The Pressures on Physician Decision-Making

But J. James Rohack, MD, president of the American Medical Association, says the survey results may also reflect the complexity of the reimbursement system and the hoops physicians have to jump through to ensure that they will be reimbursed for their work. "If I'm going to provide a service and I'm not going to get paid for it then I have to communicate that with the patient ahead of time, because otherwise, that may be a non-covered benefit and I'm going to have to deal with it," he says. (Check out my full interview with Dr. Rohack online).

Pressures from administrators and other third parties: 11.2%major influence, 34.0% minor influence, 54.8% no influence
I honestly expected to see more physicians attributing pressure to hospital administration, but more than half said there was no influence at all. Perhaps this reflects the greater emphasis placed on physician-hospital alignment in recent years, and the growing number of physicians who are employed by hospitals and health systems.

Taken alone, each of these four influences would be enough to steer the occasional decision. But these pressures are felt simultaneously nearly every day. Figuring out how to alleviate pressures to order more care and creating incentives for quality may be one of the more elusive keys to reforming healthcare.