With the current state of fee-for-service reimbursement continuing its decline, physicians across the country are being forced to explore new ways for their medical practices to survive and thrive. Reimbursement levels for new and existing patient visits declined or remained flat again in 2013, according to the annual Fee Schedule Survey by Physicians Practice, the leading online community for practice management professionals.
Pay for physicians across the country has followed this trend since the first year of the publication’s survey in 2001. This year’s data indicates relatively flat reimbursements for existing patient visits, but decline in all the categories of new patient visits, including a 21 percent decrease in the highest complexity code (99205) used by medical practices.
The data reflects 2,619 medical practices across the country; collected via survey and not provided by private or public payers.
“Year after year, physicians and their practices are receiving less pay for the same amount of work,” said Keith L. Martin, Physician Practice’s group editorial director. “So physicians — like any other profession facing this dilemma — are looking for ways to change the way they do business without compromising patient care.”
This includes exploring new strategies to boost practice revenue ― such as partnering with other physicians and health systems, developing accountable care organizations (ACO), participating in pay-for-performance programs, or creating Patient-Centered Medical Homes. These programs are getting increased attention through their inclusion in the Affordable Care Act.
This year’s Fee Schedule Survey found that 27 percent of respondents expect to receive 11 percent to 25 percent of their practice revenue through formats other than traditional fee-for service reimbursement.
And as part of the ongoing shift from volume-based reimbursement to value-based reimbursement, payers are incenting practices to embrace value, offering practices higher pay if they deliver high-quality, low-cost care. The challenge for medical practices is deciding which practice model or incentive program is right for them.
This year’s cover story in the February 2014 issue of Physicians Practice explores four of the most popular forms of value-based models and incentives with guidance for practices to help make that decision.
“With a number of options and programs to choose from, it can be hard for practices to make a choice that best fits them,” said Martin. “Our goal is to help practices look at each option and provide expert advice on conducting some due diligence before signing on the dotted line.”