While the physician burdens of payment reform vary depending on the type of practice, some of the stresses are fairly universal, experts tell Healthcare Dive, and some have potential solutions.
Dr. William Bithoney, Chief Physician Executive and Managing Director in BDO’s Healthcare Advisory practice, finds EHRs and the impacts of narrow networks to be among the top stressors. He notes while EHRs can be “debilitatingly expensive” and force physicians to change the way they interact with patients, they are now undoubtedly necessary for the sake of capturing quality metrics.
“It’s one of the things driving people out of private practice,” Bithoney says.
Adding to that challenge is the financial uncertainly presented by payments that depend upon these quality metrics, whereas “it used to be you knew how much you were going to make,” Bithoney adds.
Perhaps one of the most serious physician concerns he sees is that of being left out of insurers’ narrow networks, particularly when there are only a few insurers in a given market. “Being excluded can be a disaster,” Bithoney says, and is contributing to more physicians giving up private practice to become employed.
Some of the solutions he sees include the increased use of scribes to manage documentation during patient visits, a trend moving from the ER to primary care. Physicians are also depending more on having other staff operate at the top of their license, utilizing care coordinators to help them hit their quality metrics, and using technology to maximize efficiency. While all the necessary changes may be difficult, “Opportunities do exist to become more efficient,” Bithoney says.
According to Dr. Debbie Zimmerman, CMO at Lumeris, much of the challenge is in adapting to the new collaborative relationship between physicians and payers.
“The main areas of concern for physicians are if they will have the right information, tools and workflows to be successful under these new arrangements,” she says, citing the examples of transparency into the cost of care, the ability to evaluate comparative performance to encourage collaboration and best practice sharing, and new skills such as the understanding of chronic condition documentation.
“We have seen that when physicians are fully engaged through the right incentives and have access to information, insights, tools and workflows, they realize the benefits and outcomes in their patient panels,” Zimmerman says.
She adds through Lumeris’ work with healthcare organizations, they have found that using an effective accountable care model is critical in the transition to value-based care. “In an accountable care team, each member of the team practicing at the top of their training results in physicians being leveraged effectively and avoiding the burn out that exists today in the volume driven model,” she says.
Dr. Robert Dudzinski, EVP at West Corporation, also finds the demands on physicians are compelling many to seek safety in numbers. “By consolidating with other practitioners, becoming hospital employees, or aligning with large hospitals and health systems, they’re looking to take advantage of administrative and technical resources to keep going,” he says.
At the practice level, some physicians find it impossible to effect the necessary changes to comply with the new measures. The ultimate concern is further challenges will come with decreased financial viability, Dudzinski says. For those doctors who are modifying their practices to accommodate the new demands, the focus for many is on how they’ll optimize management of an aging population and the growing number of people with chronic disease, he says.
Dudzinski adds practice transformation strategies often involve flex staff capacity and the use of technology such as healthcare call centers for scheduling, call triage, and ‘round the clock chronic care management. He also expects to see increased use of automation for tasks such as communication for prompting patients to come in for appropriate care and screenings, as well as patient balance notifications and payment systems.
Even with emerging solutions, however, there remains a toll in the here and now, notes Lois Margaret Nora, MD, JD, MBA, President and CEO of the American Board of Medical Specialties (ABMS). She recently spoke on the challenges physicians face in transitioning to a value-based care model at at the 2016 National Health Policy Conference in Washington, D.C.
She says while measurements of quality and value are intrinsic to the medical profession, “Medicine is a profession under stress right now,” adding that burnout, early retirement and increasing rates of physician suicide are real concerns. With an estimated 400 physician suicides now occurring per year, Nora says, “That would mean we’re graduating two and half whole classes each year just to take the place of physicians who have death by suicide.”
She adds because it is culturally difficult for physicians experiencing burnout or depression to recognize and talk about it, health systems and organizations need to offer safe ways for physicians to access help.
Nora also sees hope in the Medicare Access and CHIP Reauthorization Act (MACRA), which links payments and value via the Merit-Based Incentive Program and talks about engagement of the medical profession in helping to direct healthcare reform.
“I think physician engagement is one of the answers to reducing physician stress, so they feel they are building a new health system and not having it done to them,” she says.