5 Ways Affordable Care Act Affects Reimbursement


The Affordable Care Act (ACA) enters the mature phase of its implementation, which is going to impact physician revenue in different ways – some favorable, others not much. Therefore, it is time for physicians to prepare for challenges ahead.  Here are 5 ways that the ACA will impact your income in the years to come.

Extra services covered in insurance

According to the ACA, more services will be covered by insurances that were not covered previously. This step has gained immense support because “patients who have insurance and access to primary care have better health outcomes,” said Jeffrey Cain, MD, President of the American Academy of Family Physicians (AAFP).

Now patients won’t have to pay from their pockets for medical services like blood pressure checkup, mammography, childhood and autism screenings, and contraception.

CureMD- Affordable Care Act

Increase in patient volume

More and more Americans will be insured in the years ahead and looking for primary and eventually specialty care. This means primary care practitioners can now enroll new patients bringing more money. However, most of these patients will come from low-income families, who will be insured on subsidized rates and pay out of pocket.

Increase in out-of-pocket payment patients

Practitioners will be forced to rethink their patient payment policies because of changes in the ACA that will increase the trend of out-of-pocket charges. Kaiser Family Foundation found out in a survey that 72% of employees had a deductible for single coverage, which was 20% more from 2006. It further reported that annual deductible for 72% of employees was $1,097 in 2012, which was 88% higher since 2006.

Rise in penalties will impact reimbursements

CMS incentive programs, Meaningful Use and Physician Quality Reporting System (PQRS), will reduce or stop payments from 2015. Meanwhile, physicians who haven’t complied with the programs will bear financial penalties.

From fee-for-service to pay-for-performance model

Accountable Care Organizations (ACOs) are a breath of fresh air for the physicians trying to decrease cost without compromising quality. This new payment model, pay-for-performance, was introduced to maximize the benefits for patients to improve quality of care while reducing costs. However, as the Model matures, physicians will be required to report their performance to CMS in order to participate in the shared savings.

Telemedicine: Paving Way for Cost Effective Medical Services for Primary Care


According to an article published in the Herald Journal, the history of telemedicine can be traced back to the 1920s, when patients on ships at sea would connect with physicians on shore through radios. With innovation in technology, telemedicine services were provided through interactive television in the 1970s and via video conferencing in the age of digital technology.

Telemedicine: Paving Way for Cost Effective Medical Services for Primary Care

However, the evolution of telemedicine has been curtailed in every period of time – lack of technology in the early 20th century to government regulations in the 21st century – which has added to the skepticism of physicians.

Barriers to adopt Telemedicine healthcare

Under the government’s Affordable Care Act, focus has shifted to cost-effective, quality patient care that has given rise to different approaches of healthcare delivery such as Accountable Care Organizations and telemedicine. However, there are certain barriers to adopting telemedicine at a practice:

1.      Barrier to establish patient-physician relationship

This is the major concern for primary care and specialist physicians, who haven’t introduced telemedicine at their practices. Initially, they hesitate that the use of telemedicine will hinder them from developing effective patient-physician relationship, which will affect outcomes.

2.      Barrier to prevalent practice workflow

Another barrier that most physicians face is disruption to prevailing workflows. Physicians have adapted to changes in the health IT industry by implementing EHRs technology at their practices and designing new workflows accordingly.

However, they are hesitant to adopt telehealth, fearing that it will not be possible to incorporate this approach with the current workflow that is suitable for the new technology they have spent heavily on.

3.      Barrier to medical practice beyond state borders

State and federal laws regarding physicians’ license and reimbursement procedures create a barrier to telemedicine adoption. According to the law, physicians should be licensed to provide medical services in the state they have physical presence in and where they provide telehealth services.

Moreover, changes to reimbursements – shift from value to volume – make it harder for practices to collect from patients via telemedicine.

Benefits of Telehealth services

Despite an air of skepticism among providers, telemedicine is growing by leaps and bounds. Medical Economics, quoting statistics from an IMS research, said over 300,000 patients were monitored via telehealth services for various health problems including cardiac, mental health and diabetes in 2012. The report further said that the number is expected to increase to 1.8 million by 2017.

Assisting home care patients

Telemedicine has made a difference in lives of home care patients by providing telehealth services. Its effectiveness can be measured from the success of a healthcare program introduced by the Veterans Health Administration (VHA) Department that aimed to provide telehealth services to home care patients with chronic diseases.

The services were provided via vital sign monitors, videophones, digital cameras – specifically for wounded patients and those having skin-related issues. Within four years of starting the program, 30,000 patients enrolled to receive telehealth services bringing down hospital visits by 19% which helped in saving costs.

Assisting patients in rural areas

Telemedicine has been particularly helpful in providing efficient and quality health service to patients living in rural and remote areas. Rural primary care physicians have used telehealth approach to facilitate their practice and patients by:

  • Providing quality healthcare within the community
  • Saving cost and time on travelling to city
  • Making medical care available round the clock
  • Providing emergency care to patient prior to transporting them to hospital
  • Making initial diagnosis prior to specialist consultation
  • Consulting with specialist

Assisting primary care physicians

Primary care practices have faced setback because of increase in specialist practices and changes in the health IT sector. According to a study, Primary Care: Current Problems and Proposed Solutions, a shortage of over 40,000 primary care physicians is expected by 2025.

Telemedicine has played a role in primary care health as it has proven to be a successful approach to provide cost and time effective healthcare to patients, resulting in patient retention.

  • Primary physicians can team up with specialists to provide healthcare
  • Facilitate hospitals in providing post-surgery general medical care according to specialist instructions
  • Providing cost effective care in nursing homes
  • Giving privacy to patients suffering from diseases that are still stigmatized in closed communities, like HIV and mental health issues

 Solutions to Barriers for Telehealth

Dr. Adam Darkins, chief consultant for telehealth services at the U.S. Department of Veteran Affairs (VA) has emphasized on the importance of relationship between patients and their physicians for telemedicine system to function effectively.

Dr. Jason Mitchell, director of AAFP’s Center for Health IT clarified that telemedicine is not different from regular medicine practice. He explained that only difference is the mode of interaction between the doctor and the patient.

However, the government needs to make certain provisions in order to remove barriers that hinder success of telemedicine.

  • Flexibility in practice license for telehealth physicians: Telemedicine providers should be given relaxation to practice medicine in states other than their own. This way government can cover the shortage of primary care physicians and facilitate them to recruit patients to meet their costs.
  • Modify reimbursement policies: With changes in insurance policies, patient payments have become a major part of collections. This will create further problems for practices to collect payments from patients who have received consultation via telemedicine.

Changes under the Affordable Care Act are all about providing cost effective, quality healthcare services to patients that can be achieved through telemedicine system. This system is particularly beneficial for small to medium practices that can provide services to more patients, while saving time and money.

Why EHR customer satisfaction is the highest among big groups?


The health IT market is flooded with government certified EHRs to meet the Meaningful Use program. The task is to find out the right medical vendor that fulfills practice requirements. This is particularly difficult for small to medium practices, as it appears vendors pay more attention to providing flawless services to large practices. According to Black Book Rankings 2014 Survey, practices having 25 or more physicians are more satisfied with vendor customer support than practices catering to small/medium groups.(2-5, 6-25). Among the respondents, 90.2% of physicians from large practices reported satisfaction with their vendors as compared to 72.5% of physicians from small or medium sized practices.

One of the major reasons is the vendor resources that do not allow them to give proper attention to small practices. Health IT is a competitive market where large practices and hospitals are major buyers of technology. They drive the health IT market by creating technology demand for huge infrastructures. With sufficient financial backup to implement an EHR system, they partner with vendors for a long period. Similarly, vendors prefer to utilize their limited resources on big projects that promise maximum revenue. By doing so, they usually miss the opportunity to create loyal customers among small practices and provide most of their customer support to physicians in large practices, as highlighted by the Black Book Rankings 2014

Another reason for dissatisfaction among small practices is related to their efforts in vendor search and implementation of EHR. It’s fair to suggest that part of the blame is on the physicians with small practices. Instead of conducting a thorough research of the market, they rush into buying the first EHR they come across [EHR buyer tips]. On the contrary, large practices take their time in understanding the market, the products they offer, strengths and reputation of vendors and demands of their practice before selecting the right vendor. For them, it’s a business partnership that can only work when the vendor fulfills its side of bargain with impeccable technology and customer support.

However, one cannot blame small practices entirely for lack of customer support on the vendor’s part. Ideally, it’s the vendor’s responsibility to provide customer support during the implementation and post implementation phase of EHR. Before signing a contract with a new practice, vendors should make analysis of their available resources and capabilities, so that the customer does not have to suffer in the long run.

6 Steps for Choosing the Right EHR Vendor


While switching to an EHR from a paper-based record system is a no-brainer, selecting the right Electronic Health Record (EHR) software for your practice is not an easy decision to make. The EHR market is saturated with options, with several vendors competing to provide the best EHR features and functionality. The top vendors now come integrated with other management systems, like Patient Portal and Practice Management. Many also offer advanced add-on features, like claim scrubbing and inventory management.

Since the EHR will have a major impact on your future workflows, it is imperative that you choose the right software that efficiently serves your specialty needs. Carefully research the health IT market and make EHR vendor comparison to make an informed decision.

Carrying Out EHR Vendor Assessment

It is essential that you go follow a thorough selection process, not only according to the features offered by an EHR but also keeping in mind whether it provides exactly what your practice needs.

1. Determine Your Practice Needs

In order to be able to find the best EHR for your practice, you must successfully identify your needs. This is because even the highest-rated EHR with the widest range of features may be a poor decision if it doesn’t suit the needs if your practice; you would merely be paying too much and getting too little in return.

Identify the EHR features that your practice needs. For example, if you are migrating from another EHR, an important feature you probably need is affordable and effective data migration. On the other hand, if this is your first EHR, you won’t have to worry about digital data transfer but may need to ensure that your chosen system has features like online appointments and text alerts. Remember that the best EHR is the one that specifically suits your practice.

2. Understand the Difference Between EMR and EHR

First-time EHR users often make the mistake of purchasing an EMR instead. This is because the terms EMR and EHR are often used interchangeably in the medical industry, even though they differ in functionality. Primarily, an EMR is merely a digitized version of patient charts. An EHR, on the other hand, is a more comprehensive system that records detailed data, provides analytics and helps treatment planning. Perhaps the defining difference is interoperability; data in an EMR is limited within one practice, while an EHR travels with the patient and can be shared between providers and practices.

Thoroughly understand EMR vs. EHR before you make the decision to purchase one.

3. Know Important EHR Features

While the EHR you purchase will depend on your needs, there are some primary features all practices and specialties should keep in mind while browsing top EHR vendors. Consider the following questions:

  • Do I want a cloud-based or a server-based system?
  • What is my budget?
  • Is this EHR easy to use for me and my clinical staff?
  • Is the implementation and training feasible?
  • Does it offer integration with other programs I might need?
  • Does it offer the required customizability?
  • Is the customer service fast and reliable?
  • Does it offer free and regular updates?
  • Is it MU and MIPS certified?
  • Are the current users of the EHR satisfied?

4. Set Realistic and Measurable Goals

Set the goals that you want your practice to achieve following the implementation of an EHR system. For example, you may want to grow your patient base by a certain number, or you may be looking to improve your cash flow. Regardless of the nature of the objectives, follow the SMART goal setting process. Your goals should be:

          * Specific
          * Measurable
          * Attainable
          * Relevant
          * Timely

5. Carry out EHR Vendor Comparison

Carry out EHR vendor comparison based on the analysis of your practice. During this phase, carry out EHR price comparison, analyze features of the software, and research on the support services of the vendor.

6. Contact Potential EHR Vendors

Once you have completed the research at your end, contact the vendors that you have narrowed down. Ask them to provide you with complete information about their profile, product, and services. Share your practice needs with them and request a demo, so that you know what you are buying. Additionally, don’t forget to verify the references they provide you with. Enter a binding contract only once you are satisfied with all aspects of the promised service.

Meaningful Use criteria for Eligible Professionals (EPs)


In order to avail government incentives for Meaningful Use program, eligible professionals (EPs) would have to demonstrate that they have been using their electronic health records (EHRs) according to the criteria of meaningful use program. Physicians would have to successfully attest to the program in order to qualify for government incentives program, administered by Centers for Medicare & Medicaid Services (CMS).

EPs who have just adopted EHRs would not have to attest for meaningful use program in their first year of implementation, but without later attestation they won’t be eligible for government incentives.

Meaningful Use criteria

The first criterion to fulfill in order to achieve meaningful use is to adopt a government certified EHR system. The certified software should be interoperable and have ICD-10 coding system. The software should have a patient portal to engage patients for informed and improved healthcare. This is required under the Medicare EHR Incentive Programs, which is run under by the CMS.

The objectives and criteria for the meaningful use program have been divided into three different stages that will span over five years period. The objectives are further divided into core and menu, of which core objectives should be fulfilled. However, there is option for EPs to meet any criteria in the menu set.

In meaningful use stage 1, EPs should have certified EHRs, use it to record clinical and non-clinical data of patients, share information with necessary stakeholders and patients. The meaningful use stage 2  [whitepaper] requires EPs to be more rigorous about health information data, while the third stage focuses on the efficiency and quality of data shared and improved patient care.