As significant changes continue to reshape the U.S. healthcare system, The Physicians Foundation – a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients – has identified five critical areas that will have major impact on practicing physicians and their patients over the next 12 months. The Physicians Watch List for 2015 is based on the Foundation’s insights into the medical practice landscape, supported by data from its 2014 Biennial Physician Survey of 20,000 physicians and other Foundation research and white papers.

• Consolidation Hits the Gas Pedal

An increased rate of consolidation among hospitals and health systems continues to drive smaller, independent medical practices into larger systems. This trend is adversely impacting competition in regions where consolidation is most pronounced, while increasing costs and reducing patient choice. Rapid medical consolidation is also presenting a challenge to clinical autonomy. According to the Foundation’s 2014 Biennial Physician Survey, more than two-thirds of all physicians (69 percent) expressed concerns relative to clinical autonomy and their ability to make the best decisions for their patients. Since the rate of medical consolidation shows no signs of abating, it is imperative that hospitals and physicians work together to ensure that clinical decisions are being made independent of any bureaucratic or organizational pressures that could potentially affect the integrity of medical decision-making.

• External Pressures Strain the Physician / Patient Relationship

An inadvertent effect of medical consolidation and the rising emphasis on valued-based payment models is increasing strain on the physician / patient relationship. According to the Foundation’s most recent Biennial Survey, 80 percent of physicians describe patient relationships as the most satisfying factor of practicing medicine. Yet, factors such as growing levels of non-clinical paperwork and rising administrative and regulatory pressures are leading to an erosion of quality face-time physicians are able to spend with their patients.

In addition, these pressures can also limit physicians’ choices in terms of practice type while increasing the amount of time and resources they must spend on negotiating with payers and vendors. As these regulatory and marketplace forces persist, it will be more critical than ever for physicians to identify ways to work with support staff in order to maximize the amount of quality time they are able to spend with their patients.

• Impact of ICD-10 on Physician Medical Practices

According to the Foundation’s 2014 Biennial Physician Survey, 50 percent of respondents indicated that ICD-10 will cause severe administrative problems in their practices. Moreover, 75 percent of respondents said ICD-10 will unnecessarily complicate coding.  The implementation of ICD-10 will be highly disruptive for physicians and their medical practices and will result in lost time with patients. Despite these challenges and although the federal government delayed the implementation of ICD-10 to October 1, 2015, physicians and providers cannot afford to delay planning and engagement. The preparation and implementation will require an investment of time and resources, but if medical practices continue to delay, it will result in cash flow disruption and lost revenue. Actionable steps must be implemented early in the year to ensure sufficient preparation, including auditing internal IT platforms and making key updates to computer systems.

• Cost of Care Transparency

When Steven Brill wrote his cover story for Time Magazine last year on the lack of transparency and seemingly arbitrary nature of medical costs / billing practices, patients expressed understandable frustration. Site of service differentials between hospitals and private medical practices are a clear manifestation of this lack of transparency. As cited in a white paper published by The Physicians Foundation, The Wall Street Journal noted one example where a Nevada patient’s echocardiogram bill was $373 before a merger with the local hospital system – and $1,605 after.

The lack of uniformity and consistency in how certain procedures are priced erodes the ability of physicians to make the best clinical decisions for patients, while further exacerbating patient concerns. It is incumbent upon policy makers, payers and providers to institute a system around cost of care transparency that is straightforward and understandable to patients and physicians alike.

• Access to Physician Care

According to the Foundation’s 2014 Biennial Physician Survey, 44 percent of physicians plan to take steps that would reduce access to their services, including cutting back on patients seen, retiring, working part-time, closing their practices to new patients or seeking non-clinical jobs. This trend is likely to lead to the loss of tens of thousands of full-time equivalents (FTEs) in the coming years. As millions of new patients are insured through the Affordable Care Act, the growing scarcity of access to physician care presents a formidable challenge to the healthcare system in 2015 and beyond.

For healthcare analysts and lawmakers to better plan and prepare for physician shortages at the state and sub-state level, they need real-time, actionable data. Earlier this year, the Foundation, in collaboration with the University of North Carolina Chapel-Hill, released the FutureDocs Forecasting Tool. The tool is an interactive, user-friendly, web-based model that estimates the supply of physicians, use of physician services and capacity of the physician workforce to meet future use of health services at the sub-state, state and national levels. This platform, along with other types of tools and data, is critical to helping ensure that patients have access to physician care as the healthcare system changes and expands.

“The coming year will again be one of major transition for the U.S. healthcare system,” said Lou Goodman, Ph.D., president of The Physicians Foundation and chief executive officer of the Texas Medical Association.  “Regulatory and marketplace forces are having a number of unintended effects, including challenging the viability of smaller medical practices, reducing patient choice and putting tremendous strain on the physician / patient relationship. It is paramount that policy makers bring physicians into the fold to ensure the policies they implement are designed to advance the quality of care for America’s patients in 2015 and beyond.”

“The Physicians Foundation is steadfastly committed to providing objective data and insights to healthcare analysts, lawmakers, physicians, patients and other influencers to ensure they have the information required to effectively prepare for and fulfill the present and future challenges of the American healthcare system,” said Walker Ray, MD, vice president of The Physicians Foundation and chair of the Research Committee.