With goals ranging from reducing costs and increasing coverage to offering more preventive services and raising quality standards for basic care, there’s no question that big changes lie ahead for how doctors are asked to do things under the Affordable Care Act. What’s in store? Here are my top challenges for physicians in the new healthcare environment.
Challenge 8. Changing payer mixes: As more uninsured individuals gain coverage through health insurance exchanges or government programs like Medicaid, the payer mix for private practices will shift, and providers will have to adjust to new kinds of interactions, problems, and pay schedules. Physicians will need to reevaluate and make appropriate changes to accommodate these new patient populations.
Challenge 7. Mainstreaming of information technology: We’re on the countdown to 2015, when the incentives used to entice doctors to use electronic medical records will become penalties. Given that those of us who do not adopt electronic medical records will see a decrease in their reimbursement for Medicare and Medicaid services, a tech-enabled office will become a necessity, not just an asset.
Challenge 6. Shifting payment methodologies: We’re in the middle of a movement from fee-for-service toward bundled (episode-based) payments. Physicians will need to become adept at identifying all associated costs – among these, the intricate list of services provided within the actual episode of care – and calculating how to divide the payment amongst all caregivers.
Challenge 5. Moving from volume to value: As the ACA begins to make value measures more transparent to consumers, patients will use that information to choose providers. Satisfaction will increasingly be measured by the quality of care delivered. Bedside manner will therefore be more important than ever.
Challenge 4. Changing reimbursement amounts: With more Medicare and Medicaid patients in the mix, and in light of Medicare’s sustainable growth rate plan, reimbursement may be smaller. Doctors will have to find ways to offset these losses, be it adopting new practice or workflow models, or changing the kinds of insurance they accept.
Challenge 3. Increasing documentation burdens: With the adoption of electronic medical records and related meaningful use standards, checking boxes is adding to patients’ visit times. Physicians will need to adopt or invent new documentation efficiencies. Already we are seeing paperwork spilling into personal hours, accounting for an extra one to four or hours a day of work, according to some estimates.
Challenge 2. Changing doctor-patient relationship: With more patients and more paperwork, in-office face-to-face time may suffer and there’s a risk that people find that their physicians are looking more at the computer or tablet rather than the patient themselves. From online interactions to telemedicine, new ways of connecting with patients may become more appealing.
Challenge 1. Facing the unknown: Some see this as the end of medicine; others see this as an opportunity to be part of long lasting changes. Most certainly, the situation invites discussion, problem-solving, and innovation.
Dr. Selene Parekh joined the North Carolina Orthopaedic Clinic and Duke Orthopaedics in 2009. Prior to his tenure at Duke, he was a foot and ankle surgeon at the University of North Carolina (UNC), and served as the foot and ankle consultant to the school’s athletic department, treating many of the well-known UNC athletes. A graduate of the Boston University School of Medicine, he also holds an MBA from the university’s Graduate School of Management. Following residency, he completed a one-year Healthcare Entrepreneurship Fellowship through the University of Pennsylvania’s Wharton School, and his experiences there led to the development of the “Business of Orthopaedics” conference, the first of its kind in the U.S. Currently, he is an Adjunct Faculty member at Duke’s Fuqua Business School and an Associate Professor of Orthopaedic Surgery at Duke University Medical School.