A practice administrator's perspective on healthcare transformation

Hi, I'm Marcy Shimada. I'm the practice administrator at Edmonds Family Medicine. I've been there for about 18 years. We're a mid-sized primary care group. The practice administrator needs to look for strategies that will meet the future needs of the practice and keep the practice relevant in a very changing world. We can help clinicians see themes and opportunities amidst the day-to-day grind of seeing patients and getting all the paperwork done. Doing this is valuable because it builds group cohesiveness and gives us all a sense of mission.

In practice transformation we really need to also consider reimbursement transformation. We have to ask questions like, if a health plan was ready to reimburse us on a shared risk basis today, would we be ready to submit encounter data instead of claims? To accept a per-member-per-month payment instead of our fee-for-service payments? Should we adjust our provider compensation formula? Are there salaries that need to change given different reimbursement mechanics? Do we want to accept downside risk? Are we okay accepting a PMPM payment for our in-house services? Are any services carved out of the per-member-per-month payment and they would still need to be billed as a fee-for-service situation.

If a health plan transformed reimbursement to a hybrid model that rewarded quality scores and cost containment, would we be ready to select quality measures to be used? Would we be ready to select specialists that we refer to that would really work with us to engage in cost analysis and different ways of providing care? Do we agree with attribution of patients? All of these things are important considerations and MACRA and MIPS are already here and they involve these concepts so, we've got to be ready to transform primary care so we can remain financially viable.

Beyond the operational nuts and bolts of the reimbursement issues, we still need to train staff and providers to always put the patient first. We need to train patients to self-manage and we always have to be looking forward.