5 challenges doctors continue to face in 2018, from MACRA to recapturing the joy of medicine

Doctors and physician practices face familiar challenges in 2018.

If 2017 was tumultuous, the year ahead may be one of adjustment to all that change for physician practices.

The fact is U.S. healthcare is just too expensive, driving changes for physician practices. Whether it's a new payment model or looking for better ways to meet patient needs, the ultimate goal is to cut costs and improve the quality of care. The pressure is on to change the way that leaders organize and operate their practices.

The challenge is to improve the way practices while work increasing satisfaction for physicians, patients and staff.

Here are some of the top challenges that doctors will face this year:

1. The continuing adjustment to MACRA

In 2018, practices enter year two under the new physician reimbursement system introduced by the Medicare Access and CHIP Reauthorization Act. Described by one doctor as the biggest thing that’s hit healthcare payments in a generation, it will only get tougher for many doctors.

Reimbursement will weigh heavily on physicians this year. (jansucko/iStock/Getty Images)

The good news? A final rule that established changes for the second year of MACRA exempted many more physicians from participation.

But for those that are still participating through the Merit-based Incentive Payment System (MIPS), they will need to collect quality data for a full 12 months, not just the 90 days needed in 2017 to qualify for a possible bonus payment. It will be interesting to see just how many physicians participated in the first year of MIPS, a payment system that has come under increasing scrutiny.

While physician groups urged doctors to participate by submitting the minimum amount of data to avoid a 4% financial penalty down the road, some practices no doubt gave up on trying to comply with the complex program. A study that looked at MIPS’ predecessor, Medicare’s Value-Based Payment Modifier Program, found that almost 30% of practices took a financial penalty that cut their Medicare revenue rather than participate in the program.

And the Medicare Payment Advisory Commission, which advises Congress on Medicare matters, will meet on Jan. 11 and 12 and is expected to act on a recommendation that the government replace the complicated MIPS program, which staff called “burdensome and inequitable,” with a voluntary alternative system.

2. The continuing uncertain political future and impact on patients

Healthcare will remain on the front burner in Washington with the start of 2018. One result of the election of Donald J. Trump to the Oval Office, as well as a Republican-controlled Congress, was the political involvement of many doctors.

The fight to repeal and replace the Affordable Care Act brought physician organizations that represent hundreds of thousands of doctors into the fray. It became a front-burner issue for doctors because of the significant impact on patients if the ACA were repealed and the number of uninsured increased.

U.S. Capitol with flag
Doctors are worried about the fate of the ACA. (Getty/Andrea Izzotti)

The efforts to repeal the ACA failed in three repeated tries. Before the Christmas break, Senate Majority Leader Mitch McConnell signaled he's ready to move on from the GOP's bid to repeal the ACA, but some of his peers aren't on the same page and remained committed to a full replacement.

A tax reform bill passed in December eliminated the ACA's individual mandate—which imposes a tax penalty on those who don’t maintain health coverage—leaving many doctors worried about increases in the number of uninsured patients.

The battle for healthcare funding will be front and center in 2018. Congress passed a short-term government spending bill in mid-December that included a provision to fund the Children’s Health Insurance Program and community health centers, but it’s not a permanent fix.

3. The continuing pressure to meet patients' growing demands

Patient experience is increasingly important. (Getty/monkeybusinessimages)

Practices have had to react to the unwillingness of many patients to tolerate long waits and inconvenient appointment times. Many practices have already reacted to changing patient attitudes by providing same-day appointments, convenient hours and multiple ways to communicate with doctors as they compete with a growing number of retail clinics, urgent care clinics and telemedicine services.

CVS Caremark upped the ante late last year when it comes to competing for convenience-seeking consumers with its announcement that it is buying health insurer Aetna and will expand health services at its retail pharmacies. Competition may ultimately transform how practices are designed, staffed and operated to make them more patient-centric.

Primary care practices are taking on more roles to meet the multiple needs of patients. Many practices are moving to care teams in which a physician leader takes charge of a team of caregivers that might include advanced practice providers, social workers, pharmacists and mental health professionals.

4. The continuing changes to the healthcare landscape

The number of small independent practices, once the backbone of medicine, is at a historic low. For the first time, physician-owned practices are no longer the majority, according to a survey by the American Medical Association. For many physicians, the question remains whether they can afford to stay independent or seek employment with a hospital or healthcare system.

Technology, including the growth of telemedicine, is also changing how doctors deliver care to patients. The old-fashioned office visit isn't going away. In many cases, it will always be necessary for doctors and patients to interact on a personal level. Artificial intelligence won't replace human intelligence. Instead, technology and physicians must work together.

Practices will find themselves increasingly interacting with patients in both old and new ways via phone, email, patient portals, video and other technology. The challenge is to keep pace and make it easier for patients to communicate with physicians and other providers to receive the medical care they need.

5. The continuing battle to find joy in medicine

For many doctors, the daily struggle has increased, fueled by factors such as time-zapping electronic health records. Perhaps that’s why the message of Zubin Damania, M.D., also known as the rapper ZDoggMD, resonated so soundly with physician practice leaders at the Medical Group Management Association annual meeting.

Damania got a standing ovation with his call to physicians and other healthcare professionals to remember that medicine is a calling and that they must help build the next version of healthcare. 

Given the predicted physician shortage, which the Association of American Medical Colleges says could hit over 100,000 by 2030, the industry faces the challenge of keeping the doctors it currently has working in the healthcare system. This despite research that shows that doctor burnout has led 1 in 5 physicians to plan to reduce their clinical hours and has roughly 1 in 50 planning to leave medicine altogether in the next two years. 

Leading institutions, such as the Mayo Clinic and Stanford University, are working to address the problem of physician burnout, along with organizations such as the American Medical Association (AMA). 

“America’s physicians are the canary in the coal mine,” said AMA President David O. Barbe, M.D. His organization is pushing decision-makers to take steps to curb burnout before it’s too late, in particular by promoting physicians’ well-being. Administrative fatigue stemming from bureaucratic pressure, as well as dissatisfaction with EHR technology, are the problem's primary contributing factors.