By Jeff Bendix, Charlotte Huff, Rose Schneider Krivich, Chris Mazzolini, Mary Pratt, Todd Shryock
Medical Economics, December 25, 2016
For the fourth consecutive year, Medical Economics reveals its list of obstacles physicians will face in the coming year and, more importantly, how to overcome them. For this latest presentation, we asked readers to tell us what challenges they face each day and where they needed solutions.
Here are their responses, starting with the biggest challenge of the coming year.
Challenge 1: MACRA
Healthcare reimbursements are migrating from volume to value. MACRA will most likely serve as the road map for other payers, so get used to the reporting requirements.
The law directs physicians to choose one of two reimbursement paths—advanced alternative payment models (APMs) or the Merit-based Incentive Payment System (MIPS).
Challenge 2: Prior authorizations
Prior authorization requirements have increased steadily in recent years, and the growth trend shows no signs of abating in 2017.
A 2015 Kaiser Family Foundation analysis of Medicare data found that 23% of drugs in private drug plans covered by Medicare Part D required prior authorizations, up from 8% in 2007. During the same period, the percentage of drugs carrying some type of utilization management restriction more than doubled, from 18% to 39%.
Challenge 3: Negotiating with payers
As payers move to consolidate, physicians find themselves facing the prospect of declining reimbursement and narrowing provider networks. Many doctors lament that payers now come to the table with a “take it or leave it” approach, forcing physicians to agree to one-sided contracts to maintain their patient head count.
Challenge 4: Staying motivated to practice medicine
Like everyone else, doctors want to enjoy their work, but they are finding it harder to do so. Physician professional dissatisfaction has been steadily growing in recent years, driven by increasing workloads and frustration at being unable to spend sufficient time with patients.
By now the causes of physician unhappiness are well known. They include ever-increasing amounts of time spent on administrative tasks and documentation, frustration with the demands imposed by electronic health records and the feeling they are having to cede control of their practices to government regulators and third-party payers.
Challenge 5: Maintenance of certification
More changes are on the way for physicians certifying in their sub-specialties through the American Board of Internal Medicine’s (ABIM) maintenance of certification (MOC) process.
Physicians feel as though a “board certification industrial complex” has been created by ABIM and MOC, says Christopher Unrein, DO, an internist and hospice/palliative care practitioner in Parker, Colorado. “Our profession’s very own medical societies, that we pay significant amounts of membership dues to, turn around that membership to sell us products in order to pass the exams and/or gain MOC points,” he says. “So not only is MOC a busy-work, anxiety-laden process, it is also one of financial opportunism. Physicians preying upon physicians — it disgusts me, as we are supposed to be a profession that cares and looks out for others.”
Challenge 6: Lack of EHR interoperability
Very few physicians have complete interoperability, which the nonprofit advocacy organization Center for Medical Interoperability defines as “the ability to share information across multiple technologies.”
In fact, a study released by KLAS Research in October finds that a mere 6% of healthcare providers can effectively and efficiently share patient data with other clinicians who use an electronic health record (EHR) system different than their own.
Challenge 7: Patient frustration with rising costs
The rapid rise in copays, deductibles and prescription drug prices is causing concern among physicians who see patients skipping care as a result of these increasing healthcare costs.
Challenge 8: The non-adherent patient and “quality” care
Patients who dismiss medical advice are nothing new, but that attitude increasingly threatens to cost doctors as quality metrics become tied to compensation.
Challenge 9: Changing patient attitudes
Today’s patients are educating themselves more, presenting both a challenge and an opportunity for primary care physicians.
Some, newly insured by the Affordable Care Act, may be coming to the doctor for the first time, and have questions and concerns they expect their new physician to answer. Other patients are angry. A recent Medical Economics reader poll suggests physicians are seeing that anger manifested during office visits as frustration with the cost of healthcare, from deductibles to surprise charges. Other patients are taking a consumerist approach to healthcare, looking for convenience and quick access.
“Patients feel more empowered to take control over their own health and consider the doctor an adviser. Doctors have to adjust from being in an elevated position to more of a coaching and advising role,” says Joseph E. Scherger, MD, a primary care physician in La Quinta, California, and member of the Medical Economics editorial advisory board.
Challenge 10: Patient satisfaction scores
Patient satisfaction has become an increasingly important factor in how physicians are treated by their employers and insurers, thanks in part to government regulations.
Dealing with the internet-savvy patient—but also attempting to make a personal connection with them—all while entering the data correctly into the practice’s electronic health record (EHR) system is a daunting but necessary task because of value-based care.
By Don McCanne, M.D.
Who’s in charge here? Would physicians choose to include these challenges in our health care system? What is the benefit/hassle-factor ratio in these challenges?
These intrusions are not originating with health care professionals and their patients. Instead they are emanating from insurers, from public and private administrators, from legislative bodies, and from vested interests in the medical-industrial complex.
A well-designed single payer system would eliminate some of these hassles and would modify others to more clearly benefit patients, providing a much more congenial practice environment for themselves and their health care professionals.
Our current system is designed to promote business principles, with an inevitable fight over where health care dollars end up. In contrast, a publicly-administered and publicly-financed single payer system would be designed to promote patient service, with dollars directed to health care delivery rather than to administratively-complex intermediaries and their rent-seeking puppeteers.
It seems like physicians have enough challenges in working with their patients to seek the best clinical outcomes. They really don’t need these other burdensome challenges injected by inefficient insurers, superfluous administrators, bureaucrats and legislative bodies. They need a well designed single payer system instead – an improved Medicare for all. In fact, some of the challenges listed explain why we need to improve Medicare when we convert it to a system serving all of us.