Largest disruptors in healthcare from the past year MGMA Stat Patient Access Population Health Patient Care Technology Sign in to save Ron W. Holder Jr. MHA, FACMPE, FACHE The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders attending MGMA19 | The Annual Conference: “In one word, what do you think was the biggest disruptor in healthcare in the past year? ” Some of the most popular responses included: Government/politics Technology Insurance Mergers & acquisitions Reimbursement Payers Prior authorization Value-based care This poll was conducted on October 13, 2019, during MGMA19 | The Annual Conference, with 179 applicable responses. For years, we’ve heard the one constant in healthcare is change. Change can be disruptive, but it can also provide opportunity — it’s all a matter of how to embrace that change. As author Dave E. Smalley wrote: “The survival of the fittest is the ageless law of nature, but the fittest are rarely the strong. The fittest are those endowed with the qualifications for adaptation, the ability to accept the inevitable and conform to the unavoidable, to harmonize with existing or changing conditions.” We cannot simply react to the change happening around us and hope to continue on the trajectory that got us to our current success. We must adapt to change to thrive in today’s healthcare marketplace. Some of the disruptions to the industry in recent years are not aligned with various stakeholders in healthcare. Some services that payers or patients want — and that may make sense from a population health perspective — are not reimbursed enough to cover expenses. An example is the big push to address patients’ social determinants of health. Patients who have social support, a safe home, access to healthy food options, etc., tend to have better health outcomes. A number of questions will need to be answered when addressing SDoHs: How should screening for issues occur? Who helps refer patients to nonclinical resources? Will providers be paid for this work? Will there be a financial risk for noncompliance? A strategy to assist with this is to communicate the benefit for the patient and consider the impact on the team member being asked to provide these services. Seek to understand how this extra body of work impacts not just the bottom line but the workload of those being asked to manage these services, show empathy when appropriate and show that you have given thought on ways how to minimize the disruption to the individuals on the team. Another disruption that continues to warrant attention is telehealth. Telehealth has been around for years, and more and more payers are finally starting to pay for these services. Just as telehealth continues to change — whether that’s the types of services provided, how those services are provided or the percent of total medical visits — it requires similar changes in how the services are scheduled, staffed or house to provide telehealth profitably. Make sure you understand if and how you will get paid by your contracted payers. When initially implementing, seek out those physicians and other providers with interest. Implement access to telehealth in a way that meets the demand from the patients and is least disruptive to the productivity of the providers providing the services. Once volume can support it, consider dedicating a provider to just these services or recruit for one. Patient access continues to be a challenge for many practices. It used to boil down to having enough providers to meet patient demand. Now, due in part to the changing demographics of the patient population, access means providing telehealth, as well as offering evening and weekend appointments and more convenient hours. When working with this challenge, first seek to understand the demand for your services. Demand will vary by specialty with regards to desire for evening or weekend services. Can telehealth be part of the solution? You may have to pay those staffing the evening or weekends more. You may need to hire providers who specifically staff these hours from the outset. While labor costs may be a little higher for evening and weekend work, some payers will pay more for visits outside of normal hours. Also, if you add visits during evening or weekend hours, fixed costs of the practice are already accounted for with the volumes during regular business hours. Even if you allocate the fixed costs to this new business after the fact, the additional patient revenue during idle hours of the practice can make up for the additional labor costs associated with evening or weekend staffing. There are several other significant potential disruptors on the horizon. Current shortages of providers in areas such as behavioral health will be exacerbated by the baby boomer physicians retiring at a greater rate than physicians entering the marketplace. This increase in physician shortages will coincide with increased demand for healthcare services from baby boomers. If there’s more business to get and it’s business that you want, you either need to get more providers or make your existing providers more productive. One of the easiest fixes to the latter is to make sure your staff members are all working at top of licensure. If the physicians are having to do work that nurses can do and nurses are having to do work that medical assistants can do, the practice ends up needing more provider hours than it should for the same clinical workload. Artificial intelligence (A.I.) is actively being pursued by numerous healthcare and healthcare-associated entities. Some seek A.I. to help address the coming shortage of providers either via replacement or augmenting the providers’ ability to efficiently provide care. One of the more important strategies when considering artificial intelligence in the practice it is essential to understand what the artificial intelligence will or will not do, how implementation will affect the care team, and whether it represents a value add to the practice. Five actionable tips to help adapt to change: Get buy-in. Leaders have to be supportive of the change. Your team members, including the ones the most resistant to change, know who among the organization’s leadership structure is most susceptible to complaints about how terrible the new process or initiative is and how much better it was before. You need to, as well, and make sure all of leadership is committed to the change. Overcommunicate. Your team should know why you are doing what you’re doing, what you’re doing and when, Expectations from the team and expected results. Commit. Commit to the change. Change can drain the finite resources from your organization and not just the financial or physical ones. Asking your teams to commit to a new way of doing something while also performing the old way at the same level will rapidly deplete their mental and emotional energy and may result in failure of both new and old processes. Focus. You’ve heard it that if everything is the number one priority, nothing is. Work with your teams to establish what activities take precedent, what metrics are important during the change, and what the goal is for each. Celebrate. Appreciation and recognition for small victories can build commitment and buy-in from the team on the road to achieving the larger goals. Regardless of the disruptor(s) impacting your practice now or in the near future, it will be important to prepare for change management to help navigate your physicians, other providers and staff through the process. Additional resources “Telehealth: Adoption and Best Practices” (MGMA Research & Analysis report) “Maximizing Patient Access and Scheduling” (MGMA Research & Analysis report) “Optimization of Healthcare Technology to Improve Patient Engagement” (MGMA Research & Analysis report) “Benchmarking for Success: Case Studies in Transforming Data into Action” (MGMA Research & Analysis report) “Social determinants of health in an ACO for better population health” (MGMA Connection magazine) “Searching for social prescribing: A.I. and digital tools for social determinants of health” (MGMA Connection magazine) “Engaging patients and communities virtually” (MGMA insight article) How do you improve patient access for your organization? (MGMA Stat data story) Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat Having difficulties keeping up with all the changes? MGMA Consulting can help identify critical issues and develop tailored, actionable solutions for your organization.