Vital Signs: A November 2024 wrap-up of revenue cycle management healthcare news

Welcome to “Vital Signs,” your go-to monthly roundup of all things related to RCM tailored specifically for independent practices. Access previous editions for the top insights and developments here.

November was a busy month of revenue cycle management news with important developments related to the Medicare physician fee schedule, prior authorizations, healthcare staffing shortages, and more. Here’s a roundup of 7 newsworthy stories to share with physicians and staff in your medical practice.

The specifics: On November 1, CMS published its CY 2025 Medicare physician fee schedule final rule that takes effect January 1, 2025. While the rule includes a 2.8% payment cut, it also includes many new payable services such as caregiver training, new atherosclerotic cardiovascular disease risk assessment and risk management, advanced primary care, and more. In addition, there are more opportunities to bill evaluation and management (E/M) visit complexity add-on code, G2211.

Why it matters: New services bring new revenue opportunities that can help offset the physician payment cut and provide new avenues to keep patients healthy.

What’s next: Read up on the changes and how they might affect your medical practice. Here’s a summary from the American Medical Association along with an article from the American Academy of Family Physicians. Meanwhile, if you don’t intend to participate in Medicare in 2025 due to the looming payment cuts or other reasons, you have until December 31, 2024 to update your Medicare participation status. Don’t forget to keep tabs on how president-elect Donald Trump’s policy changes could affect the physician payment system long-term. Something else to put on your radar? The growth of nurse practitioners (projected to grow by 40% from 2023 to 2033), which could have implications for the physician workforce and their compensation.

The specifics: According to AMGA’s 2024 Medical Group Compensation and Productivity Survey, medical groups reported an overall 5.2% increase in median productivity (wRVUs) and a 3.0% increase in median visits compared to the prior years’ survey data. However, staffing levels only increased 1.3% on a per-provider basis over the same timeframe. 

Why it matters: The data suggests that medical groups continue to face staffing challenges in the overall economic environment.

What’s next: While medical groups look to advanced practice clinicians to fill the gaps, especially in states where they can provide care independent of physicians, doing so may have financial implications. Having a thoughtful strategy to address increased patient demand in your medical practice is paramount.

The specifics: When medical practices reach out to new patients via the patient portal 3 to 14 days before their initial visit, 79% of patients report a positive experience, a new study found. In the study, outreach included a message with a greeting, an introduction to the research project, and an invitation to respond directly to the question, “What do you want your healthcare team to know about you as a person?”

Why it matters: Researchers found that reading patient narratives fostered an immediate sense of connection for clinicians. It also facilitated agenda setting and improved the sense of efficiency of the visit.

What’s next: Consider leveraging your EHR and patient portal for this purpose. While you’re at it, look for other ways to optimize the patient portal. Here are a few suggestions from the AMA. 

The specifics: Two out of 3 doctors say they spend “more” or “much more” time on prior authorizations than they did 3 years ago, according to the Medscape Physicians and Prior Authorizations Report 2024. 

Why it matters: Prior authorizations pose a significant administrative burden on today’s medical practices that are already plagued by healthcare staffing shortages and other challenges.

What’s next: The Medscape report found that physicians want uniformity among government and private payers when it comes to prior authorization procedures. They also want greater automation. Meanwhile, the AMA, which has long advocated for prior authorization reform, seeks a federal ban on post-service coverage denials for pre-certified care that could be a step in the right direction. Another potential step in the right direction? CMS is changing the review timeframe for standard prior authorization decisions from 10 business days to 7 calendar days for requests submitted on or after January 1, 2025. The timeframe for expedited requests remains 2 business days.

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The specifics: Participants in the ACO REACH Model collectively generated $1.6 billion in gross savings and $695 million in net savings during performance year 2023 after accounting for shared savings and losses, according to new data from CMS. 

Why it matters: ACOs can reinvest these record savings to provide better patient care and improve patient outcomes.

What’s next: While the ACO REACH program is set to expire in 2026, the National Association of ACOs strongly urges CMS to extend the program. Stay tuned for future developments and revenue cycle management news. 

The specifics: A recent study involving patient and clinician focus groups found that there are barriers to widespread adoption of uniform approaches to collecting, documenting, and exchanging social determinants of health (SDOH) data. 

Why it matters: Understanding and overcoming these barriers ensures that SDOH data can be captured in a way that improves care and allows for progress toward an equitable healthcare system.

What’s next: Researchers say several changes can help move the needle on SDOH data collection, including technical and policy solutions allowing patients more control over how their data are documented and shared, enhanced training for clinic staff who may be collecting SDOH information, and additional financial incentives and resources to allow for greater time with patients and targeted assistance. 

The specifics: Nearly 1 in 4 United States adults has health coverage all year but is underinsured, according to the Commonwealth Fund 2024 Biennial Health Insurance Survey. Among adults who were insured all year but underinsured, 66% had coverage through an employer, 16% were enrolled in Medicaid or Medicare, and 14% had a plan purchased in the marketplaces or the individual market.

Why it matters: Individuals who are underinsured face high out-of-pocket costs and deductibles that force many to skip needed care or take on medical debt. 

What’s next: If Congress fails to extend tax credits currently set to expire at the end of 2025, marketplace enrollees will face an average premium increase of $705, and 4 million more people are projected to become uninsured. This could have a profound financial impact on your medical practice, so it’s critical to stay abreast of future developments and revenue cycle management news.