Finding opportunity in the changing healthcare market
Costs are rising. Reimbursements are falling. And new government regulations seem to appear out of thin air with significant penalties if you are not compliant. Practices around the country are facing declining profits with mounting levels of work. It’s an unsustainable system, and it’s at a tipping point.
At the same time, patients are suffering greater burdens and responsibilities when it comes to their healthcare costs. As a result, they expect more for their money. Patients today are becoming true healthcare consumers, and they expect more customer service and greater care.
Rising costs, declining profits, more government regulations, and greater expectations from your patients – it’s no wonder that providers all over the country are worried about keeping their practice doors open and maintaining their independence. However, while all of these changes may seem dire – and while we are absolutely at a tipping point with the old fee-for-service healthcare model – a number of opportunities lie in the changing face of the healthcare market.
To fully discover and reap the benefits of these opportunities, we must first get a better understanding of the top perceived healthcare challenges in the minds of patients and providers today.
Top Challenges for Medical Providers
According to a recent survey conducted by Greenway Health, providers are currently losing cash flow in a number of areas, and they have serious concerns for profit losses in the future as the market moves toward value-based reimbursement models. Some of the places that providers expect to lose profits in the coming years include:
- Down-coding due to insurance denials
- Denied charges that receive no follow-up attention
- Expensive equipment that isn’t used to its full potential
- Governmental penalties for non-compliance
- Inability to offer new services
- Inefficient staffing
As worrisome as these things can be, there is actually a discrepancy between expectations and reality. In fact, the top areas that are currently causing the most losses include:
- Transitioning to value-based reimbursement models
- Maintaining profitability and other billing challenges
- Challenges with existing HIT software
- Provider and staff recruitment/turnover
- Challenges transitioning to more consumer-oriented models
- Access to services and expertise
- Access to patient clinical data
Fortunately, however, there are actually opportunities hiding in these challenges, and savvy providers and practices can take advantage of them to improve patient outcomes and increase their bottom line at the same time.
While changing government regulations and requirements have created a number of issues for providers, other changes offer opportunities, including advancements in data analytics and population health management.
When you have access to the right tools, you can reduce your per-patient costs, effectively identify care gaps, perform accurate risk stratification, improve care coordination, and increase your quality measure attainment to receive higher reimbursements each month.