Physician practices had a lot to track in 2016, and many of the big stories will likely continue to reverberate into 2017 and beyond.
That’s certainly the case with the election of Donald Trump as the country’s 45th president. Trump’s win has many implications for healthcare policy, including a possible repeal of the Affordable Care Act.
As 2016 comes to a close, FiercePracticeManagement looks back at Trump’s impact on healthcare and other noteworthy stories that had an impact on the industry this year.
Donald Trump and the future of healthcare
Trump’s election as president took many people by surprise, and the results revealed a sharply divided country. Doctors were as divided as the rest of the country, as one poll showed a third of physicians saw Trump’s election as the “most exciting” news of the year, while a similar number called it the “most frustrating” news.
Trump’s decision to name a physician as secretary of the Department of Health and Human Services (HHS) did anything but have a unifying effect on doctors. The president-elect nominated surgeon-turned-congressman Rep. Tom Price, R-Ga., a longtime critic of the ACA, to head HHS.
When the American Medical Association quickly endorsed Price’s appointment, which must be approved by Congress, there was a firestorm of protest from some doctors. Thousands of doctors signed a letter to the AMA titled “The AMA Does Not Speak for Us,” and the advocacy group Clinician Action Network has promised to fight any Trump policies that it perceives will hurt patients. Almost 450 doctors who are members of the AMA, the country’s largest physician group, signed an open letter criticizing the Price endorsement.
As the Trump administration moves forward to implement new health policies, the division between liberal and conservative doctors is likely to continue.
A rocky road for MACRA
Even before the Centers for Medicare & Medicaid Services unveiled its proposed rule to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physicians and advocacy groups were pessimistic about a plan based on the much-maligned Meaningful Use program.
Moving healthcare payment incentives away from fee-for-service and toward value-based care was never going to be easy. It did not take physicians long to discover that identifying, quantifying and reporting quality care measures would represent both a major change and a tremendous burden for their practices.
Early criticism of the rule also homed in on the way small practices seemed likely to bear a much higher proportion of the financial cost as well, both in terms of technology upgrades and higher penalties under the Merit-based Incentive Payment System (MIPS) intended to govern the participation of the vast majority of practices early on. When the CMS called for feedback, it got an earful, from individual practitioners to industry groups to Congress itself.
By the time the final rule was released, the CMS had partially acquiesced to calls for the law’s delayed implementation, allowing physicians a series of paths that would bring them into compliance more slowly than originally envisioned.
The results of the presidential election have raised some hopes, with the GOP Doctors Caucus, an 18-member group of Republican lawmakers including eight physicians and others with connections to the healthcare industry, contemplating further congressional action to reduce the rule’s complexity. Given the nature of the legislation, however, Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association (MGMA), suggested it would be better not to hold your breath. “The law is set in place at this point,” he said at the annual MGMA conference.
Physician burnout, a continuing problem
The prevalence of physician burnout became so great heading into 2016 that it’s no surprise the topic came up frequently throughout the year. The Mayo Clinic identified burnout as a contributing factor to the ongoing physician shortage, showing that doctors were making the difficult choice between their own well-being and the time spent with their patients.
“There is a societal imperative to provide physicians a better option than choosing between reducing clinical work or burning out,” said Tait Shanafelt, M.D., the lead author of the Mayo Clinic study.
Meanwhile, physicians began the process of healing themselves to the extent they could, issuing tips from the trenches that encouraged their peers to pursue wellness and improve their work-life balance. Medical schools have also increasingly recognized their role in nipping burnout in the bud by way of earlier training and an overhaul of the “tough-it-out” attitude that traditionally prevailed in the field.
The importance of the health of the physician to the health of the patient is receiving greater recognition, especially as the industry moves toward patient-centered care models in the age of paying for quality. “Every other industry understands that if you have a healthy, loyal, engaged workforce, you have an improved bottom line and loyal customers,” says Bridget Duffy, M.D., suggesting that healthcare, while late to the party, may finally be getting a handle on the problem.
A smooth implementation for ICD-10
The long-awaited introduction of new ICD-10 codes started out more smoothly than many in the industry expected, with polling that showed nearly half of practices saw no more claims rejections than usual in the early going. By midyear, most practices were reporting a smooth transition to the system’s new codes.
That easy transition was owed in large part to extensive training via educational resources provided by the American Medical Association and the CMS itself. “It’s been less turbulent than I expected,” said Robert L. Falk, M.D., a staff radiologist with Radiology Specialists of Louisville in Kentucky. “Our practice began preparing well in advance, and we were able to engage the enthusiastic support of the physicians working with administration and billing to ensure a smooth transition.”
Ethical, legal issues for doctors
The fall election meant more states approved initiatives to allow physician-assisted suicide and medical marijuana.
Colorado voters waded into the physician-assisted suicide question, approving a law that makes it legal for doctors to prescribe drugs to help patients in the final stages of terminal illness to end their own lives. Doctors’ opinions have lagged those of the public on this issue for some time. More than one hospice physician has pointed out the importance of initiating conversations about end-of-life care before patients are in such a stage of suffering that they see no other way out. Some see laws such as Colorado’s as having potential to start those conversations, suggesting there may be unintended benefits when all is said and done.
Since the law does not require doctors to issue prescriptions, individual doctors can follow their conscience with regard to whether they participate in the practice.
In several states, voters have gotten out in front of physicians in their enthusiasm for laws that raise ethical quandaries for practitioners. Voters in 25 states plus the District of Columbia have now approved the use of medical marijuana, for example, but many doctors find themselves unsure of its efficacy.
That has led to situations like the one in Maryland, where a state program approved in 2014 has had difficulty attracting enough doctors to get it off the ground. Since the drug remains illegal under federal law, some hospitals and large practice groups forbid their doctors from prescribing it. For other doctors, the evidence used to figure out proper dosing and best prescribing practices with other drugs is still largely missing when it comes to marijuana. “We don’t even have basic information on dosing like we do for all other medications generated from clinical trials,” grouses Deepak Cyril D’Souza, M.D. “What do we tell people? Take two hits and call me in the morning?”