Though it won’t come as a big surprise to practitioners, the American independent healthcare practice is alive and well – still overworked, underpaid, and challenged – but optimistic for the future.
Kareo recently surveyed nearly 800 independent practices and gathered data on their thoughts on opportunities, challenges, and priorities in the areas of care delivery, insurance reimbursements, patient collections, patient engagement, regulatory compliance, population health management, and practice viability and growth. The study results were shared in the Kareo 2019 State of the Independent Practice report. As a partner to independent practices, Kareo conducted the survey to help more widely disseminate the ideas, attitudes, and challenges of independent practices. While these independent practices continue to be the cornerstone of American healthcare, they are frequently underrepresented in the national conversation.
Optimism for the Future
The survey shows that 60% of independent practices expect to grow in 2019, 29% expect to remain the same and only 11% expect to shrink. Kareo found it interesting to see how many independent practices plan to grow in 2019, in spite of 75% stating that increasing demands on provider time are impacting care delivery, and 74% agreeing that avoiding physician burnout is a challenge. The survey found a high correlation between time demands and burnout. As could be expected, this rate is higher among established physicians who have been in practice for more than 11 years, as they were 19% more likely to be concerned with avoiding burnout than physicians in newer practices.
While practices reflect significant optimism for growth in 2019, they continue to evaluate alternative business models to meet the changing needs of the healthcare market, including consolidations, acquisitions and partnerships. The previous trend for sales of independent practices to hospital entities is shown to have slowed to a virtual halt, with 13% of practices considering joining a hospital, while 8% are simultaneously disassociating from a hospital, resulting in only a net 5% increase of physicians employed by hospitals.
Despite their optimism, independent practices face significant challenges, particularly in getting paid. More than 60% of practices said they are seeing declining reimbursements from third-party payors. These declining amounts mean that patients are now more responsible for paying the remaining balance and 63% of practices find their patients more frequently paying for services directly. While 68% of patients failed to fully pay off medical bill balances in 2016 – up from 53% in 2015, and 49% in 2014 – this number is expected to climb to 95% by 20201. These survey results show that more efficient processes for effective patient collections are needed.
The complexities of the changeover to value-based payments and merit incentives present a significant challenge to independent practices. Those who most strongly agreed with the following statements, "I am seeing declining reimbursements from 3rd party payers," "managing quality measure incentives/disincentives is cumbersome," and "avoiding burnout/remaining dedicated to medicine is an ongoing challenge," were statistically most likely to say their practices would shrink in 2019.
New Physicians vs. Established Physicians
The report looked at differences in attitudes between newer physicians (10 years or less) and more established physicians (11 years or more) and interesting variances were found. While all physicians prioritize improving care delivery as a top initiative, more established physicians gave it the highest priority, with 81% stating it is extremely or very important. Only 68% of newer physicians ranked it the same. Newer physicians give a more balanced prioritization between delivering care, care coordination, regulatory compliance and population health management, with a notably higher significance given to population health management. Sixty percent of newer physicians valued population health management highly, as opposed to only 49% of more established physicians.
Top Care Delivery Priorities
Regarding care delivery, 77% of respondents agree that “streamlining your care delivery workflow to allow you to spend less time in your EHR” is important, but six other priorities received a nearly identical cumulative total of importance:
· Security and compliance
· Improving diagnostics
· Prescription management
· Managing labs and testing
· Improving treatment adherence
· Point-of-care documentation
The survey showed that independent practices today have a lot of “job ones.” Without the right processes and systems in place, the administrative burdens that providers will need to tackle will no doubt impact patient care.
Focus on Patient Engagement
As more independent practitioners prioritize the importance of quality measures to the future of their practices, their need for enhanced patient engagement to achieve quality outcomes also increases. While 62% of respondents agree that non-adherent patients are affecting their quality metrics, they are also slower to realize adoption of technology processes that might improve patient engagement. In contrast, patients were far more accepting of the role of technology in healthcare, with 79% of respondents stating they were more likely to select a provider that allows them to conduct healthcare interactions online or on a mobile device2. Seventy-eight percent of respondents said they want better access to mHealth and telehealth tools.3
As could be expected, independent practices place a very high priority on acquiring patients and keeping them coming back. While patient referrals are the number one method of acquiring new patients for all practices, newer physicians placed greater emphasis on online marketing, including being found online (66%), patient reviews (63%) and surveys (60%). However, this response rate represents a relatively low importance given to online discoverability by independent practices, which is contrary to their goal of growing their practice. In general, independent practices are lagging in adoption of patient engagement workflows.
Love/Hate Relationship with Technology
The study confirmed that practitioners have mixed feelings about technology. Despite 75% of respondents agreeing that increasing time demands of quality measures and EHR are impacting care delivery, they recognize that the problem of increasing healthcare overhead may be solved by effective and efficient technology. Sixty-nine percent of independent practices state that integrated technology solutions are needed to improve the efficiency and profitability of their practices. Despite short-term frustrations, independent practices focus on technology as the key to eliminating many of their current challenges.
When asked what technology enables their care delivery workflow, EHR is the core software that providers rely on the most. However, only 64% of respondents are currently using EHR. Interestingly, 17% plan to acquire EHR technology for the first time in 2019, and a quarter of practices are looking to switch technology vendors. With more than 40% of independent practices planning to use new technology within the next 12 months, it bodes well for streamlining the care delivery workflow. Moreover, practices continue to depend more on technology to get paid faster and more efficiently. The survey found that 70% use billing/practice management software, and an increasing number are using technology solutions for patient engagement (52%).
Critical Role of Independent Practices
While it’s not possible to encapsulate all the data in the Kareo 2019 State of the Independent Practice report in one article, readers are invited to download the report to review the entire survey results. It is clear in the report that although practices continue to be challenged, they are working through their challenges to remain independent. Studies show that physicians gain higher satisfaction working on their own over being employed through a hospital or health network. Simultaneously, American healthcare needs the independent practice more than ever. Physician-owned practices see 990.8 million visits, or 3.1 visits per person in the U.S. each year. In contrast, hospital outpatient visits number 125.7 million visits per year, or .4 visits per person.4 In addition to the volume of care that independent practices provide, they also have lower per-beneficiary costs and a lower 30-day readmission rate compared to hospitals5 and they reduce avoidable hospitalizations by 33%.6
America’s independent healthcare practitioners are and will remain the cornerstone of healthcare delivery.
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