Primary care must become 'one-stop shop' for health needs

Primary care must become 'one-stop shop' for health needs
Primary care must become 'one-stop shop' for health needs

LAS VEGAS — Small independent, privately owned practices are becoming few and far between as primary care feels the pinch on the economic and workforce fronts, and clinicians must adapt to make sure they stay relevant in today's changing health care environment.

“There's a changing face of primary care and those of us who are independent practices have to realize that there are certain things that we need to be doing in order to survive,” Jo Ann Serota, DNP, RN, CPNP, FAANP, of Ambler Pediatrics in Pennsylvania told The Clinical Advisor.

Increasing regulations, more complicated reimbursement models, and more expensive costs associated with factors including malpractice insurance and technology implementation have combined to create a system in which fewer medical professionals choose primary care as more large hospital systems and corporations proliferate.

Serota offered her tips for staying alive in primary care during a session at the National Association of Pediatric Nurse Practitioners 2015 meeting.

Maximize reimbursement

Working closely with coding and billing is essential for small practices to insure that payment for services is timely and complete.

“Small independent practices need to follow a business model to survive. It's not enough to just do the medicine half,” Serota said. “We also have to be smart business women and men.”

Pay for performance is becoming the primary reimbursement model in the United States, and clinicians must now prove their worth to be reimbursed at a top tier, according to Serota.

This involves making sure the practice is up to date with evidence-based medicine and quality standards required by insurance companies and Medicaid using National Committee for Quality Assurance (NCQA) standards and Healthcare Effectiveness Data and Information Set (HEDIS) reports.

“You need to make sure that you're being compliant with evidence-based practice, and you need to have good patient outcomes in order to be reimbursed at a proper rate,” Serota emphasized.

Independent practices may also want to consider becoming part of an Accountable Care Organization (ACO) for support in creating stronger coordinated care networks as well for as better economic support.

“We joined a few ACOs, so we can be available for families who are working within those hospital networks and that keeps patient's coming,” Serota said. “It's nice to be able to have a group of practices, specialists and a hospital join together to work out reimbursement issues and patient outcome concerns.”

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