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Primary care physician practices are adapting to financial realities of COVID-19

With a precipitous drop in volume, some organizations are going back to basics from a revenue cycle standpoint.

Jeff Lagasse, Associate Editor

All healthcare organizations are suffering financially during the COVID-19 epidemic. Hospitals are on the front lines of treatment while also seeing precipitous drops in volume and business. The pandemic is also threatening the financial health and long-term stability of clinics and specialty practices.

Primary care physician practices are no exception, but strategies have emerged that could help them weather the storm.

Although the impact to these practices differs depending on factors like size and the type of services they render, across the board there's been about a 40% drop in volume in April, according to Niki Hemminger, senior manager of provider services operations at Availity. It's a substantial hit.

"With smaller provider groups, a lot of it has been dependent on their health prior to the pandemic," Hemminger said. "If they were in a very unhealthy place, this could be the last straw for them to shut their doors."

The next several months will be a critical time for the smaller and medium-sized groups in particular.

"Larger entities will probably weather the storm in most cases," Hemminger said. "Small provider groups and some of the mid-sized groups are the ones who are going to struggle the most. We've already seen over the last few years a move to these provider groups getting eaten up by larger hospital groups, so you might see that being accelerated more than it has been in the past.

Certain specialists, such as podiatrists, are still unable to render services at this point, though with the gradual re-opening of certain sectors of the economy, that could change. Smaller physician offices, even if they can still deliver services, are struggling with the volume drop and wondering how they can stay afloat.

To weather the storm, some practices are getting creative.

"They're going back to basics from a revenue cycle perspective, taking advantage of expertise within the billing office – looking at processes, looking at workflows, to see if there are opportunities there," said Hemminger. "Smaller groups carry a lot of days in accounts receivable. There's an opportunity to focus on denials, high-dollar claims potentially, and trying to continue to get that revenue in the door at a time when they're not getting a lot of claims transactions out."

Some practices, for example, are focusing the spotlight on claims denials, using the billing staff to dig into the trends. It's a back-to-basics approach that allows organizations to put processes and workflows in place to more efficiently address things like high-dollar claims and timely filing – and perhaps even to review their eligibility processes if they're getting a high number of eligibility errors.

With a 40%-plus reduction in transaction volumes across the board, Hemminger stressed the importance of retaining experienced billers during the pandemic. They're needed during this time.


Opportunities to get the financial house in order also exist in areas like billing and scheduling.

"From a scheduling perspective, a lot of them are kind of at a standstill," said Hemminger. "They don't know when they can start scheduling again."

In this scenario, Hemminger recommends re-strengthening the staff and getting them focused on other things – a process that can be helped out by those in accounts receivable. When they're registering patients, they can focus on factors such as prior authorizations, eligibility and trying to shorten the time it takes to get that information, and determining when the info is needed. It's all about efficiency.

Primary care groups are fortunate when it comes to the concessions that have been made with MIPS and MACRA, with the relaxation of reporting requirements. That, said Hemminger, should allow them the chance to look at what they're doing from a reporting perspective and review the requirements in general – the better to stay on top of things once things return to some semblance of normality.

"From a true transactional perspective, I think we'll continue to see volumes go even lower depending on how long this goes," she said. "From a true revenue perspective they're probably just now starting to see some of that. Over the next couple of months it will really be telling, to determine which groups will be able to survive."

Hemminger also pointed out that with the popularity of telehealth exploding during the pandemic, practices and physician groups can look into implementing some of these technologies to help make up for some of their lost revenue.

"I would just recommend providers focus on what they can impact right now," she said. "They can't perform non-emergency services or routine care, so they should use the time to determine if there are opportunities with telemedicine and telehealth. There are things they can change with the way they practice in order to be more efficient."

Twitter: @JELagasse

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