This article is a guest post from Lea Chatham, Editor-in-Chief of Kareo’s Getting Paid blog. She develops educational resources to help small medical practices improve their businesses and to help physicians, staff, and patients understand the intersection of healthcare and technology. Her work has been published in many leading journals including Physicians Practice, Medical Economics, Medical Practice Insider, and the PAHCOM Journal.
As the healthcare industry changes, many physicians are moving away from the traditional fee-for-service (FFS) practice model to reduce billing complexity and manage regulatory challenges.
Kareo’s recent survey, Practice Model Perspectives 2015, revealed which providers are using FFS vs alternate models and how they differ in structure, staffing, and technology use. As it turns out, these variables have a marked impact on which practice model you use.
The top reasons for switching to a concierge, direct primary care (DPC), or other membership models were:
- to separate from the insurance payer system, and
- to spend more time with patients.
The top challenge for these types of practices was recruiting new patients. Traditional fee-for-service practices, on the other hand, struggled the most with staying financially viable and managing regulatory compliance.
Technology choices clearly reflect these differences. Where practice management and billing solutions are a high priority for traditional practices, they’re less important for practices that have already switched. Nearly 30 percent more FFS practices use a practice management and/or billing system than nontraditional practices.
Practice marketing, patient engagement, and other patient-centered solutions tend to be more important to concierge, DPC, and membership practices. Hence, these types of practices are more likely to use telemedicine, check-in kiosks, and practice marketing software.
When nontraditional practices were asked about the top two most important practice management features, they listed:
- Online scheduling (25 percent)
- Online bill payment (20 percent)
These numbers were substantially higher than their FFS counterparts. On the flip side, only 39 percent said “claims management” was an important feature compared to 79 percent of FFS practices.
The study data shows a similar trend with top features in EHR software. While over 80 percent of all practices have an EHR in place, their top features vary based on practice model: Non-traditional practices are more likely to prioritize a patient portal and health trend reporting; traditional practices tend to prefer e-prescribing and eLabs.
Since concierge and DPC practices have a smaller patient population that pays mostly out of pocket, the difference in need makes sense — less emphasis on billing and compliance and more emphasis on patient experience. As more practices shift to these alternate medical practice models, they’ll develop a stronger interest in solutions that help recruit and engage patients.
How to Make the Right Decision for Your Practice
If you’re considering a switch from FFS, keep in mind that not all patient panels will be receptive to the DPC or concierge model. You’ll need to evaluate the makeup of your patients and their current coverage. Try running a survey to gauge interest. Then, based on the level of interest, launch a small pilot program.
For practices with a larger percentage of high-income patients, that might mean an executive wellness program, house calls, or 24/7 access to providers. For a low-income population where many patients have high-deductible catastrophic coverage, it might mean offering DPC with all preventive services covered by a low monthly fee.
Whatever the case, make sure the program fits your patients’ needs. If a small test is successful, then (and only then) consider expanding. The rules around DPC vary by state, which means you may have to opt out of Medicare. To avoid any unpleasant surprises, talk to a healthcare attorney or consultant before you get started.
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