WATERTOWN, MA – Many doctors are deeply skeptical about the future of medicine, according to a recent survey conducted by athenahealth, the provider of Web-based practice management tools, and Sermo, the largest online community for physicians.
Atop their list of complaints: long-simmering frustrations with insurers.
The first-of-its-kind "Physician Sentiment Index" showed that 59 percent of docs believe that the quality of American medicine will decline in the next five years — and only 18 percent expect it will improve.
Meanwhile, 62 percent expressed pessimism about doctors' future ability to practice independently or in small groups, and 64 percent indicated that their clinical decisions are based more on what payers were willing to cover than what they think is best for their patients.
One of the most striking numbers: a full 92 percent of doctors reported that getting paid by insurers has "become increasingly burdensome and complex," including 83 percent and 81 percent who felt that way about dealing with Medicaid and Medicare, respectively.
"Physicians want to focus on being the best doctors they can be, but there are all these things getting in the way," said Jonathan Bush, chairman and CEO of athenahealth. "They're caught between caring for their patients and remaining viable businesses. You've got stimulus dollars encouraging them to abandon a pen and paper system for electronic health records that are yet unproven, huge headaches that come from dealing with reimbursement protocols, hospital systems pressuring independents, and heath reform that will expand overly stressed state Medicaid programs — it's no wonder the sentiment is pretty bleak."
Frustration with payers' regulations and reimbursement protocols was widespread. More than three quarters (77 percent) said that time spent dealing with payers and other third parties inhibited their ability to spend time with patients. Meanwhile, 83 percent said that administrative costs incurred in order to comply with payer rules significantly affects their bottom line. And just 16 percent of doctors said they based clinical decisions on what's best for the patient rather than what payers are willing to cover.
Meanwhile, 77 percent reported that time spent dealing with payers inhibits their ability to spend time with patients and 83 percent agreed that administrative costs incurred to comply with payer regulations significantly affects their bottom line.
"Health plans have proposed far-reaching administrative simplification reforms to reduce paperwork, improve efficiency, and free up time for doctors to spend more time with their patients," counters Robert Zirkelbach, spokesman for America's Health Insurance Plans. "For example, we recently launched pilot programs in Ohio and New Jersey on a new initiative to simplify the flow of information between health plans and doctors’ offices by providing access to multiple insurers through a single Web portal. When implemented broadly, these types of changes will have a similar impact on healthcare that ATMs had on banking, potentially saving hundreds of billions of dollars across the entire healthcare system."
Red tape and administrative bureaucracy have compelled many independent doctors to take a larger front-office role. It's not a position they relish. Many docs struggle to understand cash flow (only 25 percent could correctly define the term), 33 percent didn't know their average length of time for accounts receivable, and 43 percent didn't know what their insurance submission rejection rate is.
Among physicians who did know their rejection rate, a range of 5 percent to 10 percent was most common — with the average income of responding practices $2.5 million, this translates to $125,000-$250,000 in deferred or lost income per practice. "We're seeing this cottage industry of 5-10 group physician practices go out of business because they are focused on patient care and not focused enough on their business," said Daniel Palestrant, CEO of Sermo. "These are MDs, not MBAs, and here they are on the front lines dealing with the burden of balancing patient interaction with reimbursement complexities and managing a practice. They are frustrated."
