Top 5 Physician Challenges in 2011

There are many things to look forward to in the New Year: possibly a fresh start for those physicians changing their day-to-day lives, maybe moving from a single practice to a group practice, or for baby boomers, a chance to finally curtail their hours as they promised themselves all those years ago.

This is about the carry-overs, issues that unfolded in 2010, and will continue to be especially important for physicians in 2011, whether physicians are changing their practices or cutting back on their hours. These are certainly hot-button  issues that we will be keeping an eye on in the coming year.

1.The 'Doc Fix'. Seriously, aren't we all sick of it? At the end of the year, Congress again dealt with the doc fix by putting it back another year, instead of only a few months. It seems the doc fix is the ultimate in procrastination and definitely a driver for much unpleasantness especially among physicians. President Obama, in signing a one-year delay in implementation of the Sustainable Growth Rate Formula, said, "It's time for a permanent solution that seniors and their doctors can depend on."

There is keen frustration among many that a permanent solution to the SGR formula for Medicare funding hasn't been found. The formula has called for cuts over the past decade, which include a 25% reduction in Medicare reimbursements that would have taken effect January 1, 2011. Congress delayed five times in dealing with the doc fix, as Elliot reported, and the longer it stalls,  the longer the toll on the federal budget and reimbursements. Look for more delays until Congress gets its act together.

2.EHRS. Meaningful use tops the list of healthcare industry challenges in 2011, according to a recent PricewaterhouseCoopers report. How are physicians going to fare with electronic medical records? Are they -- or enough of them -- going to join the ranks of the modern era and get moving digitally, or will they fall behind?

Instead of going forward with electronic health records, some will get out of the business altogether. But many physicians on the fence should follow the example of Anne Brooks, DO, a 72-old physician in rural Mississippi told me she would do "whatever it takes to improve the quality of life for my community," even if it means embracing electronic records. As I write this, let me remind you that CMS and the Office of the National Coordinator for Health Information Technology announced that registration will begin January 3 for eligible providers hoping to participate in the Medicare electronic health record incentive program.

3.Impact of Primary Care Shortages. Against the backdrop of the primary care shortage, the soothsayers, pundits,  and other prognosticators are saying definitely there will be an increase in mergers among physicians and medical group practices; it's starting already. In the meantime, the shortage of primary care physicians is threatening prospects for new healthcare models. To wit: the Medical Home Model.

As my colleague, John Commins, wrote in November, " Shifting specialists' routine followup care to primary care physicians in a medical home model under the new federal healthcare reforms could save time, money and free specialists for more complex patient care. However, the lack of primary care physicians could make such a policy difficult to implement, Commins writes, describing a new study by the University of Michigan Health System." The reason? Redistributing half of the routine follow-up care for patients with common chronic conditions, "would require either thousands of new primary car doctors or an extra three weeks of work a year form the primary care physicians in the current work force. Either way, good luck.

4.Accountable Care Organizations. Talking about the New Year and not mentioning ACOs, is like whistling Auld Ang Syne, and not saying Happy New Year in the next breath. So many in healthcare are soooooooooooooooo excited about the prospects of ACOs, and for the most part, rightfully so. Anything involving large organizations however, needs some caveats to keep us all grounded.

As PricewaterhouseCoopers reported in its predictions for 2011, "while ACOs hold great promise for reduced costs and improved quality, the challenge will be keeping people in the ACO and engaging them to stay health, which could be the difference between profit and losses."

In any event, for physicians, ACOs are a point of concern. Despite all the excitement and hype for pilot ACOs that begin in 2011, at least 42% of respondents in a September HealthLeaders Media report, Physician Alignment in an Era of Change, say there will be strained relations between hospitals and physicians with the advent of accountable care organizations.

The ACO movement, however, is likely to make its presence known in the years to come. In its wake, there will be "creative destruction" of the fragmented fee for service system, and "consequently the actions of physicians and hospitals during this period will determine the structure of the delivery system for many years," write Robert Kocher, MD and Nikhil R. Sahni, BS, in November 10 issue of the New England Journal of Medicine.

5.The American Board of Internal Medicine. Through much of 2010, the ABIM was dealing with the fallout of its proposed sanctions of 139 physicians for passing along and receiving exam questions from a test preparation company, which could result in dismissal of certificates for the accused physicians. At the outset, I got the impression from ABIM that it would resolve the issue expeditiously. Not the case. Appeals and settlement processes have begun, but months after the initial announcements of the alleged cheating, no formal declaration of what will eventually happen to the 139 physicians is really in sight Hopefully, the situation is resolved in 2011, with equanimity and justice for all involved.

Yes, from the uncertainty surrounding the American Board of Internal investigation to the uncertainty surrounding the Doc Fix, the diagnosis for physicians in 2011 is, well, we'll have to wait and see…