ACA tops list of 5 biggest physician concerns for 2013

The Physicians Foundation says 2013 will be a “watershed year for the U.S. health care system.” The organization says it is important to be on alert to how changes wrought by health system reform — and shifting physician and patient demographics — are affecting doctors.

In December, the Physicians Foundation put together a list of the top five issues affecting doctors in 2013, basing its predictions on what they reported in 2012 surveys. The issues the foundation lays out are familiar, but it said developments such as the Affordable Care Act and physician-hospital consolidation only will intensify in 2013.

“It is clear that lawmakers need to work closely with physicians to ensure that we are well-prepared to meet the demands of 30 million new patients in the health care system and to efficiently address the impending doctor shortage and growing patient access crisis,” said Lou Goodman, president of the Physicians Foundation and CEO of the Texas Medical Assn., in a statement. The Physicians Foundation is a nonprofit funded by health plans as part of the settlement of a class-action lawsuit doctors brought against private insurers. The foundation funds research and initiatives aimed at helping doctors.

The five issues the foundation said will be critical for physicians in the coming year:

Uncertainty about the ACA. The foundation said that although the law is advancing, many specifics about how it will work when it is fully implemented in 2014 have yet to be decided. Seventy-seven percent of physicians surveyed in the Physicians Foundation 2012 Biennial Physician Survey said uncertainty about the ACA was one of the prime reasons why they are pessimistic about the future of medicine. Ambiguity about implementation of accountable care organizations, health insurance exchanges, the Medicare physician fee schedule and the Medicare Independent Payment Advisory Board is disconcerting to many physicians.

Practice consolidation. As more hospitals and medical groups acquire private practices, it may lead to monopoly concerns and rises in health care costs. Hospitals and groups have been buying practices due to the implementation of ACOs, the goal to increase quality of care and the need to create secure referral systems. At the same time, more doctors are opting to be employees instead of going solo.

The impact of 30 million newly insured patients. During the next 12 months, doctors will be gearing up for 14 million U.S. residents who, according to the Congressional Budget Office, will join the ranks of the newly insured on Jan. 1, 2014, because of the ACA. An additional 16 million newly insured will be brought on through 2021.

But there might not be enough physicians by the end of the decade to treat them. Between 80,000 and 100,000 doctors may retire in the next five years, according to a foundation report. At the same time, about 36 million baby boomers will be eligible for Medicare. The Assn. of American Medical Colleges says the U.S. is expected to have a shortage of more than 90,000 physicians by 2020, and a shortage of more than 130,000 physicians by 2025.

A decline in physician autonomy. Decreasing payments, liabilities, defensive medicine pressure and more regulations are eroding autonomy, according to the foundation.

In November, the American Medical Association adopted principles for employed physicians that offer guidelines on conflicts of interest, peer reviews and contracting. The AMA noted that a major conflict arises when doctors feel pressure to send referrals within hospitals and health systems. In that case, patients should be told about such practices, according to Association guidelines.

Rising administrative burdens. The Physicians Foundation survey reported that increases in administrative tasks and government regulations, which decreased time with patients, were major causes of physician dissatisfaction. The foundation’s “The Future of Medical Practice” report suggested that the creation of a federal commission for administrative simplification in medicine may reduce physician reporting burdens.