Six Key Factors to Consider in Health Care Decision-Making: Improving Your Physician Services Program in Today’s Environment
The financial strain on today’s health systems is extreme, and the environment is more complex than ever. It will take a new level of vision and expertise to successfully navigate these uncharted waters. Change is the new normal in the industry amongst evolving regulations, reimbursement, realities, workforce challenges, and vendor relationships.
How do organizations manage through today’s challenges and maintain a care delivery system that works for patients, caregivers, and the bottom line?
According to Becker’s Healthcare Review, some of the biggest challenges CXOs are currently dealing with are clinical workforce issues and confronting affordability.
The market shift accelerated in 2022. After two years of Covid-induced stress on health care, an already shaky foundation additionally felt the weight of physician and nursing shortages, supply chain issues, the No Surprises Act’s impact on health system reimbursement, and increasingly challenging government rules around quality and value-based care. These impacts reverberate throughout the health care industry. The magnitude of change in the landscape means models which previously performed well need to radically evolve to perform at or near the same level going forward.
Health system executives have no choice but to evaluate their physician services models in today’s environment. Clinicians are at the heart of every health system with a disproportionate impact on patient outcomes, organizational efficiency, and driving the overall achievement of strategic goals. Physician services in emergency and hospital medicine can make or break a health system’s financial and operational goals, which means evaluating current models is more important than ever.
When evaluating options, health leaders must consider several crucial factors in the current environment:
- Cost-effective programs need sophisticated staffing and care delivery models. Improved alignment between physicians, NPs, and PAs in emergency and/or hospital medicine programs will improve patient satisfaction and reduce the cost of care. Leveraging integrated tele-support for nighttime coverage, surge periods, and other critical needs drives a long-term sustainable delivery model and prevents burnout. Accurate volume prediction, using AI technologies and real-time flexing of coverage as volumes shift are critical in the day-to-day management of an economically efficient program.
- Emergency medicine and hospital medicine integration is critical. Hospital-based clinical teams must communicate effectively and work in harmony, managing observation stays and improving appropriate ED-to-inpatient conversion to reduce length of stay and LWOTs. Evaluate your current or potential partners to ensure their experience and approaches to integrating service lines align to your needs.
- Many health systems, physician groups, and contract management vendors are not fully informed about how to manage impacts from the No Surprises Act (NSA). Keeping up-to-date with changing legal decisions and the multi-step dispute process is an overwhelming task for health system executives. Recent legal decisions could give the impression that negative effects have been mitigated, but this is not the case. Partners who fully understand the NSA’s impacts and have taken steps in response, including making choices to provide more in-network care, maintaining relationships with payors, and staying connected to the impacts and journey of the No Surprises Act can help you manage the complexities and prevent future surprises in reimbursement. .
- The ‘business’ of delivering care must be run with efficiency levels beyond the programs of the past – or the cost will be unsustainable. Consistent coding and fully and appropriately documenting patientcare to ensure effective management of all co-morbidities is more important than ever. Educating clinicians on appropriate and effective documentation practices enables best-in-class quality management systems and can be the foundation of value-based care programs. It is essential to collect at appropriate levels and effectively contract with managed care payors at scale. Consider hybrid management solutions to connect employed medical groups to sophisticated support services and infrastructure to operate at next-level efficiency and performance.
- Clinicians have choices. To improve recruitment and retention, you must develop talent and thoughtfully deploy appropriate clinical compensation models to keep costs down and reward productivity while valuing the clinician. Supporting local clinicians with strong leadership, resources, and a nationwide infrastructure reduces variation, helps reduce burnout, and drives best-practice performance. Look for those leading the way in modern compensation models that take productivity and performance goals into account in connection with clinician pay.
- Some vendor partners are struggling. Many organizations (physician groups and vendors) have suffered a tremendous blow from NSA’s reimbursement shocks and find themselves in unstable territory – with unwieldy debt and unsustainable balance sheets. Choose a healthy partner who can sustain their services in this new reality, while executing your vision and approach.