Physician Data Analytics and Challenges in 2014 – Part 2

Last month, I commented on a recent article on the “Top 10 Challenges Facing Physicians in 2014” (by J. Bendix, D.R. Verdon, A. Ritchie, D. Marbury, in Medical Economics, 12/15/13) and discussed 2014 as the year of government mandates. This month I would like to discuss how 2014 will be the year for cost control and many payer headaches.

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Payment for Medical Services
Fifteen of the 16 key financial provisions of the Affordable Care Act (ACA) will take place in 2014. Coverage for new health insurance exchange enrollees begin January 1.

Payers are consolidating networks and repositioning markets as a result of the ACA. As a result, many physicians received termination notices in more than 10 states regarding network consolidation for Medicare Advantage. Narrow networks limit choice for patients with a smaller pool of providers and hospitals.

Therefore, 2014 will be about cost control. Traditional fee-for-service is moving toward a payment structure leaning toward compensation based on outcomes. Some of the more recent models have included Patient Centered Medical Home (PCMH), Physician Quality Reporting System (PQRS), bundled payments for services, and shared savings programs (where physicians split savings with the insurer). Some of the high-deductable health plans will also pose a collection challenge for physician practices.

Obviously, strong physician data analytics can be of high advantage to a physician practice group when looking at and negotiating these various new payment models.

Payer Headaches
The ACA has caused many insurance companies to make drastic changes – such as dropping physicians from panels, and therefore causing patients to scramble for new plans and new doctors. This has made the whole process of finding quality healthcare for patients even more confusing and tedious. Insurance companies are now dictating which doctor, which medicine, which test, how long in the hospital, etc. Prior authorization activities from the payers can cost a practice up to $3,430 per full-time physician (2013 study in Journal of American Board of Family Medicine). The uncertainty surrounding health insurance will continue to fall on physicians, and ultimately on patients as well.

Physician data analytics can help your practice track payers and your internal authorizations procedures over time, and improve the overall payments with each payer. Data analytics will be critical in managing payment panels by insurance company, as well as tracking the quality of service performed for each patient assigned to a particular payer.

In summary, 2014 will be a year for more intensive tracking of detailed quality and payment data by each payer and each patient. This will become critical in negotiating with each payer in subsequent years in order to effectively show the quality and cost of providing services for each patient and each payer.

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