Poor Payer Reimbursements are Effecting Practices During COVID-19

HealthIT Answers posted an interesting article on how the pandemic is effecting providers.

“Most physicians who have been practicing for a few decades remember the days when private payer reimbursements dwarfed Medicare reimbursements. That dynamic has long since flipped, starting with the 2008 recession. Reimbursements have been flat or have lost value from inflation, while practice costs have seen double-digit increases. Meanwhile, hospitals and insurance-owned health networks have seen reimbursements increase to 300% or more of Medicare in some cases, whereas it’s not uncommon for private practices to receive rates far below Medicare standards. Many practices have seen their volumes decrease from 30% to up to 90%, and a significant number are closing their doors for now. As states start to allow elective surgeries to resume in the coming months, some specialties will see some slight increases in patient volume, but this pandemic will have long-lasting repercussions for every practice and every specialty. Whit that in mind, here are four examples of how the COVID-19 Pandemic is effecting specialties across the nation in real-time:

Primary Care Practice
One solo physician primary care practice in southern Florida has been hit particularly hard by the pandemic as the physician owner took it on himself to create a separate ‘isolation’ intake entrance with safety gear and safety partitions. He went to these lengths so he could still see patients who might be COVID19 positive without putting his other patients at risk. Every patient he sees that is prevented from going to the emergency room with a false positive saves the system, and the payers, tens of thousands of dollars. Despite this physician’s efforts to do right by patients, none of these measures are reimbursable. Everyone can see just how unfair and intolerable that is, yet he refuses to stop seeing sick patients. These are the heroes of the pandemic. Our society has chosen to give the lions share of the revenue and resources to the hospitals, even though they are overwhelmed and unequipped for this sort of a pandemic.

Podiatry Practice
One group in New Mexico was also frustrated with the ever-increasing practice costs and narrowing margins caused by years of stagnant reimbursement rates. The owners decided to merge practices with another group to find savings through efficiencies, consolidate costs, and increase patient volume. As the pandemic hit they saw their patient visits decrease by 65%. They’ve furloughed most of the staff and started the process of converting to a multi-specialty with Medicare and the payers to try to capture more revenue from more lucrative procedures. They viewed COVID19 as an opportunity to diversify their services to better weather future disruptions. There is no guarantee such a move will insulate their practice from further disruptions if the pandemic continues or sees another wave of outbreaks, but they want to invest in the future while they have the time to see the change through.” …

Read the entire article by Cameron Wood at HealthIT Answers

View all Articles by: Melissa's Mentions