Regulatory burden, staffing shortages and consumer expectations are on the minds of physicians in 2020, according to the MGMA report, A Medical Practice Leader's Guide to 2020.
Physicians are looking at legislative attempts to curb surprise medical bills, patients' increasing expectations for price transparency and convenience and their responsibility for MIPS and other reporting requirements, according to Andrew Hajde, an author of the report and assistant director of Association Content at the Medical Group Management Association.
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Burn-out from administrative burden, and an increasing physician shortage as doctors retire and baby boomers require more healthcare services, mandates a review of workplace culture and a strategy for physician and employee retention.
A shortage of nearly 122,000 physicians is projected by 2032. Unemployment in November 2019 was at 3.5%. The competition for physicians is high.
"The cost to replace a physician is expensive," said Hajde, who previously worked as an administrator for medical practices.
There is a limit on residency slots out of medical school. Retention is critical.
HEALTH SYSTEM INTEGRATION
One incentive for physician practices to integrate with larger health systems has been to lessen their administrative burden.
One of the benefits to health systems has been the higher reimbursement paid to off-campus hospital facilities compared to physician practices. The Centers for Medicare and Medicaid Services took away the higher reimbursement rate through site neutral payments, but hospitals have again sued to stop the policy from going through.
American Medical Association statistics show that more than 50% of practices are now integrated.
Hajde believes as physicians become more comfortable with reporting requirements, such as those of the merit-based incentive system of MACRA, the trend towards integration may lessen.
"It would be a curious thing if that reverses," Hajde said. "The future could go either way."
If physicians start to gain confidence in value-based care on reimbursement, they may stay independent, he said.
"A lot of that is reimbursement-driven," Hajde said. "But if it becomes more onerous, it could lead to risk and declining reimbursement."
BURDEN, REIMBURSEMENT AND THE PATIENT
Hajde said that practices participating in MIPS should review changes for the 2020 performance year to ensure they report on the appropriate measures. It's important that practices check with vendors to verify that the necessary measures are included in their EHRs. Meeting MIPS reporting requirements may not result in significant bonuses, but it will save physicians from steep financial penalties.
Physicians sorting through MIPS measures to find those most closely aligned with their practice become frustrated when measures to track performance don't align with a benefit for the patient, Hajde said. A specialist may end up asking questions of a patient that would be more appropriately asked by the primary care doctor.
Physicians tend to see MIPS this way, Hajde said: "They view it as additional work to do without a lot of benefit."
Another burden is prior authorization. For something as simple as getting a drug for a patient, a physician may be required to fill out paperwork and call the insurer.
They also want less stringent Stark anti-kickback laws that have unintended consequences for how physicians interact with hospitals.
"There are so many hoops to jump through," Hajde said.
In good news for reimbursement, the Medicare 2020 Physician Fee Schedule allows physicians to be reimbursed for services they previously did for free.
For instance, group practices that bill for Chronic Care Management services can now use an add-on code to account for additional time spent on non-complex CCM services. Medicare also expanded coverage of telehealth services.
"It's important getting reimbursed for time spent with patients," he said.
Telehealth speaks to what has become a major focus for all providers. It gives patients the consumer-friendly experience they've come to expect.
From a patient's standpoint, Hajde said, it's about cost, quality and convenience.
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