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In the midst of a pandemic, the biggest changes healthcare leaders reported in their medical practices last year revolved around staffing, cost and revenue, practice transformation, information technology, and operations, according to a December 2020 report from the Medical Group Management Association (MGMA).
The report was assembled from the results of weekly Stat polls by MGMA, which consists of 15,000 group practices representing more than 350,000 physicians. During the course of the year, more than 4800 practice leaders were surveyed, but the individual polls had far fewer respondents.
The 2020 data represents snapshots from different points in the developing public health crisis. Still, much of what practices experienced earlier in the pandemic continues to apply, and it’s likely to persist this year as long as the coronavirus spreads and its toll deepens.
One topline conclusion of the report: the economic pain felt by practices has resulted in layoffs, furloughs, and/or reduced compensation for providers and staff.
In the May 19 weekly survey, 82% of respondents said some or all of their providers’ compensation had been affected by the crisis. Sixty-two percent said every provider had been affected. Provider compensation was cut in several ways, including reduced hours and salaries, reduced or eliminated bonuses, and lower allowances for continuing medical education.
Sixty-one percent of healthcare leaders said in the June 26 poll that their own compensation had decreased.
In the following week’s survey, one in three managers said their organization had reduced staff compensation. Nearly all of the respondents in this category predicted the salary reductions would be temporary.
As of March 17, early in the pandemic, 40% of healthcare leaders said they were experiencing staff shortages. An April 21 poll found that 53% of healthcare leaders were taking steps to address their providers’ and staffers’ mental health.
“The mental and emotional toll on everyone continues to be a concern, as public health authorities continue to report alarming numbers of new [COVID-19] cases, hospitalizations, and deaths,” MGMA commented.
Telehealth and Remote Monitoring
Nearly all of the healthcare leaders surveyed on March 31 reported that their practices had expanded telehealth access because of COVID-19. The percentage of patient visits handled remotely had dropped substantially by the fall, according to a Harvard University/Commonwealth Fund/Phreesia survey. Still, it remains significantly higher than it was before the pandemic.
“At the end of 2020, telemedicine continues to play a vital role in everyday practice operations and long-term planning,” the MGMA report says. One indication of this, the association said, is that healthcare leaders are recognizing new best practices in specialty telemedicine, such as pediatrics and Ob/Gyn.
According to an April 28 poll, the top three coding/billing challenges for telehealth and telephone visits amid COVID-19 were inconsistent payer rules, pay parity and accuracy, and documentation of virtual visits.
While the Centers for Medicare and Medicaid Services (CMS) has loosened its regulations to allow reimbursement of telehealth in all locations and at the same level as in-person visits, most of those changes will not last beyond the public health crisis without new legislation.
More healthcare leaders are considering the use of remote patient monitoring, MGMA said, but only 21% of practices offered such services as of September 15. The report drew a connection between these plans and the current challenge of deferred care.
In the July 21 poll, 87% of healthcare leaders reported that safety concerns were the top reason that patients deferred care amid COVID-19. The MGMA report quoted JaeLynn Williams, CEO of Air Methods, which provides helicopter ambulance services, as saying that many people are staying home even when they face life-threatening conditions such as chest pain, drug symptoms, inflamed appendix, and gallbladder pain.
Overall, MGMA said, practices that have taken a financial risk have done better during the pandemic than fee-for-service practices because their monthly capitation revenue has continued unabated. In contrast, “most groups’ struggles to sustain visits and procedures meant less revenue and lower compensation,” the report says.
In the August 18 survey, one in three healthcare leaders reported their practices were changing their operational metrics and how often they looked at those measures due to the pandemic. “Practice managers are asking for dashboard data in weeks instead of months to measure the drop in charges and forecast the resulting change in collections,” MGMA notes. “The type of data practice managers are asking for has also changed.”
Among the new metrics that practices are interested in, according to an MGMA article, are measures that track telehealth visits, the productivity of staff working at home, and the number of ancillary services and procedures that new patients might need based on historical data.
Nearly all healthcare leaders surveyed on August 11 said the cost of obtaining personal protective equipment had increased during 2020. MGMA said it expects this situation to worsen if the pandemic lasts through the summer of 2021.
While everyone is talking about the botched launch of the COVID-19 vaccination campaign, there were also problems with flu vaccination in 2020. In the September 25 poll, 34% of healthcare leaders reported their practices were experiencing delays in getting the flu vaccine.
Looking further ahead, the report recommends that practices make plans to boost staff morale by restoring bonuses.
In addition, MGMA suggests that physician groups reassess their space needs. “The equation is simple — fewer nonclinical staff members at your facility means you should repurpose that office space or consider finding a better fit for your new real estate needs in 2021.”
Finally, MGMA noted that the practices expanding rather than contracting their business are those increasing their value-based revenues by taking on more risk. For those groups, MGMA said, “growing the patient panel can help [them] seek better rates in contract negotiations.”