Small practices struggling to adjust to new payment incentives

Executives of most small physician practices do not understand new quality measurement and payment models under the MACRA and MIPS rules, which also include changes to electronic health records meaningful use requirements.

That’s a concern for Ken Bradley, vice president of strategic planning and regulatory compliance at Navicure, a revenue cycle management vendor that caters to these practices.

Navicure and other vendors serving the market are gearing up extensive educational programs for their clients to help them understand their new costs of business and risk stratification by analyzing data from clients’ electronic health records and practice management systems, then sharing results.

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In an interview during the annual conference of the Medical Group Management Association in San Francisco, Bradley said vendors also have to explain some stark realities, such as the possibility of flat reimbursements until practices can demonstrate improved quality of care, which means less cash coming in at the same time they are trying to achieve practice improvements.

The changes in how care is delivered and reimbursed are giving new life and a new role to electronic data interchange technology, a basic financial transactions processing system that has been around for many years and now is being used to support analytics and feed insights to clinicians, according to Bradley.

EDI is being supplemented with clinical data, which will play a role in the new payment paradigm to help practices better view and understand the business and clinical sides of their practices, he says. “Cost, quality outcomes and new evidence-based medicine are core goals now in the industry,” he adds.