Solo practitioner Paul Sueno, MD, had a good idea of the challenges he would face when he opened his private practice in Tacoma, Washington, in 2012. His late father, also a physician, had practiced in the same community, and Sueno grew up helping his father and learning about medicine.

Immersing himself in every detail, from filing insurance claims to selecting equipment, Sueno has built the four­employee practice from the ground up. But now that he’s gotten a handle on the business side and made it through some “nerve wracking” moments, Sueno says the practice is doing well—and he is glad he didn’t become an employee of a giant organization.

“I want to go to work every day enjoying what I do,” Sueno says. “I don’t want to go in thinking I have a little more money in my pocket but dreading the work experience, knowing I’d have to work for a certain bottom line.”

As Sueno has found, it is possible to maintain your independence without going broke, even in an environment that is increasingly challenging for physicians who own their own practice. But we won’t kid you: You’ve got to become the equivalent of a mixed­martial arts champion in practice management.

As our list of the top 15 challenges for 2015 underlines, physicians will need to navigate some tough obstacles in the coming year. These include the increased costs of operating a practice, time­consuming regulatory burdens, and hassles with getting paid by insurance companies.

The pressures are not likely to abate any time soon, thanks to a trifecta of regulatory changes impacting physicians. Starting January 1, 2015, physicians’ payments will be increasingly tied to providing highervalue care under the Affordable Care Act. In February, financial penalties kick in for practices that could not attest to meaningful use. Then in October, the ICD­10 transition deadline finally arrives.

Perhaps it shouldn’t be surprising that, in this constantly changing ecosystem, more practices are struggling to maintain financial homeostasis.

“It used to be that physicians made enough money that they could let a lot of things slide,” says Cindy Ackrill, a non­practicing physician based in Alexandria, Virginia, who coaches physicians in areas such as leadership and stress management and sees some suffering from burnout. “It used to be that physicians made enough money that they could let a lot of things slide. The margin is so much thinner now. You do have to micromanage the money. No one taught us to do that.”

That’s the bad news. The good is that it’s possible to maintain a viable, even thriving practice if physicians confront challenges and identify fixes that can improve their lives and the health of their patients.

There are concrete steps physicians can take to minimize the burdens of these challenges. When it comes to ICD­10, for example, physicians can engage their staff now to build training, testing, and documentation protocols that will best serve the practice when the transition occurs.

As Sueno has found, it is possible to learn—and still take good care of patients. The following coverage details the 15 challenges every primary care physician needs to master to succeed in 2015.

Challenge 1: ICD-10 implementation

Practices should be updating systems and training their staffs for ICD-10. But even with an extra year to prepare, will doctors be ready to go live with ICD-10 in October 2015?

“I guarantee there will be one large payer or a few small payers, or both, that won’t be ready to process ICD-10 claims on October 1, 2015,” says Joshua Berman, director of business analytics and ICD-10 lead at Relay Health Financial.

The ICD-10 delay helped and hurt practitioners, depending on who you ask. According to a Medical Group Management Association survey in February 2014, 79% of practices had not yet started implementation or were only somewhat ready. A survey by Part B News says that the delay will cost practices more money in training, and that 34% of practitioners would have been ready for the October 2014 deadline.

No matter where practices are in their preparation for ICD-10, the new coding system will cost a considerable amount of money. The American Medical Association estimates that small practices could spend between $56,639 and $226,2015 to implement the coding system.

Pam Jodock, senior director of health business solutions for Healthcare Information and Management Systems Society (HIMSS), suggests that practitioners allot time for end-to-end testing with clearinghouses to ensure coding is working properly. “HIMSS recommends that practitioners follow the 80/20 rule to determine which health plans process the highest volume and highest value claims,” Jodock says, adding that HIMSS has an “ICD-10 Playbook” on its website to assist practices of all sizes. She suggests that practices take advantage of the Centers for Medicare and Medicaid Services ICD-10 testing on March 2-6, 2015, and June 1-5, 2015.

Berman says that practices will have to be ready to send both ICD-9 and ICD-10 claims during a period of transition to ensure payment. “The dual coding process that will need to take place at that point will prove to be very time consuming and resource intensive while at the same time may be difficult to do via their current health information system and/or practice management system.”

Having extra cash on hand during ICD-10 implementation will help practices in the event of increased denials and delayed payments. “Denials from miscoding or other process glitches could significantly slow down payment,” says Berman. “That being said, physicians need to have a financial plan in place in case payments are slowed down/delayed for a significant length of time.”

Jodock says now is the time to make ICD-10 training a priority. “Practitioners who take the time to prepare in the months between now and October 1, 2015 will have fewer challenges than those who choose to wait, especially if they participate in end-to-end testing. Those who delay their preparations or who choose not to test may experience a higher number than usual of claims that are rejected or pended for additional information, which could lead to a delay in payment,” says Jodock. “Even the most well-executed implementation effort could experience challenges.”

Challenge 2: HIPAA

Staying compliant in a fast-moving, digital world

Though the chances your practice will be audited for Health Insurance Portability and Accountability Act (HIPAA) violations are slim, keeping patient information secure is growing more complicated. Since 2009, there have been more than 800 patient data breeches and 29 million patient records affected by HIPAA violations, according to the 2013 Redspin Breach Report.

The Office of Civil Rights began its second phase of HIPAA audits in October, and will continue until June 2015. Of the 350 healthcare organizations that will be asked to submit information on patient health data security, approximately 150 will be audited. Fines for HIPAA violations can start at $100 and can go as high as $50,000, capping at $1.5 million annually, depending on the scale of the breach. Fines aren’t the only consequence practitioners face—a HIPAA violation can break the trust that patients have with their physicians.

HIPAA violations may seem like a large-organization problem, but considering that many breaches are a result of employee theft and carelessness, smaller practices are at risk. One issue practitioners face: It becomes harder to keep track of electronic communication within the practice when patients and staff often have mobile devices and can be unaware of how easily HIPAA rules can be violated.

“While there are certainly threats from outsiders, insider threat (employees accessing information inappropriately) is also a serious threat for practices,” says Lisa A. Gallagher, BSEE, CISM, vice president of technology solutions at theHealth Information and Management Systems Society.

Practices must consider mobile technology as a threat to patient security. Create a ‘bring your own device’ policy that allows the practice to access an employee’s device if there is a potential breach. Also be aware of smartphones and other portable devices that have audio and video capabilities that employees and patients bring to the practice.

Employees who use social media at work can also be a threat to HIPAA rules. “For example, an employee may think nothing of posting about an irritating patient with sufficient detail as to identify the patient. Even well-meaning employees can make such a disclosure without realizing it. If a practice employee takes a picture with their favorite patient and posts it to their social media account, the post is a PHI (patient health information) disclosure,” says Daniel F. Shay, JD, an attorney who focuses on HIPAA at Alice G. Gosfield & Associates in Philadelphia, Pennsylvania and contributor to Medical Economics.

In addition, Shay adds that “employees may post photos of seemingly innocuous content, such as a picture of their lunch…which happens to be sitting on top of a patient chart or order sheet.”

One major issue that many physicians are not aware of is the requirement, both for HIPAA and meaningful use, to complete and keep updated a security risk analaysis, intended to identify risks to record security. Many physicians are not aware of this requirement, and it is a primary reason why practices fail meaningful use audits, says Mark Norris, a consultant who specializes in privacy, security and meaningful use attestation.

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From Medical Economics, by Ken Terry, Alison Ritchie, Donna Marbury, Lisa Smith, Elaine Pofeldt, December 01, 2014