Seven Constructive Ways Physicians Can Respond to Reform

May 8, 2013

Economic and regulatory pressures are hitting physicians hard. Here’s how to react in constructive ways.

Last week, I noted five unproductive courses of action for dealing with the economic and regulatory pressures facing physicians in private practice. The intent was to help physicians avoid wasting time and energy and, potentially, making things worse.

This week I am sharing seven ways physicians can address these challenges constructively and achieve positive outcomes.

1. Be continuously aware of the stated drivers of healthcare reimbursement and regulation changes. The stated purposes of healthcare reform are to restrain the growth of healthcare costs as a percentage of GDP, expand patient access to care, and improve patient outcomes. How can you argue against any of those without looking selfish and self-centered? It is much more productive to explicitly endorse the goals, demonstrate how elements of the proposals work against them, and offer alternatives more supportive of the objectives. A cornerstone of effective negotiating is to find and claim as much common ground as possible before dealing with disagreements.

2. Clearly define your most important objectives. What are the two or three most important things to you in your practice of medicine? Whatever they are, maintaining them in the new environment is likely to require some compromise of your less vital objectives. Acknowledge that fact, and negotiate your deal with yourself as early as possible.
Be sure to state your goals positively. You'll be able to delegate most or all of the work of achieving them to others, and you will know when they've been met.

3. Utilize professionals who thoroughly understand business and operational issues to devise effective responses. Coding, billing, EHRs, compliance, managing cash flows, and general office operations are complicated, and getting more so by the day. Maximum productivity and profitability require input from business people who have invested the time to become experts in these areas. A neglected, and very cost-effective, option for getting the necessary business expertise is to engage specialists on a strictly, as-needed basis. The specialist can design and implement processes and systems that run with minimal oversight. They can also be brought in for periodic checkups and adaptations to changes in situation.

4. Require those professionals to cite specific portions of primary documents in support of their recommendations. Not all self-proclaimed experts are reliable. If you are depending on an expert to advise you on coding, HIPAA compliance, meaningful use or anything tied to a law or regulation, require her to show you the portions of the governing documents that support her position. A competent professional will have them readily available.

5. Require these professionals to quantify the expected benefits of their involvement, and tie compensation to the realization of the benefits. This is another instance of the importance of clearly defined objectives. The value of a project depends on both costs and benefits. If the anticipated benefits do not exceed the costs by at least enough to cover the aggravation of making a change, it is foolish to undertake the project.
Part of contracting with a professional is to define the measures of benefits and costs over a specific period of time. If the benefits are not achieved, provided the physician has met all his obligations to the project, there should be a corresponding adjustment to the fees.
Remember: Value = Benefits – Costs

6. Examine all of your options. Physicians have all sorts of options, although not all of them will be equally palatable to every physician. Age, stage, personality, and personal preferences affect the viability of various options. Before committing to any course of action in dealing with change, identify at least half a dozen options. Eliminate all but the two or three that seem most likely to meet your objectives. Take a hard look at the pros and cons of the surviving alternatives, and make sure that negative consequences are identified for each alternative.
The objective is not to find a perfect course of action. The objective is to anticipate the consequences and minimize unpleasant surprises.

7. Expect the process of adapting to marketplace changes to continue indefinitely. The U.S. healthcare system is huge and complex, with a plethora of stakeholders. We seem to have reached a point where there is momentum for fundamental changes. The first few attempts are going to cause unintended consequences that require more changes. There's no reason to expect stability any time soon, but there is opportunity to shape the changes to your benefit.