Doctors expect more pressure from practice finances

Shifting payment models and practice financial management issues were identified by primary care physicians as the biggest challenges they face over the next three to five years, according to a survey released in July by Wolters Kluwer Health, a health care information company (link).

Nine out of every 10 doctors, in the survey of 300 primary care doctors, identified those two issues as the ones they struggle with the most. Meanwhile, 88% identified spending sufficient time with patients as a business challenge, 84% cited the impact of the Affordable Care Act, and 83% picked keeping up with the latest research. Doctors could choose more than one issue.

As the ACA moves toward full implementation, public and private payers are trying to shift doctors from a fee-for-service model to one that includes payment based on quality and efficiency measures through such structures as accountable care organizations. Other surveys have tracked doctors’ frustration with rising costs in their practice, including the purchase price of electronic health record systems, while collections have not kept up. In the latest survey, 68% of doctors said their costs were going up, with 73% citing information technology as a reason why, followed by ACA/other legislation (67%) and uninsured patients (62%).

Whether to stay independent

The Wolters Kluwer Health survey reflected how these cost pressures might affect physicians’ desire to stay in their practices. Asked about their likelihood of leaving their practice in the next one or two years, 34% of doctors said they would be very or somewhat likely to do so. Of those who said they might leave, 29% said it was because it was “hard to make practice profitable.” Twenty-five percent said it was “time to retire,” 15% said being a doctor no longer was rewarding, and 11% cited health reform.

The survey did not specifically ask physicians if they planned to leave practice in favor of an employed position. However, when asked about their general business focus areas for the next three to five years, 34% said “exploring different business models,” which includes merging with other practices, selling to a hospital, or becoming part of a patient-centered medical home or ACO. The leading answer to that question, at 48%, was to increase their practice’s efficiency.