7 Issues Affecting
Physicians in 2016
By Karen Appold, Physicians Practice
A Greater Push Toward Value
“In 2015, the U.S. Department of Health and Human Services announced performance goals and timelines
for the transition of Medicare payments from volume to value-based outcomes.
In 2016, the push toward value will increasingly impact how physicians deliver care and how they are
reimbursed. A challenge, however, stems from the fact that ‘value’ is a loosely defined term — it means
different things to physicians, patients, insurance companies, policy makers, and so forth.
Without sufficient input from practicing physicians on how to shape these initiatives and clearly define what
is meant by ‘value,’ legislative and regulatory policies will continue to have unintended consequences that
will likely create further uncertainty, confusion, and frustration.”
Walker Ray, a retired pediatrician and president of the Physicians Foundation, Boston, Mass.
More ICD-10 Stress
“While the implementation of ICD-10-CM coding is still in its infancy, the introduction of tens of thousands of
new diagnostic codes, paired with prior authorization challenges and ongoing meaningful use requirements,
translates into less time physicians have to spend with patients.
In fact, according to the Physicians Foundation 2014 Biennial Physician Survey, 50 percent of physicians
indicated that implementation of ICD-10-CM will cause severe administrative problems in their practices; 75
percent of physicians believe ICD-10-CM will unnecessarily complicate coding.”
Dr. Ray
Insurance Mergers
“Ongoing merger and consolidation activity within the insurance marketplace will likely generate profound
and unintended consequences for physicians and patients. For instance, the recently approved mergers
between Anthem and Cigna and Aetna and Humana announced last year present a great upside for the
insurance market: less competition, more price control, and likely increased profitability.
As the trend continues, competition will continue to be compromised. This means that insurers will likely
squeeze more doctors, hospitals, and other providers out of their networks, thereby decreasing patient
access to care. Moreover, physicians will be pressured to accept unfavorable terms that undermine their role
as patient supporters, as well as their ability to provide high-quality care to their patients due to restrictive,
unwarranted, and arbitrary parameters placed upon medical practices.”
Dr. Ray
Telemedicine Enters the Scene
“The use of telemedicine is on the rise. The change is driven partly by the fact that a majority of states now
have a telemedicine parity law, requiring health plans to reimburse telemedicine the same way, and at the
same rate, as in-person services. Telemedicine might be a challenge for some physicians because it requires
that they be strong, effective communicators who can project the right ‘bedside manner’ through a
videoconference with a patient.”
Talbot McCormick, a board-certified internist and president and CEO, Eagle Hospital Physicians, Atlanta, Ga.
Bring on the Alternative Providers
“With the physician shortage having a significant impact, primary-care doctors will increasingly work with
nurse practitioners, physician assistants, and locum tenens staff to fill voids in patient care. By performing
key, but time-consuming roles such as providing education to patients and their families, these providers can
give physicians more time to focus on patients with complex, acute needs. For some physicians, particularly
those who haven’t been trained in or lack experience in working in this type of model, it could be a challenge
to integrate alternative providers effectively into the clinical team.”
Dr. McCormick
Competition from Hospitals
“Recruiting new physicians to private primary-care practices has become increasingly challenging due to the
competition for candidates from hospitals. Many physicians perceive hospital-based groups as providing
better job security and lifestyle advantages.”
Paul J. Wadin, director, Professional Business Management, Inc., Barrington, Ill.
Threat of Burnout
“The number of U.S. physicians who say they are suffering from ‘burnout’ has jumped to more than half of
doctors as the practice of medicine becomes increasingly complicated and millions of Americans gain health
coverage under the ACA.
Contributing to burnout are meaningful use requirements which require the use of certified EHRs, thousands
of new diagnostic codes introduced via ICD-10-CM codes, and 2,167 new quality metrics with which
physicians must contend.”
Dr. Ray