Uncertainty of Future Physician Reimbursement Rising

NORWALK, Conn., Feb. 2, 2015 /PRNewswire/ -- While the reimbursement shift from volume to value becomes more clearly defined by payers, the effect on physicians and their practices is becoming murkier.

This is one of the key findings of the annual Fee Schedule Survey from Physicians Practice. The data reflects 1,616 medical practices across the country; collected via survey from physicians and their practices and not provided by private or public payers. Respondents provided reimbursement levels for new and existing patient visits based on 2014 data.

According to the survey results, 20 percent of respondents thought the shift away the from fee-for-service payment methodology will be good for their practice, with 23 percent saying it will be a detriment. In this year's results, 44 percent of medical practices said they were "not sure" of the effect, a 10 percent increase from our 2013 survey.

"It's clear there is a growing uncertainty among physicians and their practices about how — and perhaps even when — the long-discussed shift from volume to value will affect their day-to-day operations," said Keith L. Martin, Physician Practice's group editorial director. "Adding to the confusion are moves by payers to change contracted rates and adding and subtracting patient insurance plans. It's more important than ever before that practices keep a close eye on payer contracts and communications in an ever-changing reimbursement environment."

While there was a slight uptick in the reimbursement levels for new and existing patient visits, practice management experts told Physicians Practice that fee-for-service reimbursement is likely to continue falling over the next few years.  The good news, as outlined in our February 2015 cover story, is that there are ways practices can make the most of their current payer contracts and still capitalize on the changes in reimbursements. Such strategies include:

• Conducting payer contract checkups, through an annual review, and consistently checking the accuracy of payments from payers.
• Keeping an eye on health insurance exchange plans offered by payer partners to know if you are included — or more importantly excluded — from these plans.
• Ensuring that health insurance exchange plans don't negatively impact your practice in terms of collection efforts.
• Finding new negotiation strategies for your practice, to boost your leverage when it comes to renewing or possibly dropping patient insurance plans.

"While the reimbursement game may seem like an unwinnable one for practices, there are strategies to tilt the odds in their favor," said Martin. "With the right policies, procedures, and people in place, quality patient care reimbursed at fair levels is attainable." 

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