Physician Practices Should Watch These Trends in 2015

State-level requirements. The Massachusetts legislative environment has brought about a significant number of changes that will continue to impact physician practice well into 2015. A few examples of the requirements and impact at the physician-practice level are:

Price transparency. Physicians and payers are required to provide cost estimates to patients who seek healthcare services or procedures. While many practices (and payers) have not received a significant number of calls requesting the information in 2014, it is likely that the number of requests will increase in 2015 following a public push by the Office of Consumer Affairs encouraging consumers to shop around and compare prices for medical services. Health plans now offer web-based tools to estimate those costs.

Registration and certification of certain provider organizations. The registration of provider organizations and certification of risk-bearing provider organizations have begun. Many provider organizations must register and obtain certification to continue to engage in risk-based contracting. Additional processes, clarification, and other steps will continue to roll out in early 2015.

Prior authorizations. The Division of Insurance is in the process of creating standardized prior authorization forms for medical services, prescriptions, behavioral health, and other related areas. Once final, all physicians and Massachusetts payers will be required to use the forms.

How will this impact your practice? Physicians will want to stay on top of these new requirements in order to not delay patient access to medical services and/or medications.

Massachusetts payer contracts. Payers will continue to expand on alternative payment models with a strong focus on maintaining high-quality care while reducing cost. Global budgets and other alternative reimbursement structures will continue to develop. High-deductible and limited-network product offerings will likely continue to grow as employers seek ways to reduce cost.

In addition, wellness programs may expand, and patient engagement and satisfaction will likely remain a focus point for physicians and healthcare organizations working to improve metrics in this area.

How will this impact your practice? Physicians will bear more responsibility when it comes to the clinical management of patient populations, and data will be the key driver for success. It’s extremely important for physicians to understand their data and to have the tools necessary to track their high-risk patients.

Furthermore, as high-deductible health plans continue to expand, physician practices will have to develop new strategies for staying on top of patient-owed balances.

Physician reimbursement. In 2015, reimbursement will likely be impacted by physicians achieving high quality and patient-experience scores. Payers are developing new reimbursement strategies that incentivize physicians to meet metric targets for quality and utilization.

How will this impact your practice? Whether a physician accepts fees for service or operates within a global budget, he or she will be asked to reduce cost while providing the best-quality care and patient experience possible. It is also important to regularly review payer and employment contracts and align internal processes to successfully meet contract-based goals. As physicians continue to align with ACOs, they may be required to shift referral patterns. It is very important for practices and physicians to understand and stay on top of organizational policies. –