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Providers, especially primary care physicians, are struggling to meet increasing demands.
NATIONAL REPORTS - Providers, especially primary care physicians, are struggling to meet increasing demands. Not surprisingly, stress factors include healthcare reform, Medicare and Medicaid policies, and dealing with uninsured patients, according to a study conducted by Physician Wellness Services (PWS) and Cejka Search.
"This study shows that healthcare organizations are not providing support for their physicians, and the physicians don't know where to go for help," says Alan Rosenstein, MD, medical director of PWS.
Payers, too, can contribute to the support providers need to deliver cost-effective, efficient care. Today's trends indicate payers and providers will have to work together more often on coordinated care, payment reform and emerging delivery models.
"We've seen an increased level of cooperation in the last few years," says Tennant. "But if it's a health plan giving advice, there's a natural wariness of providers. We have to balance the needs of the patient and the professional judgment of the physician and the desire of the health plan to generate efficiency and cut costs."
Generally, Tennant says payers could offer more IT resources-for example, moving to machine-readable member insurance cards. Such innovations would save time and resources at the provider level, decrease room for human error and save the healthcare industry billions-even though the cards come at a cost to payers, Tennant says.
MGMA launched Project SwipeIT in 2009 as an industrywide effort to get health plans, vendors and healthcare providers to initiate processes to adopt standardized, machine-readable patient identification cards based on guidelines developed by the Workgroup for Electronic Data Interchange (WEDI). Guidelines call for cards featuring either magnetic strips or bar codes. MGMA adds that the card should contain all the information necessary to register a patient and initiate an insurance eligibility inquiry.
The average practice now spends about 10 minutes to register each patient. MGMA says that time could be reduced to five minutes with swipe cards, plus it would generate nearly $300 million in savings for the 60 million claims that have to be resubmitted to payers each year due to incorrect patient information. For the average six-physician practice, MGMA says electronic ID cards could save staff members an estimated seven hours worth of work each day.
MGMA has collected industry pledges to move to electronic ID cards, including agreement from eight payers.
TECHNOLOGY CAN OPEN DOORS
Independence Blue Cross (IBC) has begun offering a growing number of online tools to help practices evolve into Patient Centered Medical Homes (PCMH). Richard L. Snyder, MD, IBC's senior vice president and chief medical officer, says the company has teamed with the American College of Physicians to offer online resources that will help physicians analyze how they currently deliver patient care and identify way to increase efficiency.
One such resource is the Medical Home Builder 2.0 (MHB), which aims to help physicians adopt a patient-centered care model. Practices can use this tool to analyze how they currently deliver patient care and identify ways to be more efficient, including improved scheduling, patient education and coordination of care, says Snyder. Physicians can access instructional videos as well as a library of more than 500 resources and policy templates. The ultimate goal of this tool is to streamline administrative processes.
Snyder says IBC also has recently enhanced its Quality Incentive Payment System (QIPS). The QIPS program offers financial rewards to primary care practices that meet some, or all, of the National Committee for Quality Assurance's core requirements to become a nationally recognized medical home. The incentive program was put in place to motivate and encourage doctors to improve patient care and operate in a more efficient manner, which helps control rising healthcare costs, he says.
Another online tool offered by IBC is access for network primary care physicians to Clinical Care Reports. The reports are available through IBC's provider portal and may be accessed only at a centralized, secure location through a designated security officer in a doctor's office. An example of the benefit of the reports, Snyder says, is that physicians could be alerted about a patient's medical history, including recent tests, medications or gaps in care.
But aside from IBC's internal programs, Dr. Snyder agrees that more overall changes in the healthcare industry are what's needed to turn around the physician burnout trend.
Health insurers should be looking to provide more process standardization and automation that can help physicians become more efficient and focus on patient care, he says. Case managers and disease managers help serve as an additional physician resource, but supplemental reimbursement and support could also offset the resources physicians must provide in order to become a PCMH, he adds.