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Andrew Montalvo · Jan 19, 2022

Top three challenges facing today’s independent medical practices

The number of independent medical practices has decreased significantly in the past several years. Only 14% of U.S. physician practices were hospital-owned in 2012; that number had increased to 29% in 2016.1 According to a 2018 survey, 54% of physicians worked in independent medical practices in that year, while in 2020, that number had decreased to just 49%.2 The Affordable Care Act provides financial incentives for physicians to join hospital-affiliated accountable care organizations,3 and hospitals and multi-hospital systems have been acquiring more and more independent practices in a process known as vertical integration.1,3,4

The goal of vertical integration is to decrease healthcare spending while improving quality of care. So far, though, research has not shown an association between vertical integration and either financial savings or improved care. In fact, several studies show that vertical integration is associated with increased spending.1

On the other hand, independent practices deliver cost effective, quality care to patients. Despite their dwindling numbers, they are responsible for the majority of the healthcare delivered in the U.S. today.5 Studies show that smaller, physician-owned practices provide a higher degree of personalization and responsiveness to patients’ needs; lower average cost per patient; fewer preventable hospital admissions; and lower readmission rates than larger or hospital-owned practices.5-7

Independent practices are a valuable part of the medical system—but they face numerous challenges in today’s changing healthcare environment. In this article, we look at three of the top challenges currently faced by independent medical practices and explore some ways Practice Fusion can support today’s independent medical practices.

Challenge #1: Decreased time with patients

Electronic health records (EHRs) and other administrative work have consistently demanded more time from physicians in recent years, both in independent and hospital-owned practices. These tasks decrease the amount of time providers have available to spend with patients.5,8,9

One facet of this challenge is that the nature and workflow of patient visits are changing. In the past decade, nearly all providers started using EHRs to document their patient encounters. Adding healthcare IT into clinical encounters has made it necessary for providers to change their patient visit and documentation workflows—a process further complicated by the arrival of COVID-19.10

A physician survey found that clinicians are working longer hours but spending less time with patients, due to the growing amount of paperwork required, including time spent in EHRs.12 Providers are spending more time than ever before on documentation and administrative tasks, leading to dissatisfaction and burnout.10 A 2016 study found that providers spend nearly two hours on EHR and desk work for every hour of direct clinical face time with patients, and a 2018 physician survey found that providers spend almost half their time on data entry and other administrative tasks.13,14

Time is an essential resource for physicians. Time is what allows a physician to get to know their patients and any relevant psychosocial circumstances; to make a thorough diagnosis; and to develop an effective treatment plan. More time with patients can lead to:10,11,15

  • Enhanced job satisfaction for providers
  • More positive patient outcomes
  • More satisfied patients
  • Decreased rates of malpractice claims

More time with patients can help to decrease the risk of inappropriate prescribing practices, as there is an association between shorter visits and increased rates of medication prescriptions.15

Giving providers the time they need to effectively care for patients is essential for both patients and providers.

Challenge #2: Increased regulatory requirements for data reporting

Another pressure facing independent practices is the increased data reporting required by regulatory measures such as the Quality Payment Program (QPP). As payment models shift from volume-based to value-based, there are more and more reporting requirements for the QPP and similar programs.16 Staying on top of the latest programs and their reporting requirements is an ongoing challenge for today’s providers. This is particularly true for providers in independent practices, who are less likely to have administrative support from IT personnel, office managers, practice managers, or other support staff.

For instance, the Merit-Based Incentive Payment System (MIPS) is one of two programs used by the Centers for Medicare and Medicaid Services (CMS) to reward high-quality providers with payment increases while simultaneously decreasing payments to providers who fail to meet performance standards.17 MIPS is used to determine Medicare Part B payment adjustments under the QPP based on eligible providers’ participation and performance levels.17,18

MIPS participation requires eligible providers to track and submit data for three of four performance categories for the 2021 MIPS performance year:19

  • Quality
  • Improvement activities
  • Promoting interoperability

Performance in these categories is used to help determine providers’ MIPS Final Score which, in turn, is used to help determine if a provider receives a positive payment adjustment, negative payment adjustment, or neutral payment adjustment.19

This increased need for data collection and reporting also affects physicians’ time with patients.5,8

Challenge #3: Increased physician burnout

The first two challenges contribute to the third top challenge facing physicians in today’s independent practices: burnout.

The Agency for Healthcare Research and Quality defines burnout as a long-term stress reaction that is characterized by emotional exhaustion, depersonalization, and a loss of feelings of personal accomplishment.20-22 The National Academy of Medicine reports that more than 50% of U.S. physicians report symptoms of burnout.22 A survey from the Physicians Foundation reveals:12

  • 80% of physicians in all specialties report feeling they are working at full capacity or are overextended
  • 78% report feelings of burnout
  • 65% feel more overworked now than at the start of their careers

COVID-19 has only exacerbated the issue.23

Initial studies of physician burnout focused on hospital settings and large primary care practices.24 However, when researchers looked at small, independent practices (fewer than five physicians, nurse practitioners, or physician assistants) they found a burnout rate of just 13.5% of providers.9,25 A closer look revealed that there is not a direct connection between practice organization and burnout rates, though; instead, burnout seems to be connected to a number of organizational risk factors, such as:26

  • Excessive workload
  • Lack of workplace control
  • Misalignment of physician and organizational values

Studies suggest that smaller independent practices are associated with several protective factors against burnout:24,25

  • Greater autonomy
  • Opportunities to form deeper relationships with patients
  • Fewer work hours
  • Increased learning opportunities

Burnout also affects clinicians’ happiness, personal relationships, and career satisfaction.27 The consequences of burnout range from high rates of provider turnover to reduced job performance, threatening patient safety and quality of care.20-22,27 A study in the American Journal of Critical Care shows a link between burnout and an increase in medical errors. Burnout is also associated with decreased patient satisfaction and malpractice claims become more likely when physicians are suffering from burnout.23,28

Researchers believe the leading cause of provider burnout is the administrative burden physicians face.27-29 The 2017 Medscape Lifestyle Report names bureaucratic tasks as the primary cause of physician burnout.30 The 2017 Medscape Physician Compensation Report revealed that more than half (57%) of physicians spent at least ten hours per week on paperwork and administrative tasks.30 By 2018, that number had increased to nearly three-quarters (70%) of physicians; 32% of providers were spending 20 hours or more a week.27,29,31 By 2021, physicians were spending an average of 15.6 hours per week on paperwork and administration.32 They also found that EHR usability was unacceptable to most U.S. clinicians.33

Burnout is a major challenge for independent practices, but by tackling EHR usability, practices can address one of burnout’s major causes.

Combating challenges for independent medical practices

Physicians in today’s independent medical practices face steadily increasing pressures. The three challenges highlighted here—decreased time with patients, increased regulatory reporting requirements, and increased provider burnout—are connected, each magnifying the others. At Practice Fusion, our goal is to help providers combat and minimize each of these pressures.

Since EHRs can directly affect all three of these challenges, we believe it’s critical to work closely with providers to identify their specific workflow needs. This enables us to improve our EHR in ways that will:

  1. Make EHRs faster and more intuitive to use, so they free more time to spend with patients and don’t contribute to provider burnout.
  2. Improve EHR usability, which is associated with improved patient care, more positive patient outcomes, and improved work-life integration for providers.
  3. Implement features that will help combat other pressures, such as helping track and report data for the QPP.

We utilize a user-centered design process in order to develop a product more closely aligned with providers’ requirements.35 Our goal is to develop an EHR with high usability—that is, one that is intuitive to use and allows users to perform required tasks quickly and efficiently. By prioritizing usability, we believe Practice Fusion can help improve both patient care and physician well-being, helping independent medical practices to thrive in 2022 and beyond.34

References:

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  2. AMA analysis shows most physicians work outside of private practice. American Medical Association; May 5, 2021. https://www.ama-assn.org/press-center/press-releases/ama-analysis-shows-most-physicians-work-outside-private-practice.
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