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Five-Step Private Medical Practice Survival Plan: Part III


Having plans in place for ICD-10 and patient engagement are the final steps in creating a medical practice survival plan for 2014.

In Part II of this blog, Rodrigues discussed looking at your payers and your technology as key steps to a survival plan for 2014. Here, he continues with the final steps: addressing ICD-10 and patient engagement.

Step 4 - Your ICD-10 Plan

One of the biggest challenges in 2014, and one that requires careful planning and execution is the transition to ICD-10. The ICD-10 transition takes place on Oct. 1, 2014. A practice should start next year with a documented ICD-10 transition plan as well as a structured process for actually making the switch. This is essential for minimizing the potential impact of moving to ICD-10, which could actually bankrupt an ill-prepared practice.

An effective transition plan should include the following important steps:

1. Identify and contact all current vendors that will be impacted and verify their implementation timelines and identify any that won't be ready before September 2014 so that they can be replaced.

2. Audit all office forms impacted by the change and determine when and how to update each.

3. Order new CMS-1500 claim forms (02/12). It's best to do this as soon as possible.

4. Order ICD-10-CM coding books or subscribe to an online equivalent. If ordering printed coding books, be sure to do this as soon as possible due to possible supply issues or price increases as the transition deadline gets closer.

5. Determine who in the practice will need to be trained and when. Find appropriate training courses and reserve spots early. Again, as the transition period gets closer it may be difficult to find availability.

6. Set aside a time period either in late 2013 or early 2014 to audit the most commonly used codes in the practice and identify the equivalent codes in ICD-10. In doing so, review current documentation for the most used codes and validate if there is enough detail to determine equivalent ICD-10 codes, since the level of specificity may have changed up or down.

7. Recognize that the transition may slow down reimbursements. Establish a financial plan to cover reimbursement delays during the transition by asking your bank about a line of credit or special funding or by building up working capital ahead of time.

8. If you do your own billing, consider the benefits of outsourcing. Credible billing service companies will be well positioned to help their practices through this difficult transition.

Taso Michalopulos, MS, CCC-SLP/L, owner and founder of Illinois-based Right Start Pediatric Therapies, said the practice is extremely well positioned to manage the ICD-10 transition since their revenue cycle management partner Kareo will help facilitate and drive changes the practice needs to make to manage through the ICD-10 changes.

Ideally, a practice will start the year with an ICD-10 transition plan in place and have a clear path to getting through the transition during the year. Support from suppliers like practice management application vendors are critical as well and can play a key role in helping with this major change. 

Step Five - Your Patient Engagement Plan

One of the unfortunate challenges with running a private practice is all of the activity that must be managed that isn't directly about patients and their health. Despite this, now is a good time to re-commit to building strong, proactive patient relationships and looking to build the patient into the center of all practice activities.

This can start with core administrative details such as ensuring that patients are aware of financial policies. Given the rapid growth of patient-driven programs such as Health Savings Accounts, practices must be much better at collecting identifiable charges at the point of care and setting expectations around post-care collections processes. The good news is that inexpensive but very effective technology is now available, including patient portals and electronic billing and reminders, to ensure this process is easy for the practice and the patient. These same tools can often be used to help patients schedule appointments, view health data such as lab results, and renew prescriptions.

Beyond patient administration, a practice should work to understand their patient population and evaluate the implications for expanded care services. Understanding patient population goes beyond payer mix to look at such things as patient demographic factors such as age, gender, geographic distribution, and trends in common conditions.

Evaluating additional services doesn't have to be complicated or even permanent. Practices should give themselves the flexibility to try new or expanded services that align with the characteristics of the patient population. For instance, if patients are a given age (young or old), offer special "caregiver programs" that speak to parents or adult children who are caring for their aged parents. What about offering a "free check up" for the adult child when they bring their parent into the office? 

Due to volume demands, many private practices seem to have forgotten that the patient is the customer and needs to be treated as such. Without a change in this current orientation, many private practices will face growing competitive risk from innovative new practice models such as direct pay models, minute clinics, multi-purpose urgent care facilities, and hospital driven practice model. With the proper training and orientation of practice staff, leveraging new solutions, and improving communication with patients, practices can not only improve patient satisfaction, but drive better outcomes, while easing the burden of getting paid for care delivery and heading off competition from new practice models.

Bringing it All Together

There are many signs that positive fundamental changes are possible for private practices over the next few years. These changes will lead to a more favorable operating environment for small practice-based care, an environment that returns some balance between care delivery and administration. At the same time, though, 2014 will be a year of transition and a challenging one at that.

To make the transition, it is essential that a practice analyze itself to understand its strengths and weaknesses and lay out an actionable plan to get through 2014. While this does take time to complete and commitment from the physician and all staff, the benefits will far outweigh the effort involved. A practice with a plan for 2014 will get through the year with the least amount of distribution and will emerge in 2015 stronger than ever.

Dan Rodriguesis the founder and CEO of Kareo, the cloud-based medical office software and services platform he launched in 2004. Today, Kareo serves nearly 20,000 healthcare providers through its integrated practice management, EHR, and revenue cycle management solutions. Prior to launching Kareo, Rodrigues designed technology for healthcare, and other industries, as a co-founder and managing partner of Skematix, and earlier in his career, he also co-founded and led Scour, a popular search engine for finding music and video content online. He holds a Bachelor of Science in Computer Science from the University of California, Los Angeles and is a resident of Orange County, Calif.E-mail him here.

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