Yes Virginia, We DID make house calls.
There was a time when the doctor as depicted by Norman Rockwell really did exist. House calls for ill or disabled patients was the norm. In the mid-1900s many physicians had solo practices, often they were the entire office staff – no receptionist, no in-office billing staff and no medical assistants or nurses. Physicians extenders were unheard of, and doctors were on call 24/7.
With the advent of Medicare and employer provided healthcare insurance medical practices became busier and more complex. More patients caused doctors to hire ancillary staff such as receptionist/billers and medical assistants.
In the later part of the 20th century and continuing today, hospitals have been buying and consolidating physician practices even at the primary care level.
They have formed giant group practices to handle Medicare and serve to entrench the hospital or hospital system with health insurance companies and their provider networks.
With the finding of the Supreme Court that the Affordable Care Act is constitutional primary care physicians can expect more patients that may be sicker than before. In addition, reimbursement to physicians will change from volume payments to performance based payments. Billing codes are set to change in 2014 and insurance company audits are on the rise. Norman Rockwell’s physician is extinct, but, the solo or small group practice can continue so long as they approach the practice of medicine by embracing physician extenders, IT and technology. Outsourcing of back office services is high on the list of things to consider in order to survive.
Solo and small group practices account for 55 percent of all medical practices. It is unlikely that these physicians will decide en masse to go to work for hospitals and give up being their own business. The likely scenario for solo and small group medical practices is likely that they will evolve to meet the coming challenges on the horizon.
Meaningful Use and Electronic Health Records
The United States government through the Centers for Medicare and Medicaid (CMS) is incentivising physicians to adapt electronic health records (EHR). Compliance with the regulations need not be onerous as there are many vendors of EHR that will meet both the phase 1 and phase 2 regulations. Phase 2 goes into effect into 2014 and solo and small group medical practices can find “off the shelf” systems that meet requirements and streamline their clinical practices. The caution for these practices is to avoid the temptation to add bells and whistles to a basic system that cannot be justified by a cost benefit analysis. Evolution in implementation is to find the least expensive solution to meet regulatory requirements. As needs evolve through discovery by use, additional features can be added.
Increased Volume
In order to meet the anticipated increase in volume that will be created by adding millions of patients to the insurance rolls can be met by using physician extenders, these can be either physician assistants or advanced nurse practioners. While physician extenders can be expensive as a payroll item they easily pay for themselves by increasing the amount of patients seen by the practice.
Billing Challenges
CMS has issued final rules for the introduction of ICD-10 in 2014. This will increase the number of codes used for billing from the present approximately 14,000 ICD-9 codes to more than 60,000 ICD-10 codes. Clearly this a huge and potentially difficult challenge to the small practice with a small billing staff that cannot be spared for ICD-10 seminars and courses. Hiring new graduates will not solve the problem as while they may be adept at the technical side of billing they do not know the human side of dealing with patients or insurance companies. A good alternative is use an experienced third party billing service that has the knowledge and experience to effectively bill on behalf of a medical practice.
So, while the coming years will present many new opportunities and challenges to solo and small group medical practices, solutions can be found and these medical providers are here to stay.
Alan E is a freelance writer/editor with a background writing about healthcare issues.