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American Academy of Family Physicians
Wednesday Dec 19, 2012

Five issues to watch out for in 2013

If you think the health care system has changed a lot over the last couple of years, just wait until 2013. It will be "a watershed year for the U.S. health care system," said Lou Goodman, PhD, president of The Physicians Foundation and chief executive officer of the Texas Medical Association, in a statement announcing the Foundation's "Physician Watch List for 2013." Based on research studies and policy papers issued by the Foundation, the list identifies five issues that are likely to have a major impact on patients and physicians in the coming year.

1. Ongoing uncertainty about health care reform. Although the Supreme Court upheld the Affordable Care Act (ACA) in June, key parts of the act have yet to be fully defined or fully implemented, including accountable care organizations, health insurance exchanges, and the Independent Payment Advisory Board for reducing Medicare spending. According to the Foundation's "2012 Biennial Physician Survey," uncertainty about health reform was a key reason that 77 percent of physicians reported pessimism about the future of medicine.

2. Ongoing consolidation. Hospitals and large groups are acquiring small private practices at a steady rate by offering physicians income security and relief from administrative burdens, according to the Foundation report "The Future of Medical Practice: Creating Options for Practicing Physicians to Control Their Professional Destiny." While consolidation can yield benefits, such as improved communication between providers, it can also create monopolistic behavior, raise the cost of care, and reduce the viability and competitiveness of solo or small private practices, cautions the Foundation.

3. Patient access challenges. More than 30 million individuals are expected to gain health insurance in 2014 under the ACA. This will likely create challenges for patients trying to access care because the current physician supply is not adequate to meet this demand. In fact, according to the "2012 Biennial Physician Survey," physicians are working fewer hours, and if this trend continues, the health care system could lose the equivalent of more than 47,000 full-time-physicians in the next four years.

4. Eroding physician autonomy. Doctors' ability to exercise independent medical judgment is markedly deteriorating, says the Foundation, because of threats to their reimbursements, liability pressures, and an increasingly burdensome regulatory environment. Increased consolidation may also play a part.

5. Growing administrative burden. One of the chief contributors to physician discontentment, according to the "2012 Biennial Physician Survey," is the increased burden physicians carry because of administrative and regulatory tasks. "The Future of Medical Practice" report calls for the creation of a new federal commission for administrative simplification to evaluate cumbersome physician reporting requirements and eliminate those that do not save money or improve quality.

The Foundation hopes this watch list will serve as "a pragmatic resource that will help policy makers, physicians, and health care providers formulate smart policy decisions that are beneficial to America's patients and doctors," said Walker Ray, MD, vice president of The Physicians Foundation and chair of the Research Committee.

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