By Dr. Sue Kressly
For more than ten years, early adopters of EHR technology have promoted the power of choosing the right EHR tool to improve the care of their patients and ensure the financial success of their practice. Buzzwords like population health, patient engagement, and value-based payment are now commonplace in medical literature. Practices who are not just surviving, but truly thriving in the midst of practice change, have incorporated this mindset into their DNA. Yet, many pediatric practices have not translated the relevance to their day-to-day operations. It’s time for us, the hesitant and reluctant among us, to roll up our sleeves, dig in, and join your colleagues who are leading the way.
Someone from your practice should be asking the question, “how do we survive and thrive in today’s changing healthcare environment”? Success is rooted in the following:
- Know your patient population
- Excel at prevention, health maintenance and wellness
- Effectively manage your patients with chronic conditions
- Develop or consult expertise in coding, billing, and payment oversight
Wherever the changing environment leads us to in 2017, it will be critical to have a real understanding of who your active patients are. You should be able to easily see the distribution of your ages, payer mix, and their major diagnoses if you are going to plan to effectively meet their needs. An understanding of where you might need additional expertise (such as lactation consulting, mental health integration, an asthma program) is key to transforming your practice.
As we move towards pay-for-value, having routine processes to recall patients who are due for preventive services (including well visits according to Bright Futures guidelines and immunizations) is key to keeping your patients healthy and creating relationships with them as their medical home. Every touchpoint is an opportunity to educate families and give them the right care, at the right place, at the right time. Not only is it good medicine, but all pay-for-value programs recognize the importance of preventive care and reward top performers.
The subset of your patients with chronic conditions should be managed with care plans to make sure they are getting evidence-based care. Gaps in services and unmet needs should be identified and closed. A care coordinator might be a good investment in assisting these patients and their families. Some might even benefit from access to your office via Telehealth.
Financially sound pediatric practices either develop expertise in coding, billing, and oversight, or they recognize they need a partner to help them. Do you know how much it costs you to deliver care? Do you know if you are maximizing your income? Do you know which payers are your most troublesome in rejected claims and bundled payments, and are they inadequately paying you? If not, you NEED to either commit to learning more, monitoring closely, and make adjustments or partner with someone who does! Even if you use someone else to do your revenue cycle management, as the person who is doing the work, you need to have awareness. It’s your money, and the financial health of your practice depends on someone in your office waking up every day with this as their top priority.