Questions Physicians Ask about 2016 Healthcare Trends

The Q1 2016 Provider Advisor is focused squarely on the onboarding process and how providers are affected by it. This post excerpts an article about significant issues and trends currently facing physicians.                               

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Mergers of Major Payers on the Horizon.

If payers narrow provider networks to save money, how can I make the referrals I need to make for my patients? What recourse do we have against payer monopolies when they dictate pricing?

The nation’s largest health insurers began a highly-publicized move toward consolidation in 2015. The requisite approvals are in process as are the details of these mergers – Aetna with Humana and Cigna with Anthem. More will come to light in 2016 when, as the consolidation of these healthcare funding giants become reality, numerous providers of medical care may begin to experience the early impact. Physicians fear these mergers will lead to monopolization which will make it more difficult for physicians to negotiate fair and favorable terms for their services, and introduce narrower referral network options. Stephen Stack, MD, President of the American Medical Association noted that if insurance mega-mergers are approved “employers and patients may be charged higher than competitive premiums, and physicians may be pressured to accept unfair terms that undermine their role as patient advocates and their ability to provide high-quality care.” 

Insurers will likely also push back on the drug companies and their escalating price of pharmaceuticals. This payer resistance is likely to include some combination of the following: not adding higher-priced drugs to their formularies, instituting a more stringent preauthorization process or moving such drugs to a higher coinsurance tier. 

Telemedicine on the rise.

From a quality standpoint, how can remote technology replace a thorough office visit? How does this affect liability and malpractice premiums?

Telemedicine—the delivery of health care by phone or over the Internet—has accelerated dramatically fueled by a convergence of mobile devices and home technology services. A recently published report by iData Research predicts that by the year 2020, the patient monitoring market in the U.S. will grow by roughly $5 billion, mostly due to the expansion of telemedicine use (Bowman, 2015). Dr. John Shufeldt, CEO of MeMD, a telemedicine company observed, “Thanks to telemedicine, all you need is an Internet connection and a webcam and you can have an online consultation with a board certified physician no matter where you are traveling in the U.S.”

Improved access made possible by technology helps patients receive immediate medical attention, which can minimize the duration and severity of an illness, and reduces the amount of time spent in waiting rooms and Emergency Departments. Further fueling the move to telemedicine, the Association of American Medical Colleges predicts that by the year 2025, the United States will face a shortage of between 46,000 and 90,000 physicians.

Health data breaches likely to continue.

What is my responsibility for keeping my patients’ health information safe?

The healthcare industry is more vulnerable to cyberattacks than other large industries, according to a recent study by security rating firm BitSight Technology (Hall, 2014). “Unlike the financial institutions and electric utilities…the healthcare and pharmaceutical companies do not view cybersecurity as a strategic business issue… They do not spend enough resources to protect their data,” according to the BitSight report. Against this backdrop, physician offices are particularly at risk. Small organizations, such as physician offices, account for the largest number of data breaches, with 72% occurring in organizations with fewer than 100 employees (Dolan, 2012). This issue has only escalated over recent years.

From a physician perspective, patients who read of cyber-attacks or breaches of patient health data may be reluctant to seek care from a hospital or affiliated medical practice that has had a data breach. Yet, physicians want to know who has the responsibility for the protection of their patents’ health information and who will assure them of those protections.

Other issues covered include:

  • Consumer education about costs and coverage is needed
  • We’re gaining a better understanding of unnecessary readmissions
  • Drug prices soar
  • We’re more concerned about employee turnover
  • We’re demanding better tools to manage our employed physicians
  • Skillful revenue cycle management becomes essential
  • Physician burnout

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April 1, 2021