No matter what they think of the bill Congress passed to reform healthcare, physicians face enormous challenges in the decade to come.

 

How group practices will manage through this treacherous terrain of shifting regulations comes down to some of the most important people in any practice: the office manager.

 

Barbara Forgione, RN, president of the Central Florida Medical Group Management Association (MGMA), said it’s too early to know whether the healthcare reform law will lead more physicians to form groups.

 

“We suspect, from what we’ve already seen, that the impact of the legislation will vary from specialty to specialty,” Forgione said. “We’ve already seen indications that within specialties the impact will be very different. Whether that will cause people to band together or become facility employed depends on the strength or size of the group.”

 

As for reimbursement levels, Forgione predicts primary care physicians will fare better while specialists such as cardiologists, urologists and anesthesiologists will fare worse. Facility-based group practices – those tied to a hospital – will likely see less of an impact because they are less prone to competition, she said.

 

For those practice managers stepping in with tepid toes, Forgione said this is the perfect time to take a leadership role in their group and stay on top of changes in the law to educate their physicians.

 

“Try to create a sense of order within the group,” she said. “Right now every doctor is in a panic over this.”

 

Part of the disorder comes from uncertainty. Even aspects of the law that appear certain could change as the numerous phases of the legislation roll out over the next few years.

 

“We’re going to see not only that the law is going to change,” Forgione said, “but even the things that remain the same will have to be adjusted. Once you really try and do it, now you find out how it doesn’t work and how it needs to be changed. By 2018 this won’t look the same. The biggest advice I can give is don’t panic.”

 

Many physicians have expressed frustration that Congress neglected to address the Standard Growth Rate formula used to establish Medicare reimbursements. The formula results in proposed cuts each year around 20 percent, only for Congress to propose a temporary fix. This time, lawmakers put off a 20 percent cut for several months to try and work out a fix.

 

“We have known for years that the model the government is using to be budget neutral with the SGR formula would not be sustainable,” Forgione said.

 

Other challenges facing practice managers these days come from requirements already in place under federal law. One requirement to report quality indicators to the Patient Quality Resource Improvement program has been giving many practice administrators a headache for some time, said Forgione. The program collects data through Medicare billing information.

 

“It really is addressed at improving quality, but you cannot put it on a bill with a zero dollar amount because it will kick back the claim,” Forgione said. “So you have to put it as a penny. This has been going on for years. It does a good thing, but they were a little short on how it would be implemented. There are so many things like that, when you get down to the grass roots level of how you actually do it.”

 

Another example is electronic medical record implication. As the government moves to encourage adoption, practice managers complained that the criteria it established was too burdensome. The Centers for Medicare and Medicaid Services then pulled back some of their guidelines.

 

“It’s an expensive proposition to do and it’s a real re-education from the bottom up of your practice,” Forgione said. “Small practices struggle with affording it, and for large practices it’s a monumental task. Everyone understands there are benefits, but it’s just overwhelming for a lot of people.”