Genesis also faces challenges from Medicare, which has a negative impact on regional payment rates, Cohen said. Further, there has been a broad shift of patients from commercial plans to managed care plans, which do not pay as much for services. In terms of payment, Cohen said the preferred provider organization market is much more limited than in other cities because many patients are in managed care groups. California is known for its burdensome regulations, and that creates a struggle for everybody.” For medical practices in general, not just in California, requirements for documentation and the switch to electronic records systems has also been a challenge, he added. “In California, we recently started having to report and check the California database for every narcotic and every schedule 2 to 4 drug that we prescribe. The regulatory requirements are getting more intense, Cohen said. A patient could come in with a specific issue, and I have a doctor who can manage it, but they’re not in that particular managed care or independent physician association.” As a result, there can be a lot of work gaining prior authorizations and getting the approval to perform procedures. “A large number of patients are in managed care models. Some of the challenges in this market directly affect patients and their access to care, explained Edward Cohen, MD, CEO of Genesis. Even so, the urology practice has found ways to grow and improve care for its patients. ![]() ![]() Genesis Healthcare Partners, the region’s largest independent urology practice, is challenged by regulatory changes and the dominance of the regional managed care market, which has huge control of patient flow and payment structures. The San Diego Count, California, weather and lifestyle may be ideal, but not the business conditions.
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