The Verden Group

How You Can Successfully Participate in P4P Programs

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Pearl | April 30, 2014 | PerformancePayersPearlsPhysician Compensation

 

Participating in pay-for-performance (P4P) programs can work out well for both provider and payer. By “performing well” on certain clinical and administrative measures, savings are created that can be shared with both parties. That is, if providers can meet specific metrics that appear to produce some savings by, say, coordinating patient care better or ensuring that the population is receiving timely preventive care, then everyone wins and costs go down.

However, it can be a little perilous to participate in these programs if you don’t have a good understanding of your own data. Signing up to meet specific goals without first knowing where you currently stand or without being able to monitor progress as you go along a defined time period can mean falling short of expectations and losing out on additional revenues. So, it is vital that you must be able to run reports in your own system to either validate or dispute the data that the payer will be producing, in terms of how your providers have performed. Depending on your IT infrastructure, this may or may not be an easy task!

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Participating in New Healthcare Exchange Plans

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Pearl | February 19, 2014 |

It is early with regard to the healthcare exchange plans and yet practices across the country are already feeling the impact. It’s not just consumers who have experienced problems while attempting to sign up for the exchange plans on the healthcare.gov website; providers too are dealing with major headaches as they navigate through the first couple of months of this new system.

Looking for more information about the effects of healthcare reform on your medical practice? Join us May 2 & 3 in Newport Beach, Calif., for Practice Rx, a new conference for physicians and office administrators.

Let me explain. The insurance companies created something called “narrow networks” within their full network of providers. What that means is that only a subset of physicians within any given insurance company’s network “qualified” for participation in the exchange plans. The result is that while some physicians got rolled into these plans, others were excluded, even though they participate in some of the other products with that particular insurance company. For example, a physician could be participating with an HMO and a PPO-type product, but be excluded from the exchange product. This has created a dilemma for many practices. On the one hand, it means no new business coming in from new exchange members. On the other hand, it also means scrambling to hold onto existing patients that have switched to these new, lower-priced health insurance products.

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Medical Practice Super Groups, Are They for You?

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PHYSICIANS PRACTICE Pearl | November 20, 2013 |

Practices today are facing challenges such as lower earnings, more complex regulations, higher costs, obligations to create higher-quality care and produce better outcomes, all while they see other colleagues merge or become acquired by local hospitals or healthcare systems. So at least once a week I get an inquiry from a physician asking, “Should I sell my practice?”

There is no single answer to that question. It depends on many factors, including whether or not the practice is in good financial shape and if it is well managed. I do consider those to be two of the strongest indicators for successfully remaining independent. However, the options shouldn’t be limited to either selling or remaining independent.

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The Independent Pediatrician

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Our good friends over at PCC (Physicians Computer Company) in Vermont, very ambitiously set about to launch a new journal, aptly titled The Independent Pediatrician. They believe, much like we do at the Verden Group, that the day of the independent physician is not gone, rather, it just needs support from folks like us to help ensure that those brave docs thrive.

You can read the first issue here, free, on Issuu: http://issuu.com/independentpediatrician/docs/tipvol1

Enjoy!