1. Ten Predictions for Medical Practices in 2014 Ten Predictions for Medical Practices in 2014 By Mary Pat Whaley, FACMPE, CPC

2. PREDICTION #1 - MORE CASH PRACTICES More practices will add a cash component to their practice. It may be cash for additional services, cash for telemedicine, email or texting, a Direct Primary Care (DPC) model where cash augments or replaces the insurance payment or an all-cash practice that bypasses insurance payment altogether.

3. PREDICTION #2 – GROUP VISITS MAKE $EN$E Medical practices will adopt group visit models. The group visit will become more popular as physicians realize that seeing 12 – 15 patients in a group for 90 minutes makes more sense than seeing 10 patients each for 15 minutes. Most patients really enjoy a visit that includes time with other patients that share the same problems – widely used for diabetes, COPD and heart failure patients.

4. PREDICTION #3 – INDEPENDENCE WILL NOT DIE Physicians will hold on to their independence via a variety of practice models. The models that will allow physicians to continue to practice independently are lean solo practices, Independent Physician Organizations (IPAs), Physician Service Agreements (PSAs), Accountable Care Organizations (ACOs) and Single Tax Identification Number Organizations (S-TINs.)

5. PREDICTION #4 – TOS PAYMENTS ARE CRITICAL Practices that master time of service payments will be able to pay their physicians. The “shock absorber” in private practice is the physician’s take-home pay. Only those practices that have substantial cash (elective) services or that build strong time of service collections will be able to sustain the physician’s desired salary. Even surgeons will struggle with the balance of insurance payments vs. patient payments.

6. PREDICTION #5 – OUTSOURCING BRINGS SAVINGS Forget what you thought you knew about what you can outsource. Practices can outsource appointment scheduling, billing and even nurse triage. Virtual assistants, home workers, apps and software-as-a-service (SaaS) can be the answer. If physicians can adjust to the idea that their employees aren’t physically in the office, they can take advantage of what technology has to offer in savings.

7. PREDICTION #6 – THE HEALTHCARE CLOUD IS HERE The cloud has gone mainstream. Small practices cannot justify the investment in hardware and mid-to-large practices are looking for the flexibility and mobile advantages the cloud has to offer. Traditional On-site, client-server HIT is now the exception, not the rule. Groups are looking for a basket of services – EMR, PM, email and calendar, marketing etc. - that can work together, as well as with their legacy systems.

8. PREDICTION #7 – THE VALUE PARADIGM Everyone has heard that healthcare is moving from volume to value. Whether practices are part of an ACO or negotiating independently, they will be expected to demonstrate value to patients and payers. That means population management, no duplication of tests, outpatient care vs. inpatient care, care protocols, and a focus on prevention and wellness.

9. PREDICTION #8 – THE YEAR OF THE GOVERNMENT MANDATE It is a tsunami year for government mandates and it will push some practices over the edge and into opting out of Medicare. If a practice wants to maximize their paltry Medicare payments, they will have to comply with and act on Meaningful Use (MU), the Physician Quality Reporting System (PQRS), the Health Insurance Portability and Accountability Act (HIPAA) and the International Statistical Classification of Disease, 10 th Edition (ICD-10).

10. PREDICTION #9 – SOCIAL MEDIA MAKES SENSE Engaging with current and potential patients on social media platforms does three things for your practice. First, it communicates medical, nutritional, and specialty health information to your patients in a place they are looking for it. Second, it creates an Internet presence that is widely picked up by search engines – again, where your patients look. Third, it produces value as a marketing tool.

11. PREDICTION #10 – PHYSICIANS LEAVING HOSPITAL EMPLOYMENT Some physicians will leave willingly and others will be released from employment. Hospitals are finding (again) that managing physician practices is not intuitive, and they will start to weed out physicians who are not toeing the line. Some physicians who have put their time in at hospitals, finding that they can return to private practice for as little $20K, will start over again in a new world.

12. Mary Pat Whaley, FACMPE, CPC President, Manage My Practice (919) 370.0504 marypat@managemypractice.com