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As a proud partner of Allscripts and eChart Courier, the DataFile team was excited to attend ACE 2017 in Chicago last week. We were grateful to meet with so many of our clients, partners and friends face to face, sharing conversation and stories which ran the gamut across all facets of healthcare. Through our conversations one theme was truly apparent: uncertainty. So many of the attendees we met with are in a time of uncertainty right now. With the many changes in healthcare spanning from regulatory transformation to reimbursement or even technology, groups of all sizes are sharing very similar experiences, and it seems no practice is immune. Through our interaction with ACE attendees, we heard three common themes regarding uncertainty, including:

Keeping the Doors Open:

While working in the HUB, we were approached by a physician of almost 20 years sharing his powerful story. He came to us asking what we do and we shared the mission of DataFile to provide relief from administrative health information management tasks. From there he looked up with a sadness in his eyes and visible tears forming. This physician who had been in his own practice for over half of my life stated: “This would have been great, but unfortunately it’s too late.”

Not fully realizing what he meant, I asked why? He then opened up and admitted with all of the changes he is facing along with the increasing cost of labor, supplies, technology and regulations, he is in the process of closing his doors. He stated there was no way to get out of the hole and be profitable as a single provider practice.

It was heart-wrenching to be on the receiving end of this story; experiencing this man’s pain as he took a chance and continued independently, despite the uncertainty of the future of healthcare, and unfortunately was not able to remain profitable. While this provider experienced the ultimate defeat, other attendees expressed concern over remaining independent in concurrence with the many changes currently occurring in healthcare.

Changes in Reimbursements:

While speaking to an administrator for a small pediatric practice, we had a great conversation on reimbursement. She stated essentially pediatrics is considered the bottom of the financial barrel when it comes to financial reimbursement. Being mostly immune from MACRA/MIPS is a double-edged sword. While the costs of reporting and having the proper staff to maintain regulatory compliance for MACRA/MIPS aren’t there, they also aren’t receiving the financial benefits other specialties receive to offset other costs in the practice.

MACRA/MIPS reimbursement as it stands currently are geared toward the older population, as the program is governed by Medicare. Rarely is Medicare utilized by those under the age of 18, as typically if a child is on assistance they have Medicaid. She discussed with us the unique challenges they share as a practice and their need to see as many patients as possible in a day just to be profitable enough to keep the doors open.

Luckily for this practice, there may be a light at the end of the tunnel, though it’s uncertain when the help will arrive. We discussed that typically when CMS makes a change private payers do follow suit. Despite the uncertainty of when the private payer change will occur, their goal is to hang on as long as possible, whether that be by making staffing cuts or hiring additional physicians without hiring additional support staff, in order to see as many patients as possible. Regardless of the size of practice, many organizations expressed concern over the great unknown of MACRA/MIPS and its impact to reimbursement.

Financial Challenges Lead to Staffing Reductions Which Leaves No Plan B:

While it may seem at times the brunt of the changes falls on the shoulders of small practices, that’s not always the case. In order to succeed financially, staffing reductions have occurred at some of the largest health care systems in the United States.

With the adoption of new technology which has been acquired to handle functions which have needed a human touch previously coupled with a decrease in staff, what happens when the new technology fails? There’s uncertainty as to who is available to help remedy the issue.

We spoke with a large health system with thousands of employees where technology failing had just an issue they experienced. When their dictation system was unable to input data into patient charts as it had been expected to, employees at this system were left struggling to handle the problem. With thousands of providers relying on these teams to ensure the data was in the system appropriately and clinical staff already stretched to deal with immediate needs like patient care, the team was left scrambling for alternatives. Ultimately, the system was left with no choice but to hire costly temporary medical staff to handle structuring of discrete data and deal with backlogs of information which was unavailable to physicians for patient care, ultimately causing headaches and increased costs. In an increasingly technology-driven industry, technology fails impact patient-care and an organization’s bottom line.

While DataFile was fortunate to interact with many attendees, these three stories resonated with me as examples of larger themes we heard regarding uncertainty. Three different stories, from three different sized groups, from three different parts of the United States. While we are facing an era of somewhat unknown in the future of healthcare, we are united by our shared experiences and narratives. We love hearing your stories, and sharing strategies on how we together can mitigate current issues to the best of our ability. Regardless of the future of healthcare, DataFile remains committed to advancing healthcare delivery and allowing practices to do what they do best – care for patients.

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