Top 5 Challenges in 2015 for Healthcare Organizations

February 20, 2015
  • Carestruck's Top Five Challenges of Marketing Strategy

Revised from Jessica Parker, Healthcare Expert on LinkedIn.

Government regulations, financial pressures and consumer expectations will continue to drive changes in the US healthcare industry. Experts believe that to thrive, healthcare practices must overcome challenges from multiple sources of pressure in 2015. From increased costs and regulatory burdens to declining reimbursement, leaders will have to gear up for some tough obstacles this year.

1. ICD 10

Practices struggling with transition to ICD-10ICD-10 will be challenged to enhance patient care, reduce costs and increase efficiency – competing priorities that may prove daunting for organizations that aren’t prepared for the transition. Many small practices are not yet prepared to go live with ICD-10 this October. Transition may be costly to small as well as large healthcare organizations. To ensure payment, billers will need to send ICD-9 and ICD-10 claims during a brief period of transition. Dual coding multiplies workloads, becomes time consuming, and creates new opportunities for error.

2. Second Phase of HIPAA Audits

Many organizational leaders remain unaware of the requirements for HIPAA and Meaningful Use (MU). The Office of Civil Rights will conduct its second phase of HIPAA audits in June 2015. Approximately 350 healthcare organizations will be asked to submit patient health data security information from which approximately 150 will be audited. Depending on the scale of the HIPAA breach, practices could see fines as little as $100 or as high as $50,000.

3. Stage 2 of CMS Meaningful Use

OrganizatiHealthcare consumers face additional financial pressureons that meet Centers for Medicare Meaningful Use (MU) Requirements will see significant dividends. However, organizations that fail to meet MU requirements will experience a 1% decrease in their Medicare reimbursement in 2015. According to a poll conducted on 2000 physicians, approximately 55% don’t plan to attest to MU Stage 2 (MU2) this year. As pa
rt of MU2, physicians face the challenge of persuading 5% of patients to view, download and transmit electronic health information through a patient portal attached to their EHR.

Accomplishing this milestone will require a very deliberate strategy for communicating to patients, promoting behavioral change in the patient base, and additional ongoing technical support. It’s likely to increase the average length of visits and could hamper operational efficiency if not carefully planned.

4. Co-pay Collection and Deductibles

New plans created under the Affordable Care Act (ACA) will add to the existing burden of co-pay collections and deductibles. Since more patients purchase and use ACA plans with higher deductibles, physician practices will face a significant challenge in getting timely payments. A sharp rise in average deductibles will add pressure to an already tapped healthcare consumer since healthcare premiums have seen broad scale increases simultaneously.

5. Shift in Payment Model

Most medical specialties, especially primary care physicians (PCP’s), will face challenges due to the transition from fee-for-service to value-based payment model in 2015. Physicians who fail to report PQRS data to the CMS will have to face financial penalties, and these lapses will not only impact their profitability, but invariably they will trickle up to the larger hospital systems with which they are affiliated.

These are just a few of the challenges facing healthcare organizations in an environment changing as rapidly as this one. So, stay tuned.