Changes Coming With Healthcare Reform Worry Physicians
Only a handful of physicians are involved in alternative patient-care delivery models. About 3% participate with Accountable Care Organizations (ACOs) but another 5% say that they plan to become involved in the coming year.
ACOs are a type of payment and delivery model that ties provider reimbursement to quality metrics and reduction in the total cost of care for an assigned patient population. They may initiate bundling of payments for various clinical outcomes. Fifty-two percent of physicians believe that they will cause a decline in income, while 12% say they will have little or no effect.
In a sentiment expressed by many of the 3200 physicians who commented on our survey, one doctor said, "ACO arrangements are a conflict of interest. Administrators, not physicians, will decide what's allowed. It would also spell the end of solo or small group practices."
Aburmishan says that's a common attitude. "Of course, physicians are skeptical about ACOs. It's yet another set of initials coming from the government, and history shows that that means less money and less autonomy for physicians."
What About Quality Measures and Treatment Guidelines?
Physicians are also skeptical about whether quality measures and treatment guidelines will improve patient care. Close to half of doctors say that they will have a negative impact on care, while 25% believe that they will lead to better-quality care.
The vast majority of physicians (67%) said that they won't reduce the amount of tests, procedures, and treatments they perform in order to comply with the guidelines because those guidelines aren't in their patients' best interests or because doctors still need to practice defensive medicine.
"More and more, physicians feel that someone is telling them how to treat patients," said Bohannon. "They worry that the guidelines are promulgated to reduce overall costs rather than put patients first. Doctors feel that they have to give up more autonomy and they resent being told how to exercise their medical judgment."
Almost half of physicians (46%) discuss the cost of treatment with patients only occasionally, if the patient raises the subject. Just over one third of physicians (38%) regularly discuss the issue with patients. About 16% say they never discuss costs because they don't believe it is appropriate or they don't know the cost of the treatments.
"Too many doctors have little idea or time to devote to the cost of care," said Aburmishan. "They often don't do their own billing or collections so they don't know what each insurer pays. They are so busy with paperwork and seeing more patients that they don't devote much time to overall cost issues."
Bohannon agrees. "As medicine moves more and more to an employed model, most physicians feel that their responsibility is to treat the patient's clinical problem. The cost issue is secondary. Most doctors don't believe that it's their job to focus on that."
For further details on physician compensation, see Medscape's complete Physician Compensation Report: 2012 Results.