Keeping a U.S. medical practice afloat in 2010 is still a struggle, according to new survey data collected by the Medical Group Management Association, or MGMA. However, the specific day-to-day challenges of running a practice have shifted somewhat when compared with similar MGMA surveys conduced in 2008 and 2009.
MGMA collected responses from 1,798 medical group practices across the country for this year's survey, dubbed "Medical Practice Today 2010: What Members Have to Say." The survey responses are available for review online(www.mgma.com).
The issue of dealing with rising operating costs topped the list of practice challenges in 2010, just as it did in 2009. Managing finances with the uncertainty of Medicare reimbursement rates ranked No. 2, and selecting and implementing an electronic health record, or EHR, filled out the No. 3 spot on MGMA's challenge list.
"It is not surprising that 'maintaining finances with the uncertainty of Medicare reimbursement rates' jumped to the No. 2 spot this year due to the continued congressional irresponsibility in not permanently addressing the flawed sustainable growth rate formula," said MGMA President and CEO William Jessee, M.D., in a June 29 news release(www.mgma.com).
Rounding out the top 10 challenges for 2010 (in descending order beginning with No. 4) are
- maintaining physician compensation levels;
- recruiting physicians;
- collecting from patients with self-pay, high-deductible health plan or health savings accounts;
- negotiating contracts with payers;
- managing teamwork and group dynamics among physicians;
- modifying physician compensation methodology; and
- participating in CMS' Physician Quality Reporting Initiative, or PQRI.
Survey participants also ranked each issue on a five-point scale, with "five" being extremely challenging and "one" considered no challenge at all.
Electronic health records -- David Gans, M.S.H.A., is vice president of innovation and research at MGMA. He told AAFP News Now that comparing three years of survey results helps researchers see how health care is evolving.
For instance, the challenge of selecting and implementing an EHR has remained in the No. 3 spot since 2008. However, the level of challenge this activity represents has dropped steadily each year since then: 72.4 percent of respondents said the task was a "considerable" or "extreme" challenge in 2008 versus 58.6 percent in 2010.
"It's still a very challenging issue, but the challenge shifts from implementation to optimization," said Gans. To gain the benefits of an EHR, "you have to re-engineer workflow and the processes in the practice" he added.
For instance, using an EHR to populate a diabetes registry can help a physician better manage patients with that chronic disease. But the process of setting up the registry takes time, "and the difficulty is doing that on an already busy schedule," said Gans.
Patient-centered medical home -- The challenge of implementing a patient-centered medical home, or PCMH, model of care leapt from No. 22 in 2009 to No. 12 in 2010.
That means an issue that didn't even make the survey in 2008 saw the largest gain in 2010.
"In primary care practices, this has been a very serious issue," said Gans. "Outside of the primary care specialties (family medicine, internal medicine and pediatrics), the patient-centered medical home was almost unheard of until last year."
Gans said the medical home also is gaining momentum with subspecialists, who now are recognizing that their practices interact differently with a patient who is part of a medical home compared with one who is part of a traditional primary care practice.
The medical home interaction requires more than "just a referral report," said Gans. The PCMH requires electronic tracking of the continuity of care from the medical home to the subspecialist and back again. "You can't have gaps when that patient is referred to a subspecialist," he said.
Physician compensation -- The issue of physician payment dropped two spots -- from No. 2 to No. 4 -- between 2010 and 2009 and lost nearly 17 percentage points in the extreme or considerable challenge rating since 2008. "Maintaining compensation levels is as much about keeping physician expectations reasonable as anything else," said Gans.
"When you have constrained payment levels and you have increased costs, is it reasonable to expect a substantial increase in physician compensation? Gans asked. "The answer is 'probably not,' and I think doctors are much more understanding of what (constitutes) a reasonable compensation level."
Performance measurement and evaluation -- The survey indicates that practices are having an easier time dealing with tasks such as tracking performance rating criteria and completing physician credentialing processes. "We're getting better at it," said Gans, pointing to Medicare's PQRI as an example.
When PQRI was first introduced three years ago, "it was a tremendous amount of work" to change the process of how care was documented, said Gans. "Now it's just a part of doing business."
Gans also discussed a companion survey that, for the second year in a row, ranked survey participants' responses to how their practices dealt with the effects of the economic recession(www.mgma.com).
The top priority remained unchanged since 2009; namely, practices said they need to improve billing, collections and denial management processes.
Also in the 2010 survey, more practices indicated that they already had considered -- or were considering -- not taking new Medicare patients than in 2009.
Physicians "are concerned about the vagaries of Medicare payment policy," said Gans, noting that the issue gained nearly 10 percentage points on the probability scale used to measure each effect (i.e., more respondents answered that this was a "considerable probability" or had "already happened") and saw an upward shift of three spots on the rankings list -- from No. 26 last year to No. 23 in 2010.
"We will see this as a more important issue in the future if we are not able to resolve the sustainable growth rate issue," he added.