5 Ways to Increase Physician Income Despite Healthcare Reform

Healthcare reform and declining Medicare reimbursement have thrown physicians for a financial loop; how can medical doctors increase physician income despite healthcare reform?

Here are 5 ways to increase physician income despite healthcare reform, while understanding the legal and regulatory trends driving healthcare change:

• Telemedicine: Shift from a physically-based practice to a virtually-based, online, tele-health / telemedicine practice. Expand medical practice to include online alternatives so the patients can be seen anytime, anywhere, via online and mobile tools.
• Mobile Health Apps: Develop an educational-based app that garners income based on clicks and not physical patient visits. Be sure to fall within FDA guidelines for low-risk general wellness consumer products so as not to fall within the more burden regulatory category of medical devices. Also be sure your healthcare and FDA attorney reviews your product in light of FDA’s mobile medical app guidance – again, to be sure your product falls within those health apps that FDA is unlikely to regulate as medical devices.
• Concierge Medicine: See few patients, out opt of Medicare, and develop a cash-only (or hybrid / partly insurance-based) concierge medical practice or direct primary care (DPC) clinic. Charge more to do less.
• Wellness Program: Focus on lifestyle education, meditation & relaxation response therapies, and retool from disease care to a concierge-like wellness program that has patients take charge of their lifestyle, and utilizes advances from functional medicine and related disciplines to put together gut, behavior, diet and nutrition, fitness MBSR, and stress-releasing self-care. Become a patient educator instead of a health disaster management specialist – keeping disease care for those patients who truly need it.
• Integrative Medicine: Combine the best of conventional care with evidence-based complementary and alternative therapies, so as to maximize prevention and provide patients with high-touch, low-tech alternatives to low-touch, high tech medical care. Increase patient satisfaction by discussing and offering CAM alternatives that will keep them healthier in the long run.

Concierge Medicine Today points out a number of trends that affect physician revenues, in 12 Changes That Will Affect Doctors’ Income in 2015. These include:

• High insurance deductibles (creating pressures on physicians to provide cost estimates to patients)
• Lower malpractice premiums (especially for OB-GYNs, internists, and general surgeons — good news for physicians)
• ICD-10 (new coding)
• ACO-driven healthcare
• Telemedicine (with telemedicine companies both employing physicians, and, creating competitive challenges for physicians
• Retail clinics creating competition (staffed mostly by nurse practitioners who follow clinical protocols, and basically treating 5 common conditions: sore throats, ear infections, sinus infections, bladder infections in women, and conjunctivitis)
• Loss of Medicare reimbursement especially for primary care providers
• Meaningful use penalties
• Penalties for not reporting under the Physician Quality Reporting System (PQRS)
• Legal requirements that physicians report payments made to them by Medicare and manufacturers of drugs and medical devices
• Medicare paying for chronic care outreach (which will pay physicians for managing Medicare patients with two or more chronic conditions, even when contacts are made by phone or email rather than face to face)
• New CPT subset modifiers XE, XS, XP and XU (respectively for separate encounters, separate structure, separate practitioner, and non-overlapping services)

Some of the above trends facilitate physician revenues, but most go contra.

Our philosophy with respect to maximizing physician income is, “if you can’t beat ’em, join ’em.” For example, national telemedicine networks will disrupt the traditional patient office visit – and, many physicians will join these networks, seeing low-hanging income fruit (although probably a low amount, which the marketplace will continue to drive still lower – then again, this may beat Medicare and insurance reimbursements). The alternative will be for physicians to expand their physical practices into the virtual world, maintaining the same trusted relationships but going beyond brick-and-mortar to provide concierge level, individualized, wellness and preventive and diagnostic services via the Web.

Current prohibitions on following patient care into different states, as patients move or vacation elsewhere, will relax as telemedicine laws continue to loosen current regulatory boundaries, lagging behind yet still tracking technology trends. See our earlier post on telemedicine – licensing, fee-splitting, HIPAA, and corporate practice of medicine.

Similarly, as retail clinics move care from the physician level to nurse practitioners and other physician extenders, physicians can create consortiums of providers – through integrative medicine clinics – that move care into the domains of other providers (such as chiropractors and acupuncturists), while creating a legal umbrella for the integrative care center that drives revenues to the physician-owned professional medical corporation as well as the management services organization (MSO) that can also be physician-owned. This takes detailed understanding of how to legally structure the integrative care center, and of legal strategy so that revenues flow in a compliant way that also maximizes the bottom line.

Physicians should be aware that the products side of healthcare has as much income potential as the services side. Wearable health technology and the “appification” of healthcare signal a shift away from physical services into new delivery models for health and wellness services. Patients are looking more and more to the self-care quick fix as opposed to sitting in a waiting room for a Wizard of Oz like figure to come greet and reassure them. Physician clinics will be competing with retail medicine clinics and the more physicians can do to streamline their services (or turn them into products), the healthier their bottom line.

Our healthcare attorneys and healthcare lawyers track physician developments so we can counsel our clients on their healthcare compliance legal obligations. Contact our healthcare legal team for laws and updates relevant to your situation.