Many of the most significant provisions of the Affordable Care Act, such as payment models and health insurance exchanges, have yet to take effect. There’s concern from physicians losing clinical autonomy as solo practices assimilate with hospitals and what the impact of Medicare reimbursement penalties will be. And yet, the efficiencies created by health IT systems and accountable care organizations are slowly changing attitudes toward healthcare reform. An author of a survey assessing physician attitudes toward healthcare reform indicated that physicians seem to be shifting from denial to reluctant acceptance.
In an interview with MedCity News, Paul Keckley, the executive director of Deloitte Center for Health Solutions and an author of the report, said he was surprised by the level of “constrained optimism” by physicians over healthcare reform and said he had seen some shift in the past few years. About 38 percent of physicians said ACA is a step in the wrong direction, compared to 44 percent who said that last year.
As far as the lingering uncertainty among physicians, particularly as to how Medicare reimbursement penalties are levied, he said part of the problem was that policymakers and regulators have not made a convincing argument to physicians.
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“The regulators and policymakers have not convinced doctors that these are tools rather than rules,” said Keckley. “Most measures are process measures not outcome measures. Doctors are incentivized to advise patients appropriately [such as] what foods not to eat or not to get out of [a hospital] bed because there’s a risk they’ll fall. That is something doctors are responsible for.”
Asked whether the reimbursement issue would lead to physician practices trying to limit their Medicare and Medicaid patients, Keckley said it depended in part on the laws of each state and the hospitals. But it’s an issue that will likely be decided by the courts.
“There are no quotas in the U.S. in a hospital or state that say you have to see 5 percent to 10 percent or that 15 percent of your patients need to be Medicare patients.
It is probably the next wave. Some [practices or hospitals] will end up in court.” It could also lead to a competitive differentiating strategy.
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One of the findings of the survey was that more physicians are joining hospitals for greater financial security, but that’s accompanied by a certain amount of concern over clinical autonomy. But this issue isn’t limited to physician practices. It concerns hospitals consolidating with larger health systems too and the potential impact on patient autonomy.
The survey of physician attitudes reflected the views of 613 physicians across the country who filled out a questionnaire online. Among some of the other interesting findings were:
- Two-thirds of physicians say they use electronic health records that meet meaningful use stage 1 requirements.
- Three in five physicians are satisfied with their EHR system. About 74 percent said it provides faster and more accurate billing for services. Sixty-seven percent said it helped with time-saving through e-prescribing. Another 67 percent said it improved communication and care coordination capabilities because of interoperability.
Relatively fewer physicians said consumers could interact with or use services from the practice’s website.
- 33 percent can communicate with patients using email or texts.
- 26 percent can direct consumers to trusted healthcare websites.
- 24 percent offer scheduling or provide access to test results through their website.
- 19 percent allow consumers to request prescription refills through a website.
- A quarter of physicians would place new or additional limits on the acceptance of Medicare patients if there were potential payment changes to the Medicare program such as lower payments or a switch to vouchers.
- Two-thirds of all physicians believe that physicians and hospitals will become more integrated in the next one to three years.
- Eight in 10 physicians expect that working in interdisciplinary teams and with care coordinators will be a big trend in the next decade.
The findings show there’s still a big gap between what the future state of healthcare is supposed to look like and where physicians are in their day-to-day practices.
Still, it’s tricky to accurately gauge how physicians feel since healthcare reform has not been fully implemented in 2014. Until, for example, the shift in payment models from fee-for-service to outcomes-based care and bundled payments happens, and until the infrastructure is in place to exchange patient information more regularly between healthcare providers, the best these surveys can do is measure the uneasiness that most industry professionals are feeling amidst unprecedented change that has yet to be fully realized.
