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I think it would be fair to say that most health care professionals in the United States understand that health care reform is more about politics than it is about health care. I see new statistics rolling out daily about either the success or failure of the Affordable Care Act (ACA) and its impact on the US populace.
Whether you support it or not, one thing is for certain: the changes are affecting how we deliver care to patients. While these changes seem to have accelerated since the January 1, 2014 implementation of the ACA, they have been going on for some time. What worries me the most is that, while these things have been in plain sight, most practitioners have their eyes shut and are either believing the changes don’t apply to them or are simply not aware these changes are happening.
Top 10 Changes
My concern is that the list of top 10 changes that have been happening in parallel over the past decade is astounding. I am hopeful many will sound familiar—if not, then my concerns are even greater:
- Mandatory use of electronic health records
- PQRS/QRUR
- Meaningful Use (1, 2 and 3)
- Narrow Networks (ACOs)
- ICD-10
- Diagnosis Related Groups
- Hierarchical Care Categories
- Value-Based Modifier
- MIPS Score (Merit Incentive-Based Payment System)
- Outcome-Based Care
While most have viewed these as isolated programs, they are, in fact, intractably intertwined, and current forecasts indicate they are going to affect your practice with complete implementation by 2020. More changes will take place within the next three years than there have been in the past 50—since the implementation of Medicare.
Where We Are Heading
While a complete explanation of the impact of this convergence is beyond the scope of this column, it is imperative that you understand that these changes can, and most likely will, affect the economics of your practice, your ability to participate in health care plans you have taken for granted and, most of all, your access to your patients.
Here is a simple illustration: Outcome-based care is where our payment system is moving—where we will get compensated based upon how quickly and effectively we are able to provide the best outcome for our patients. That means that there needs to be a feedback mechanism that allows the monitoring of quality and outcomes in terms of costs. This is what the PQRS/QRUR and ICD-10 will facilitate.
We have already seen, with the October 2015 release of the CMS Comparative Billing Report, how we are being compared to our peer group in caring for patients, both on a state and national basis. Now expand this one example to your entire patient base, for both refractive care and medical eye care. These outcomes may be a significant factor in determining your ability to be part of a care network and how much you are compensated for a particular disease state management. And this is only a small illustration of where things are heading.
Preparing Your Practice
In presenting my Eyes Wide Shut curriculum around the country, I have noticed many optometrists are receptive to making formative changes in their practices. Some of these changes are easy, while others are much more difficult; yet they are all critical and you must realize how they will impact your individual practice. They are not just for practice owners, but for every licensed health care provider who is actively providing patient care in any setting.
The perception that 2015 was a busy year in health care reform may ring true to many. I see it as just the beginning of the onslaught of changes heading our way. Many say it is just too hard to keep up—likening it to drinking from a fire hose. Unfortunately, the hose just got bigger and with more pressure behind it, so we have to either learn to drink faster or drown. Whether you provide primarily refractive care or are a full-scope practitioner, these changes will apply to you. Stay tuned—we will take this wild ride together.
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