Published January 19, 2012 – Samantha Gluck, MedCity News
The U.S. health care industry has evolved and changed rapidly over the past several decades. This evolution took place in response to a number of environmental influences including, technological advances, demographic shifts, and economic and political changes.
Many Private Practices Suffer Under HITECH.
These changes have resulted in the emergence of a number of challenges both for physicians and those seeking health care services. The fall out from the Patient Protection and Affordable Care Act (PPACA) will continue to reveal itself bit by bit over a course of the next few years. The health care reform act, broken into [supposedly] easy-to-manage stages, includes considerable changes to Medicare reimbursement policy for both physicians and hospitals.
Independent physicians with private practices will have considerable difficulty meeting the benchmarks and metrics set forth in the act. Well before the Obama administration’s health reform came on the horizon, physicians reported that many factors, including regulatory burdens and Medicare reimbursement changes, have nearly crushed their practices in many instances.
As the pieces of the health reform act begin to fall into place, the expenditures required to keep up with the various requirements will likely add another layer of stress to private sector physicians running independent practices. The new health care act will then bring physicians to an inevitable crossroads – a choice toward which they were headed anyway before reform began. A majority will either move to an intimate, boutique practice model or forego traditional practices altogether, opting for the abundant resources offered by larger entities in exchange for their independence.
It’s not as bleak as it seems at first glance for modern physicians.
Rapid Change Begs a Rapid and Effective Response
Countless startups, offering EMS, EHR, and adjunct high technology solutions to overextended doctors and newly emerging practice models, have formed all over theU.S.entrepreneurial landscape. From iPad and iPhone apps designed to assist with diagnostic procedures to more sophisticated apps created to help ensure physicians receive the maximum allowable reimbursements for CPT code allowables and everything in between ’ there’s an app for that.
Epocrates jumped to the forefront, offering one of the first Rx and mobile clinical suites to doctors who hoped to get in on the technological revolution occurring in health care from the get-go. Now they’ve come out with a robust EHR solution. Other companies have designed clinical diagnostic tools for nurses, drug reference databases complete with drug interactions, side effects, and other critical data.
Fresh, Innovative First Aid for the Policy Weary Physician
CodeToolz comes to the aid of anxious, overextended physicians working to come into compliance with the new policy. They’ve designed an application to assist physicians in comparing the difference between their current rates and the maximum allowable reimbursement for any CPT code. The AMA reports that health insurers paid doctors the correct, and justified, payment rate only about 67 % of the time. That’s not just a one-off mistake; that’s either theft or incompetence. Physician, protect thyself.
This simple to use, sleek new tool even allows docs to verify that reimbursement amounts match contracted rates. For those wonks, you know who you are, that love to analyze everything in and out of their practice environment, the program will thoroughly analyze any proposed changes in contract payment terms, leaving the guesswork out of this complex aspect of reimbursement.
The company, headed up by Dana R. Bellefountaine, Jr., has garnered considerable media buzz lately, with a featured write-up in the Orlando Medical News with follow-up features scheduled in various health care media publications, such as Modern Health Care Magazine, and others throughout 2012.
Says Bellefountaine about the company’s dedication to stand in the gap for doctors, ’Early on in my career, I aligned myself and my team with the physician and the unique aspects of running a successful practice. During that time, I gained critical expertise and an intimate knowledge of the idiosyncrasies and challenges faced by these professionals — acting dually — both as healers and as the end game for the business aspects of their practices.’
Truly, someone must stand up for the physician and healer – the giant who is fast becoming a 12-year old, frightened David in the wake of health care reform. But, David had that sling shot. Now, physicians have theirs.
CPT® codes and descriptions are copyright 2010 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association (AMA).