Sagin.
With all this discussion about the difficulty of moving toward value, it may be tempting to ignore new staffing recommendations and continue staffing your practice as usual. But that's a bad idea, says Sagin. Practices need to keep the staff that they do have informed of new reimbursement methodologies. That way they'll be better situated to participate in new initiatives in the future.