Electronic Health Records

Independent docs not optimistic about accountable care, EHRs

Independent physicians are significantly less optimistic about the state of the healthcare industry than their employed or hospital-based peers, according to a new survey conducted by athenahealth.  With three quarters of independent doctors not even sure small practices will be able to survive the changes in store for healthcare over the next few years, trepidation over the murky path forward colored most of the findings in this year’s Physician Sentiment Index (PSI) report.

Accountable care figured largely in physicians’ minds when asked about the future of medicine, and the response to pay-for-performance medicine was mixed.  While physicians don’t necessarily blame payers for the difficulty of getting reimbursed for services, they do feel that accountable care initiatives might make the process even more burdensome.  Three-quarters of respondents said they have only “heard of” or are “somewhat familiar with” the idea of an accountable care organization (ACO), so it might be a lack of knowledge that’s holding back their enthusiasm.

Financial margins are shrinking even as regulations are increasing, requirements for meaningful use and ICD-10 get more stringent, and patients demand more of their physicians.  Sixty percent of participants think the current climate of the industry is ultimately detrimental to patient care. “Physicians are overwhelmed,” said Todd Rothenhaus, MD and CMO of athenahealth. “Whether you look at the impact of first-generation EMRs on their workflow, the growing confusion associated with ACOs, or the dwindling level of confidence they have in their own future, an increasing number of physicians are struggling.  We believe in the value of physician independence, but also acknowledge that the tides have shifted and the landscape in which care is delivered is complex.”

The landscape will only get more complex as the ICD-10 deadline approaches.  Confidence is low, with only 38% “somewhat confident” and 34% not at all confident that they will be able to be ready for the new coding requirements by October 1, 2014.  In contrast to the nervousness surrounding ICD-10, the leap to Stage 2 of meaningful use seems like it will be much less problematic.  Seventy-nine percent of physicians report feeling very confident that they will be able to meet the new thresholds for the second phase of the EHR Incentive Programs.

As for the future, the outlook is a little less cheerful.  Physicians generally expect their financial outlook to get worse over the next year, and only one in ten think that independent practices will be able to thrive in the new healthcare climate.  Independent physicians were more likely to be pessimistic about the quality of medicine than those employed by a larger health system or hospital, and were also more likely to believe EHRs were too expensive for what they can provide.

While the survey’s findings are not entirely encouraging, physicians are generally more accepting of the fact that change is coming than they were when the same questions were asked last year.  How they will meet that change remains to be seen, and how independent physicians will continue to practice in a changing world is a matter for ongoing concern. “Physicians lack the time and, in too many cases, the resources to thrive through change,” Rothenhaus said.  “As an industry and country, we need to pay attention to the fact that doctors are overwhelmed and challenged in areas they shouldn’t be.”

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