Most physicians who have been practicing for a few decades remember the days when private payer reimbursements dwarfed Medicare reimbursements. That dynamic has long since flipped, starting with the 2008 recession. Reimbursements have been flat or have lost value from inflation, while practice costs have seen double-digit increases. Meanwhile, hospitals and insurance-owned health networks have seen reimbursements increase to 300% or more of Medicare in some cases, whereas it’s not uncommon for private practices to receive rates far below Medicare standards. Many practices have seen their volumes decrease from 30% to up to 90%, and a significant number are closing their doors for now. As states start to allow elective surgeries to resume in the coming months, some specialties will see some slight increases in patient volume, but this pandemic will have long-lasting repercussions for every practice and every specialty. Whit that in mind, here are four examples of how the COVID-19 Pandemic is effecting specialties across the nation in real-time:
As insurance giants continue to grow, physicians in private practices are routinely used as a cost-saving measure as they are forced to accept ever-decreasing fee schedules. Every player and participant in the healthcare system agrees that the costs are spiraling out of control faster each day, with higher costs and increased deductibles. The misnomer is that private practices are a part of the problem when really they should be one of the most important elements in decreasing costs. Private Practices provide better care and outcomes that save money in the long run, so it’s essential that they are properly compensated so they can avoid being absorbed by vastly overpaid payer owned and hospital-owned systems. Yet, Physicians are having to jump more hurdles than ever just to get paid.
Revenue Cycle Management is the financial process that helps to bridge the ever-growing gap that divides business and healthcare. The revenue cycle itself encompasses all the administrative tasks and processes that take place from the scheduling of a patient to the collection of revenue. This may include patient registration, coding, collecting payments, and submitting or collecting claims from insurance providers.
We all know that the need to maximize profits and volume has depersonalized the healthcare industry. Effective and thoughtful medical care can’t thrive in an environment overrun by payer politics and a business model built to push physicians to their breaking point. When the number of obstacles facing the modern physician seems to grow every day, how do we adapt? Here are some of the major challenges private practices are facing and how to overcome them: