The pressures on independent physicians can be staggering. In addition to the many trials and tribulations all entrepreneurs must face, physicians have some additional obstacles that are unique to their profession. In part one of our two part series, we’ll focus on six key challenges facing physicians in the year ahead and opportunities to meet these challenges.
Bogged Down by Administration
Today, many physicians spend twice as much time per patient filling out paperwork compared to before the Affordable Care Act was passed. If time per patient was spent with the real-live patient then that would be considered a plus. Unfortunately, that additional time is spent in front of a computer. It’s becoming clear that mounting paperwork is keeping physicians from spending enough time with patients. In addition, mandatory and redundant file keeping has become so time-consuming that many practices have had to hire full-time compliance officers.
Prior authorizations are a major, and growing, source of physicians paperwork burden. More and more payers are requiring prior authorizations for more drugs and procedures as a way to hold down costs, improve treatment and ensure patient safety. But the feedback from physicians has been mixed, with many saying that prior authorizations are in fact, an obstacle to actually delivering the best care possible to their patients.
The law of unintended consequences, is that actions of people—and especially of government—always have effects that are unanticipated or unintended. The Affordable Care Act, which requires physicians to fill out specific forms, document specific health patterns, and more—has had a negative impact on the day-to-day life of independent physicians.
Payers Setting the Rules
In health care, a payer generally refers to entities other than the patient that finance or reimburse the cost of health services. In most cases, this term refers to insurance carriers, other third-party payers, or health plan sponsors.
The payers have a role in the Affordable Care Act and their emphasis on cost-cutting is having some negative consequences for many other parties. It’s all good and fine to putting the spotlight on return on investment and scrutinizing costs while increasing care for patients. Needless to say, the rising emphasis on valued-based payment models is increasing strain on the physician patient relationship.
Physicians seem to be bearing an unfair share of the burden. Staying compliant in a fast-moving, digital world is critical and has become very expensive.
Another area of concern involves the increase of audits. Physicians have had to deal with a range of audits tied to meaningful use and other programs. Since the ACA, these audits have increased due to the fact that there is money on the table for the payers. The best thing a physician can do to ensure an audit goes well is assume they will be audited and to prepare for it. Physicians require documentation from their vendors confirming the version of the EHR system they are using and they need to document everything.
It’s no secret that independent practice costs keep rising. Dealing with rising costs was noted as the single biggest daily challenge for physicians. So is this driving physicians to become employees? Yes and no. The 2015 Independent Physician Outlook Survey, which provides insight into that state of independence in the medical field from the physician perspective clearly showed that the majority of physicians desired continued independence.
Some of the increase in costs comes in the form of increasing rates for malpractice insurance and for directors and officers liability coverage. As well, there area higher health insurance costs with their own practice staff. As well, there are now more software and training costs that practices must shoulder.
The independent medical practices that thrive in the new healthcare environment will be the ones that take a proactive approach to managing these changes. In part two of our series, we’ll cover three remaining challenges for physicians and explore how medical practices are thriving on non-insurance based revenue.