Changes expected to be good

For physicians who view a crisis as an opportunity, 2013 might be a great year.

By necessity and statute, changes in payment and practice design are coming, and that could be good, two experts say.

Dr. T. Clifford Deveny, senior vice president of physician practice management at Catholic Health Initiatives, foresees physician compensation moving away from productivity-driven models and predicts physicians being assessed like managers with pay based in part on performance expectations.

In an interview last month, Dr. Jeffrey Cain, president of the American Academy of Family Physicians, correctly predicted that Congress would pass a measure suspending Medicare physician pay cuts driven by the sustainable growth-rate formula, and he thinks this may be the year Washington finally replaces the SGR.

“Nobody's been courageous enough to move this forward,” says Cain, regarding an SGR replacement. “But sometimes you get more courageous when you're standing on a cliff.”

Cain also sees a national discussion on reforming Medicare and Medicaid design and financing with ideas on beneficiary age, copayments and vouchers all on the table.

Also, while others have called for reforming graduate medical education in order to avoid future physician shortages, those calls have been ignored and the same old unsustainable residency training programs keep “chugging along,” Cain says.

But he predicts an Institute of Medicine report coming out this year will highlight projected doctor shortages and create the motivation to do something about it.

“To have the IOM say that will have an impact,” Cain predicts.

Deveny foresees an increasing challenge to state medical boards and specialty societies to continuously monitor scope-of-practice issues where other providers attempt to deliver services previously only performed by doctors. “There will be some opportunists who say, 'We can do that,' ” even when it's clear they can't, Deveny says.

Cain sees the CMS and private payers moving away from fee-for-service in primary care and toward payment methods that support the patient-centered medical home practice model, which focuses on care coordination, increased access and quality improvement.

“If you spend more money on primary care, the system benefits,” Cain says.

As the U.S. health system moves toward more population health management with coordinated care, Deveny sees tension growing between primary care and specialists to develop better working relationships to reduce healthcare fragmentation.

He also predicts that specialists will generate “a louder roar” regarding electronic health records that they say slow workflow and lower productivity—but these doctors may need to take an added role in EHR design for their specialties.

“Specialists have got to take some accountability and run with it,” Deveny says. “I don't see the world turning around and going backward.”