Daniel Sabido

The good news is that American medical practices are generally doing well. Along with 

 and other UBM Medica brands, CareCloud surveyed over 2,000 medical practice leaders earlier this year to compile the 2017 Practice Performance Index. This research found that 61 percent of practices are holding steady, and nearly 1-in-4 practices can be deemed a "high performer" - showing growth across practice collections, number of practice locations, number of providers, total patient volume, and provider satisfaction.

The bad news is that 15 percent of medical practices are falling behind based on declining performance in those same categories. What can these falling-behind practices teach us about the future of independent medical groups? What warning signs do their responses offer?

First, it is significant to note that falling-behind practices weren't likely to be in a specific specialty, region, or size of practice. There are other factors at work here. Let's take a closer look at the data setting falling-behind groups apart from the rest of the sector:

: Regulatory pressures on medical groups have been building for the last decade, and it looks like our falling-behind segment is throwing in the towel. Falling-behind practices are twice as likely to not have a plan in place for the shift to value-based care compared to high-performers, and only about a third think they will earn an incentive under the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program this year.

 It's not too late to catch up to avoid 2017 Merit-based Incentive Payment System (MIPS) penalties, as part of MACRA. Talk to your EHR vendor about how to prepare for the latest requirements and look to your specialty association for more guidance. The 

 and nearly every specialty group has free MACRA resources available online. Without action, a primary-care provider could see their reimbursements from Medicare be reduced by $5,000 to $15,000, an orthopedic surgeon could see a reduction of $15,000 to $25,000, and an ophthalmologist could see a reduction of $20,000 to $30,000, based on average net collections per provider as reported by The 

AMGA 2016 Medical Group Compensation and Productivity Survey

 and assuming 40–60 percent Medicare Part B patient share.

The data also showed a wide gap between high-performers and falling-behind practices on health technology adoption. Falling-behind practices are skeptical about technology's ability to improve care - 18 percent of these practices couldn't name a single way that technology was helping and responded with statements along the lines of "innovations have destroyed medicine as it was" and "being forced [to use technology] by government against our wishes."

Not all technology is created equal. If your practice hates its technology vendors, it's time to start the search for new partners. Replacing technology is rarely easy, but our research shows that it matters. High performers are twice as likely to be using technology such as telemedicine, advanced analytics for population health management, and check-in kiosks that help them deliver improved patient experience. And going back to the first point about the transition to value-based care, it's no coincidence that two-thirds of falling-behind practices report they're not getting enough support from their current technology vendors on regulatory changes. 

A disheartening 75 percent of providers in falling-behind medical practices report being dissatisfied at work. Of all the criteria we surveyed, this was the measure most closely correlated to practice performance. Compare this to 90 percent of providers in high-performer groups reporting career satisfaction. A signal about dissatisfaction hiding in the data: 87 percent of falling-behind practices said they're spending too much time on administrative tasks.

 Take action to improve provider satisfaction immediately. Start with open

conversations among your staff about the issue. Start to measure satisfaction and build a committee to lead the change. Can you update your vacation policies? Build fairer shift schedules? Are there repetitive, low-value workflows that could be automated, such as scanning patient documents? Switching out those technology vendors could also be a start. Check out 

 for advice on reducing burnout and improving provider satisfaction at your practice.

 According to our research, almost half of falling-behind medical practices collect no patient feedback, compared to 83 percent of high performers who do. Listening to patients isn't just an unavoidable side effect of online ratings sites or a handy business practice, it also impacts the bottom line for medical practices as the medical economy shifts toward value-based care and patient consumerization.

 Don't wait for negative reviews to appear on Healthgrades or Yelp. Work with a marketing vendor to gather private feedback from every patient and then ask the happiest to post public reviews. Start with these  for your practice and brush up on the  from the Agency for Healthcare Research and Quality.

Can falling-behind medical practices catch up to the rest of the sector? Our research indicates that embracing change is the most crucial factor for medical practices looking to grow and succeed. That could mean change in regulatory policy, change in technology vendor, change in clinic policy, change in patient relationship, or even change in leadership. Just like an extinction event in biology, it is the organisms that can adapt and evolve the quickest that go on to survive.

Daniel Sabido is CareCloud’s Director of Product Marketing, where his responsibilities span the entire portfolio of products, and is particularly focused on identifying trends that will affect the performance of medical groups across the country. Previous to joining CareCloud, he was an Engagement Manager at OC&C, a global management consultancy, based in their London HQ where he focused on B2B clients. Daniel has also held strategic planning roles at McCann Worldgroup in New York and at the Monitor Group as a consulting analyst. Daniel holds an MBA with Distinction from the London Business School and completed his undergraduate at the University of Pennsylvania's Wharton School with majors in Finance and Operations.

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A recent survey shows a grim, but still avoidable, extinction for some medical groups. Here's what these guys need to do to turn it around. 

Crucial Lessons from Falling-Behind Medical Practices

There's a widening gap between medical practices in the U.S. Some are falling behind - feeling that regulatory pressure and technology change is getting to be too much to overcome. Many others are growing rapidly - finding opportunities for expansion in an uncertain market. What sets these two groups apart and what can we learn from the two categories?

I recently carried out a survey of over 2,000 medical practice leaders to try to get to the bottom of this gap. I created five categories to measure practice success: practice collections, number of practice locations, number of providers, total patient volume, and provider satisfaction. We ran the survey in March 2017 and found that 24 percent of practices qualified as "high performers" who were seeing a lot of growth and success. About 15 percent of practices qualified as "falling behind."

There were no major geographic, specialty or size differences between these practice groups in the data. What was causing some practices to thrive and others to fail? I found a few surprising correlations:

: By far, the strongest correlation to practice success was physician satisfaction. Providers and staff in high-performing practices report almost 10 times higher rates of overall job satisfaction, 69 percent compared to only 7 percent those working in falling behind practices. If you're unhappy in your medical career, odds are that your practice isn't doing well either. We almost didn't include this category but I'm glad it made it into the final survey.

Compared to falling behind practices. I'm not sure if this is a result of high performers being better prepared (many have a plan for value-based care transitions) or if their concern reflects a more realistic assessment of the challenges facing practices today. So, you're in good shape if your physicians are satisfied in their careers but also worried about the future.

: Opening up to patient feedback hasn't been easy for many medical practices, but our survey showed it matters a lot to the bottom line. More than 80 percent of high-performing practices gather feedback from patients through surveys and online review sites, compared to almost half of falling behind practices that collect no feedback from patients.

 High-performing practices are almost twice as likely to have a plan in place for the transition to value-based care and also almost twice as likely to be ready to earn a MACRA incentive this year compared to falling behind practices. Understanding the opportunities in this changing healthcare economy is crucial to your practice success.

: Health technology goes way beyond EHRs for high-performing practices. These successful groups are embracing patient portals, advanced population health analytics, telemedicine, iPad-based intake forms and check-in kiosks.

At the end of our research work, I had a much clearer picture of high-performing medical practices in the market today. I was surprised to see that high-performing medical practices were so focused on patient experience and making big investments in technology and feedback programs to support that. At the time, the news was dominated with uncertainty about health reform and we just didn't see that anxiety reflected in the practice responses. High performers are moving forward with value-based care regardless of the debate in D.C. Finally, practices that perform better have a patient-centric attitude embedded into everything they do.

Millennials seem to be raising expectations as patients. They expect to check for physician reviews before scheduling an appointment online. They expect to have everything be seamless and integrated during their medical appointment. They expect the kinds of technologies that we see everywhere else in life to be in the medical setting, too. Approximately, 14,000 of these patients are even Instagramming a photo from their doctors' appointment with the hashtag 

. High -performing practices see this change happening and are responding. They're not fighting the change but instead embracing openness, creating "grammable" patient experiences, listening to feedback and building teams of happy physicians.

 is CareCloud’s Director of Product Marketing, where his responsibilities span the entire portfolio of products, and is particularly focused on identifying trends that will affect the performance of medical groups across the country. Previous to joining CareCloud, he was an Engagement Manager at OC&C, a global management consultancy, based in their London HQ where he focused on B2B clients. Daniel has also held strategic planning roles at McCann Worldgroup in New York and at the Monitor Group as a consulting analyst. 

What does the average high-performing medical practice do to stay ahead of the curve? A recent survey looked at this.

Author | Daniel Sabido

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