ABOUT THE PRACTICE PROFITABILITY INDEX (PPI)

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2 ABOUT THE PRACTICE PROFITABILITY INDEX (PPI) The PPI provides an annual window into the issues affecting the financial and operational health of physician practices across the United States. It serves as a barometer of the current state of physician practices spanning a wide range of practice sizes and specialties and provides insight into physician outlooks on the year ahead. The PPI originated in 2013 out of a partnership between CareCloud, a leading provider of cloud-based revenue cycle management, practice management, and Electronic Health Record solutions, and QuantiaMD, an award-winning web and mobile community for physicians. QuantiaMD is a wholly owned subsidiary of Physicians Interactive. 5,024 physicians participated in the third annual PPI survey during July and August of 2015, making it one of the largest efforts of its kind in the industry. Participants provided their insights via an interactive online survey

3 KEY FINDINGS US physicians profitability outlooks are flattening out, rather than trending downward. In contrast to prior years, this year s PPI revealed a moderate upswing in physician profitability projections. More physicians now expect to see profitability staying the same rather than declining in the year ahead. While almost one-third of physicians still anticipate a negative trend, optimistic views grew alongside neutral ones. Declining reimbursement remains the top threat to profitability across the board. Declining reimbursement and rising costs were the top two challenges again this year, but the transition to ICD-10 replaced the Affordable Care Act at number three. More than half of physicians identified ICD-10 as a factor weighing down profitability and three in five expressed doubts about their readiness for it. Fewer physicians with ownership stakes are looking to give them up. The PPI continues to reveal resilience among physician owners. In fact, the share of physician owners looking to sell or merge declined versus However, almost onequarter of physicians are still looking to make a change, primarily due to administrative burdens, profitability challenges, and regulatory pressures. Billing processes, staffing, and technology are key targets for operational improvement. Forty percent of physicians continue to focus on shoring up their revenue cycle management processes, while optimizing staffing came in a close second. In addition, onethird of physicians are eying technology as an area to address to improve performance. Physicians are seeking stronger core IT solutions while capitalizing on new innovations. This year s findings confirm that physicians continue to seek out more versatile, userfriendly systems for their key financial, administrative, and clinical needs. The number one reason they re replacing these systems? Lack of integration with other technologies. In addition to replacing these systems, physicians continue to see promise in patient engagement tools and show growing enthusiasm for mobile technologies

4 PROFITABILITY OUTLOOKS IMPROVING, BUT CHALLENGES REMAIN Neutral Outlooks Now Outweigh Negative Ones This year s PPI indicates that physician outlooks on profitability are improving, with positive perspectives rising from 19% to 24%. However, negative outlooks continue to outweigh them at 31%. While downward predictions remain prevalent, there are signs of stabilization as physicians adapt to healthcare reform: negative views declined from 39% in 2014, while neutral ones increased from 30% to 35%. Figure 1: How physicians see profitability trending in the next year* Staying about the same 35% Somewhat negatively 25% Somewhat positively 19% Not sure 10% Very negatively 6% Very positively 5% Regulatory Pressures Remain Despite improvement in overall outlooks, physician profitability continues to face major challenges. Consistent with prior years, declining reimbursement and rising costs (e.g., supplies, staff) topped the list at 62% and 55% respectively. However, the transition to ICD-10 took the place of the Affordable Care Act (ACA) at number three this year. ICD-10 rose from 43% to 52%, while the ACA declined from 49% to 44%. Given the proximity of this survey to the October 1, 2015 ICD-10 deadline and fact that the physicians have had more time to adapt to the ACA, ICD-10 s place in the top three is no surprise. However, what is surprising is the lack of ICD-10 readiness so close to the deadline: 61% of physicians expressed uncertainty that their practices would be ready. Figure 2: Key challenges to practice profitability (Multiple answers accepted) Declining reimbursement - 62% Rising costs (e.g., medical supplies, staff) - 55% Transition to ICD-10-52% Ongoing impact of the Affordable Care Act (ACA) - 44% EHR / Meaningful Use - 35% Efficiency of staff - 26% Patient privacy & information security requirements (e.g., recent HIPAA changes) - 16% * Next Year = Second Half 2015 to First Half

5 PHYSICIAN OWNERS UNDER PRESSURE, BUT STAYING PUT Fewer Physicians Looking to Sell Their Practices Trends in practice ownership plans mirror the improving trend around profitability outlooks. Physician practice owners not planning to sell rebounded to 59% in 2015, after dropping to 53% in 2014 as industry pressures, such as the ACA and ICD-10, took their toll. However, while more of their peers are staying put, a considerable share of physician owners continue to be overwhelmed by the pressures of running a practice. Almost one quarter (23%) are actively looking to sell or considering it. Another 6% have already sold and 12% are looking to merge with another group. Figure 3: Physicians looking to sell or merge No, not looking to sell or merge 59% Yes, considering selling 15% Yes, looking to merge 12% Yes, actively looking to sell 8% Yes, already sold 6% But Financial and Administrative Pressures Too Much for Some The top three drivers of a sale or merge for those physician owners looking to make a change are too much administrative work at 40%, profitability challenges at 35%, and regulatory burdens at 35%. However, 18% of physicians had a positive rationale, seeing an opportunity for business growth from going in a new direction. Figure 4: Key drivers behind the decision to sell or merge (Multiple answers accepted) Too much administrative work - 40% Profitability challenges - 35% Pressure of regulatory burdens (e.g., ICD-10, Meaningful Use) - 35% Opportunity for business growth - 18% Retiring or changing professions - 14% None of the above - 1% - 5 -

6 BILLING, STAFFING, AND TECHNOLOGY TOP TARGETS FOR IMPROVEMENT Billing and Collections Top of Mind As physicians look to position their practices for success going forward, they continue to focus on three key areas: billing/collections processes (40%), staffing (34%), and technology (33%). Once again, billing/ collections is the top target area, which is fitting since most physicians struggle to obtain accurate and timely payment for patient care. In fact, as in 2014, only two in five physicians believe that their current staff, technology, and processes are effective at securing quick and proper payment. Figure 5: Top five target areas to improve operational performance (Multiple answers accepted) Billing/Collections processes - 40% Staffing - 34% Technology - 33% Analytics to evaluate practice performance - 26% Improving how we manage population health - 24% Interestingly, despite having another year to explore them, accountable care organizations (ACOs), do not appear to have gained traction with physicians: only 14% indicated they plan to join one to improve operational performance, one percentage point lower than in Administrative Tasks Continue to Weigh on Physicians Physicians are undoubtedly focused not only improving practice performance, but also on finding relief from administrative burdens that distract them from patient care. These hassles remain a time sink for both those who own practices the number one reason for selling/merging and those who do not. Almost two-thirds of physicians (64%) spend a day or more per week on administrative tasks. However, it appears there has been at least a degree of relief overall, as this declined from 71% last year. Figure 6: Time physicians spend on administrative work per week 11% 24% 29% 16% 10% 9% 0-10% 11-20% 21-30% 31-40% 41-50% > 50% Note: Totals do not add to 100% due to rounding

7 PHYSICIANS NOT SETTLING FOR OUTDATED TECHNOLOGY Physicians Continue to Rip & Replace Core Systems The rip and replace trend around core practice IT systems showed no sign of slowing in Consistent with 2014, almost 20% of physicians plan to replace their practice management (PM) and/or Electronic Health Records (EHR) systems in the coming year. Figure 7: Operational changes in the coming year (Multiple answers accepted) Don t plan on making changes - 59% Replace existing EHR - 13% Adopt better analytics solution - 13% Implement first EHR - 10% Outsource billing/collections - 10% Replace current practice management system - 6% Lack of Integration, Usability Drive Dissatisfaction Physicians replacing their PM and/or EHR systems are doing so primarily because their current systems do not integrate with other technologies (39%), are hard to use/slow them down (37%), and/or are not cost-effective (33%). While lack of integration was a new option in this year s survey, usability and costeffectiveness were key drivers in 2014 as well. Physicians appear to be growing increasingly frustrated with hard to use solutions, as that figure jumped six points from 31% in 2014 to 37% in Figure 8: Key reasons for PM and/or EHR replacement (Multiple answers accepted) Current solution does not integrate with other technologies - 39% Current solution hard to use / slows me down - 37% Current solution not cost-effective - 33% Current solution not ready for ICD-10/MU - 27% Vendor is not innovating current solution - 20% Physicians Tapping Into Healthcare Analytics This year s findings provide support for the growing role of analytics in helping physicians and other practice leaders understand, monitor, and improve their operations and financial results. Over onequarter of physicians (26%) are targeting analytics as a means of improving operational performance in the coming year and 13% specifically plan to adopt a better analytics solution

8 PHYSICIANS SEE PROMISE IN NEW TOOLS FOR MANAGING PATIENT CARE Patient Engagement Enthusiasm Continues, Mobile Solutions Gain Momentum As physicians emerge from the immense pressures of health reform, Meaningful Use, and ICD-10, we asked them to provide insight into positive developments on the horizon. Consistent with 2014, patient engagement landed on top, tied with new alliances with other healthcare professionals at 22%. Rounding out the top three? Mobile technologies, which saw the biggest gain year over year, rising from 11% to 19%. Figure 8: Most promising developments for operational performance Patient engagement programs (e.g., patient portals, disease mgmt. for high-risk patients) - 22% New alliances with other healthcare professionals (e.g., mergers, ancillary services) - 22% Mobile technologies - 19% Tools for population health management - 17% Fee for value/quality contract participation (e.g., ACOs) - 16% Other - 5% Note: Totals do not add to 100% due to rounding

9 CLOSING THOUGHTS The past few years have brought significant industry changes to physician practices from Meaningful Use to the ACA and ICD-10. The convergence of these monumental shifts, compounded by other challenges like declining reimbursement, has put a strain on many practices. However, this year s PPI indicates a potential, albeit slow, shift in sentiment. The share of physicians looking ahead with positive or flat profitability expectations is growing, while the share convinced of a downward path is declining. It remains to be seen if this year s PPI reflects the start of a turnaround in physician outlooks. Administrative burdens, profitability challenges, and the continued fast pace of industry change continue to weigh heavily on physicians across the US. However, as the ACA and ICD-10 implementation dates move farther into the rear view and physicians take proactive steps to improve practice performance, there s room for optimism that at least some relief may be on the horizon. CareCloud is helping thousands of physicians increase profitability, streamline workflow, and improve patient care nationwide, and currently manages more than $4 billion in annualized accounts receivables on behalf of its revenue cycle management clients. To learn more about CareCloud, visit hello@carecloud.com