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    Ron W. Holder Jr.
    Ron W. Holder Jr., MHA, FACMPE, FACHE

    The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders: “What will be the biggest change in 2020 for your organization?” Some of the most popular responses included:

    • Staffing (hiring, retaining, retiring of management, staff and providers)
    • Cost and revenue (cost reduction, collections, contracting, revenue streams)
    • Practice transformation (growth, mergers and acquisitions, consolidation)
    • Technology (adding and updating software, EHR)
    • Operations (practice efficiencies, workflows)

    This poll was conducted on January 7, 2020, with 398 applicable responses.
    With the new year upon us, let us look forward into the future to identify possible changes in 2020. While we have no looking glass or sage to tell us what’s to come, we can look at the next best thing: the past year’s largest disruptors.

    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 we 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 where we are. 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 (SDoH). 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 SDoH:

    • How do we screen for SDoH?
    • 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 additional work affects not just the bottom line but the workload of those being asked to manage these services, show empathy when appropriate and demonstrate ways 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 — so too will the way services are scheduled, staffed or offered to provide profitability. Make sure you understand if and how you will get paid by your contracted payers. When implementing these services, seek physicians and other providers with interest. Implement access to telehealth in a way that meets the demand of patients and causes the least amount of disruption to providers providing the services. Once volume can support it, consider assigning duties to a dedicated provider. 

    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 changing patient demographics, access means providing telehealth, as well as offering evening and weekend appointments and more convenient hours. When addressing this challenge, first seek to understand the demand for your services. Demand will vary by specialty with regard 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 or hire providers to staff these hours. While labor costs may be a little higher for evening and weekend work, some payers will pay more for visits outside normal hours. Also, if you add visits during evening or weekend hours, the practice’s fixed costs are already accounted for during regular business hours. Even if you allocate fixed costs to this new business after the fact, the additional patient revenue during these extra hours can make up for the added 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 baby boomer physicians retiring at a greater rate than physicians entering the profession. 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 you want, you either need to get more providers or ensure that your existing providers are 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 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 A.I. is to understand what it can or cannot 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 leader buy-in. Leaders must be supportive of change. Your team members, including the ones most resistant to change, know which leaders are most susceptible to complaints regarding a new process or initiative and how much better it was before. You need to make sure leadership is committed to change.
    • Overcommunicate. Your team should know why you are doing what you’re doing, what you’re doing and when, and expectations for the team and expected results.
    • Solidify your team’s commitment to change. Change can drain the resources from your organization and not just financial or physical ones. Asking your team to commit to a new way of doing something while continuing to work at the same level will rapidly deplete their mental and emotional energy and prevent them from succeeding. It is important to implement changes incrementally and transparently to help your teams feel like they are making progress and solidify their commitment.  
    • Focus. You’ve heard that if everything is a priority, nothing is. Work with your team to determine what takes precedence, what metrics are important when making changes and establishing goals for each.
    • Celebrate. Appreciation and recognition for small victories can ensure commitment and buy-in among team members and motivate them to achieve larger goals. 

    Regardless of what your practice faces in 2020, it will be important to focus on change management to help physicians, other provides and staff navigate through the process.

    Additional resources

    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:  

    Having difficulties keeping up with all the changes? MGMA Consulting can help identify critical issues and develop tailored, actionable solutions for your organization.

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