With Better Management System, Smaller Medical Practices can transition to Value-Based Care

Photo by Michael Emono on Unsplash

he government has been rewarding healthcare institutions for providing better service to Medicare patients and penalizing providers who fail to implement new care-management programs.

The Physician Quality Reporting System, as it’s called, is an effort by policymakers to ensure better care for specific patient populations by reimbursing doctors based on patient satisfaction and positive outcomes, rather than establishing reimbursement solely on the number of these patients treated.

It’s a commendable idea because it incentivizes doctors to focus on quality instead of quantity as they deliver care. Unfortunately, the system is not working.

Nearly a half-million doctors are choosing to be penalized by the government because complying with new value-based care models is too expensive, too time-consuming, and too much of a drain on resources. It turns out that paying the fine is less burdensome than implementing new policies for many healthcare providers.

This was not the result that anyone wanted.

The burden of implementing new quality measures falls disproportionately hard on independent physicians because their resources are already strained. Independent practices have been closing their doors in more significant numbers because staying in business as a separate enterprise is too expensive.

All care providers — from the considerable health networks to the clinic staffed by a single doctor — must contend with hours of data entry to show compliance with state and federal regulators, maintain the relevant certifications and collect copays and deductibles.

Larger health systems have the budget and the staffing to handle these administrative and regulatory burdens, but smaller, independent practices do not. Too often, the doctor must handle this administration when they should be focusing on patient care. For this reason, smaller practices must struggle harder to implement new systems and to pay fines.

It takes advanced practice management to track patient care, which is necessary as medical practices show regulators that they are implementing a higher standard of care for Medicare patients. While more extensive health networks have adequate management systems, independent providers have been using fragmented, software-based solutions for practice management. This solution is falling short, and independent doctors are at higher risk of being fined by the government.

The providers who comply with new value-based care models — mostly the more extensive health networks — are rewarded for successfully making the transition. The government rewards those institutions with fines it collects from providers who find it too difficult to comply. That means, in many cases, We will financially strap it to smaller practices that will be funding rewards for more extensive health networks, many of which are already doing well financially. The program was never meant to work this way.

Rather than accepting the fines, more minor, independent practices should implement software systems that make patient data collection more straightforward and accessible. We should connect their practice-management systems to larger providers and the government. That will ease the burden of complying with new rules.

Smaller practices are under fierce financial pressure and should not be penalized for failing to do what more extensive networks are in a far better position to do.

It’s time for independent providers to demand more from their practice management systems. These systems should combine sophisticated software with human expertise to save time, save money, and help move to value-based care.

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