How the ACA is Affecting Private Practices: The 3 Top Things You Need to Know

The Affordable Care Act (the ACA, aka ‘Obamacare’) has been the center of news headlines and chatter for quite some time. It’s no wonder, as it is considered one of the most politically contested bills in American history. Whether you are for or against it, or somewhere in the middle, one thing is for sure: the ACA will bring about many changes in America.
The Private Practice sector of healthcare will not remain immune to these changes. We have consulted several healthcare professionals to get some inside information on what you need to know about the ACA, and how to deal with these changes.

Re-Focus and Re-educate

Often these kinds of policy changes can make a complicated healthcare system even more confusing. Medical analyst Melissa McCormack shares how choosing the right focus can lead to a smoother transition:

With the complexity of reform, providers are finding that the success of a practice relies on more than just patient care. Many providers are responding to that challenge by deciding to focus on their specialty (the patient care), while outsourcing operations such as billing and marketing or bringing on expert consultants to help with business management.

Melissa McCormack is medical analyst at Software Advice. She is also the managing editor for their medical blog. McCormack offered another tip to help private practices thrive under the ACA.

If you prefer to maintain tighter control [over your office], another option is to pursue a business education to equip you with the skills needed to operate a successful practice. Consider getting a healthcare MBA. These advanced degrees are ideal for doctors who have been in practice for several years and need or want formal training in areas such as marketing, management, finance and strategy.

Getting someone with advanced knowledge of the business aspect of a practice will help doctors focus on what really matters: taking care of the patients. Such programs can be found at many universities including UC – Berkeley, UC – Irvine and the University of the Pacific.

Re-Thinking Payments

An increase in deductibles can be a challenge for the patients as they pay more out-of-pocket expenses. Lin Dworshak, who has over 30 years of experience in the healthcare field, shares her advice.

For those patients who do seek care in spite of the out of pocket expense, they can expect to be asked for that payment at time of service. Primary care practices and specialists will be wise to develop a comprehensive and fully thought out self-pay policy. Using some of the same strategies as self-pay without insurance….high deductibles will mean practices must ask for payment at time of appointment.

Lin Dworshak is an Executive Consultant for Business Development with Medical Management Services. She has worked in many areas in healthcare, specializing in IT and change management. Lin went on to explain how practices can make his change easier on their patients.

Practices would do well to familiarize themselves with their states’ exchange offerings and what they can expect to see with newly covered patients. At the time the appointment is requested, the patient should be informed about the practice policies concerning collection of visit and procedure payments. If patients present for “wellness” visits and procedures, practices need to have well planned policies and procedures concerning what those wellness visits are, and where “free” wellness visits stop and paid-for visits begin. This will demand practices do some research and consider their new policies.

Clear communication with patients is key, especially in this time of transition. It is important that staff is trained to simply explain and share these changes with patients.

Review to Avoid Confusion

With many changes taking place in the healthcare field, it is a good time to make sure all current contracts are reviewed, and to be sure all staff is well-prepared and trained through this transition. Practice Management Consultant Mary Pat Whaley explains how the changes can cause confusion.

I see practices being affected by confusion over the exchange plans, and being unclear which ones they are taking and which ones they aren’t. Some practices are not clear which payers have offered exchange plans in their states, and whether the practice is taking the plan by default due to an “all products” clause in a current contract vs. a separate specific decision that practice has made to take the plan based on reimbursement. This confusion is leading, in general, to practices having to give more time and attention to current contracts and new contracts, and to training or retraining staff as to what plans the practice takes, what the cards look like, etc.

Mary Pat Whaley has over 25 years experience managing physician practices. A popular blogger, she draws over 30k visitors to her website Manage My Practice each month. Mary is considered one of the preeminent physician advocates in the US today. She also shared how to avoid the confusion and be make sure everyone is on the same page.

Now is a good time to review all your current contracts and make sure you know what you are being paid by each plan. I always advise practices not to have more than 30% of your business with any one payer if you possibly can. Put time and resources into revenue cycle management on both the insurance and the patient receivables as both are critically important today. Consider adding a cash component to your practice – is there any service you can offer that patients would be willing to pay cash for?

A patient has enough to think about without having to deal with confusing payment policies. Private practices that focus on good customer service will continue to thrive despite the inevitable changes.

A Thriving Private Practice

While some changes may be difficult, with an understanding of the ACA and a well-trained staff, private practices will continue to thrive in the United States. For legal advice regarding changes in your practice as a healthcare professional, contact us at Simas and Associates, Ltd. today.