Let's start with what The Physicians Foundation sees as the top five issues facing its members in the upcoming year. And I'm throwing in four concerns of my own, related to quality and clinical achievements.
- The "nebulous" PPACA. The foundation sees a swirl of uncertainty around a host of issues that contribute to widespread physician pessimism: accountable care organizations, health insurance exchanges, the Independent Payment Advisory Board, Medicare physician fee schedules.
- The consolidation movement. The foundation is worried that while large hospital systems and medical groups continue to acquire smaller/solo practices at a high rate, "increased consolidation may potentially lead to monopolistic concerns, raise cost of care, and reduce the viability and competiveness of solo/private practice," Goodman says. With everything from ACOs to hospital consolidation with practices, "We believe there's a mad rush toward getting bigger," he adds.
- The uninsured. As the PPACA expands eligibility for Medicaid and provides tax credits that make insurance more affordable, the Congressional Budget Office projects that 32 million people will have more insurance by 2019. By 2014, companies with 50 or more full-time workers must provide health insurance that the government deems affordable and fair. "As the 12-month countdown to 30 million continues across 2013, physicians and policy-makers will need to identify measures to help ensure [that] a sufficient number of doctors are available to treat these millions of new patients—while also ensuring the quality of care provided to all patients is in no way compromised," the foundation notes.
- Physician autonomy. The Physicians Foundation believes that physician autonomy—particularly related to a doctor's ability to "exercise independent medical judgments without non-clinical personnel interfering with these decisions"—is deteriorating. Add to that decreasing reimbursements and liability/defensive medicine pressures. In 2013, "physicians will need to identify ways to streamline these processes and challenges, to help maintain the autonomy required to make the clinical decisions that are best for their patients," the foundation says. Of all the issues facing doctors this coming year, "the erosion of physician autonomy concerns me the most," Goodman says.
- Administrative burdens. Increasing administrative and government regulations were cited as one of the chief factors contributing to pervasive physician discontentment, according to the foundation's 2012 Biennial Physician Survey. "We're not making widgets, but providing care and making life and death decisions," Goodman says. "We don't need to be involved in wearing green eye shades, but financial decisions need to be reviewed by doctors. Doctors have to be involved in the conversation."