Trends in Practice Management

What lies ahead for private practitioners in 2016 and beyond?

Vol. 27 • Issue 6 • Page 8

Management Focus

Some of the megatrends we’re seeing in healthcare today foretell what the top practice management trends will be in the next year:

  • Fee-for-service payments are continuing to decrease;
  • Fee-for-service models are being replaced by other models, ranging from flat per-visit payments to payments-per-episode to bundled payments;
  • More third-party payers (commercial insurance, government payers, and self-insured employers) are requiring evidence of value in the form of outcomes;
  • Patients are paying more out of pocket than ever.

Based on the above, here are my fearless predictions of the top practice management trends facing our industry.

Care coordination across silos. There will be more emphasis on care coordination, collaboration, and communication for effective case management across different healthcare settings. Many payment arrangements are designed to encourage more collaboration and coordination of care across the continuum, from hospitalization through post-acute care and outpatient services.

Providers who develop personal relationships with providers from other facilities can better take advantage of these payment arrangements. For example, outpatient PT clinics would be well-advised to develop a closer working relationship with orthopedic surgeon referral sources and hospitals in the Comprehensive Care for Joint Replacement bundled project.

Changes in productivity standards. Therapist productivity standards will evolve to reflect a post-fee-for-service world. We have lived with discounted fee-for-service bureaucratic rules and arbitrary utilization management for so long that it’s clouded our thinking.

Take a step back and visualize how your care would change if there were no rules. Would it affect the frequency of visits for some of your treatment plans? Would some of the treatment be delivered by qualified assistants, aides, or technicians rather than licensed therapists?

As rules imposed by our current system begin to change, productivity metrics will likely change. For example, instead of measuring productivity based on visits or (worse yet) units, it will likely be measured by cases under management and patient compliance.

Embracing employer-led healthcare activism. Practices will market their services directly to employers. Employers are eager to find effective, low-cost care for their employees, and self-insured employers are becoming more diligent purchasers of healthcare. Forward-thinking managers will develop relationships with employers and offer value-added services for their employees.

Use of existing technology to enable improved home care. Practices will use inexpensive available communications technology to enable better home care while waiting for the release of more specialized affordable telehealth technology and services.

As fee-for-service diminishes and pay-for-performance initiatives gain traction, the ability to provide and manage safe, efficient and effective care outside your clinic walls becomes even more important.

Many patients already have broadband internet access and computers or gaming systems with video conferencing capability. Many have smartphones capable of supporting video conferencing, text messaging, and even heart rate monitoring and exercise logging. Thinking outside the box to implement this technology will be a practice management theme in the next 12 months.

Consumer engagement. More clinics will start programs to better engage patients by demonstrating the value of their services. Since consumers are paying for more healthcare out of pocket, they are becoming more discerning consumers. I don’t believe they are as interested in aggregate outcomes analysis as they are in concrete evidence of the progress they are making.

Direct-to-consumer marketing. Clinics will invest more in direct-to-consumer marketing in lieu of marketing to physicians. Since consumers will have more freedom to choose their own providers under newer plan models, we will see more direct-to-consumer marketing.

Integrating outcomes systems into clinical workflow. Patient-reported outcomes will continue to increase, and these systems will become better integrated into the clinic workflow. Outcomes systems will be tightly integrated with EMR systems, and information from outcomes tests will be utilized in clinical documentation for individual patient goal setting.

This is certainly not a comprehensive list of all the changes likely to occur in the ensuing months. Taking some time to reflect on what’s likely to happen in the next year, is an investment in time very well spent.


  1. For some interesting thoughts on this and other trends, I highly recommend The Grassroots Healthcare Revolution by John Torinus Jr.
  2. I call this the Viagra® model. Pfizer figured out long ago that they needed to go direct to consumer. They knew there was a high demand for their product, but that men were reluctant to bring up this particular problem with their physicians. Their TV commercials and print campaigns urging consumers to “ask your doctor” were genius.

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