The year ahead promises many changes and challenges for the medical profession. From taking on regulatory burdens to improving health outcomes for patients, 10 of the top issues physicians should monitor in the year ahead encompass the broad spectrum of today’s medical practice.
1. The administrative load and competing regulatory programs. Studies show that one of the greatest frustrations to physicians is the time and expense they must devote to administrative and regulatory requirements, pulling time away from patient care without a direct benefit to care delivery or health outcomes.
In 2015, the AMA will be taking many of these barriers to providing high-quality care head on, including:
• Electronic health records (EHR) and meaningful use. At the top of many physicians’ lists of things that need to change are unhelpful EHR systems and unachievable meaningful use requirements. According to data the Centers for Medicare & Medicaid Services (CMS) released in mid-December, more than 50 percent of eligible professionals will face payment penalties next year because they could not fulfill meaningful use requirements.
The AMA will continue to push for the adoption of solutions to the one-size-fits all meaningful use program, as outlined in a blueprint submitted to CMS in October.
In addition, the AMA is building on a new framework for EHR usability that it developed with an external advisory committee of practicing physicians and health IT experts, researchers and executives. The AMA is working with physicians, EHR vendors, policymakers, health care systems and researchers to drive EHR improvements that can advance the delivery of high-quality, affordable care.
• ICD-10 implementation. With an implementation deadline of Oct. 1, the ICD-10 code set will be a time-consuming focus of the year ahead for many physician practices. ICD-10-CM has 68,000 codes—a five-fold increase from the approximately 13,000 diagnosis codes in ICD-9.
Given the dramatically high costs of adopting the new code set for physicians, the AMA will continue to urge regulators to ease this physician burden. At the same time, physicians can access ICD-10 resources that can help ensure their practices are prepared for implementation of the new code set.
• Prior authorization. As prior authorization rules continue to interrupt care delivery and place undue administrative and financial burdens on physicians, efforts are underway at the AMA to mitigate the burden of preauthorization and other utilization review tactics health insurers require.
This includes an in-depth study that will quantify the administrative burden of prior authorization, authorizations and denials of authorization appeals. The study also will look at time taken away from patient-care activities. It will be conducted this year, and results will be shared early in 2016.
• Federal fraud and abuse programs. While preventing unscrupulous activities in the Medicare system is an appropriate goal, many physicians are being unduly taxed by the “bounty-hunter” efforts of the Medicare recovery audit contractors (RAC). In fact, more than 60 percent of RAC determinations are overturned when appealed. Meanwhile, CMS has a two-year backlog of appeals to sort through. The AMA will continue to push the agency to overhaul this program in the year ahead.
2. The Medicare physician payment system. Congress will need to act early this year to avoid a 21 percent pay cut scheduled to take effect April 1 under the sustainable growth rate (SGR) formula. Because Congress missed its opportunity last year to repeal the SGR formula using a bipartisan legislative framework, the AMA and physicians will continue communicating with lawmakers—including those newly elected—to make reforming the Medicare payment system a priority for the new Congress.
In addition to addressing the SGR formula, the AMA will be tackling other timely issues related to the Medicare fee schedule, including the value-based payment modifier, elimination of the global surgical period and potentially misvalued codes.
3. Adequate provider networks. The current trend toward very limited provider networks has necessitated physician action to ensure patients have access to the care they need. The AMA is bolstering its national- and state-level efforts to make sure health insurers are required to maintain adequate networks, provide timely information about the physicians and other providers to whom patients will have in-network access, and comply with all laws and regulations.
4. Prescription drug abuse and overdose. Most stakeholders now agree that the nation’s prescription drug overdose epidemic should be addressed primarily through treatment, prevention and education rather than law enforcement. But much work remains to execute solutions in local communities. The AMA will continue to lead policy development around this issue in the states and nationally, and engage physicians in practical activities to prevent prescription drug abuse and allow pain management for patients who need it.
5. Preventing type 2 diabetes and heart disease. As two of the nation’s most troubling diseases, these chronic conditions have been targeted for elimination before they develop in patients. Physicians can expect to see practical resources to help prevent diabetes among their at-risk patients and tools to help improve blood pressure control among hypertensive patients throughout the year ahead. Such resources have been under development with physician pilot sites and national partners in the AMA’s Improving Health Outcomes initiative.
6. Advances in clinical knowledge and information sharing. New medical information, treatments and technologies continue to evolve at an astounding rate. Staying on top of the latest knowledge and developments will be more important than ever this year. The JAMA Network continues to find ways of helping physicians keep up with clinical knowledge, including a new journal that will debut early this year: JAMA Oncology.
7. Transformation of medical education. Medical schools that are part of a special consortium of the AMA’s Accelerating Change in Medical Educationinitiative have been driving undergraduate medical education into the future by developing and implementing innovative ideas for medical student training. This work will continue to advance over the next year, and new schools will be adopting the best practices they are putting forward. Additionally, the initiative will be working toward changes in graduate medical education to improve physician education across the learning continuum.
8. Modernization of the AMA Code of Medical Ethics. This 167-year-old standard for the medical profession has been undergoing a comprehensive update for the past six years, and 2014 was spent soliciting and reviewing physician feedback on the proposed changes. A draft to be considered for adoption will be released this year. AMA members can continue to provide feedback through Jan. 15.
9. Improved professional satisfaction and sustainability of practices. Physicians will have access to tools currently in beta testing that will help them address common clinical challenges so they can boost their professional satisfaction and the quality of their patient care. Part of the AMA’s Professional Satisfaction and Practice Sustainability initiative, the tools will offer proven practice solutions, such as pre-visit planning, synchronized prescription renewals and collaborative documentation.
10. Court rulings on critical health care issues. Given the number of court cases that have made it to the Supreme Court of the United States and state supreme courts over the last few years, physicians can expect that the nation’s courts will continue to play a crucial role in the practice of medicine. Topics of greatest importance continue to be the patient-physician relationship, medical liability and patient privacy.
An especially important case heard by the U.S. Supreme Court several months ago should be decided early this year. The decision will determine whether state health care licensure boards will retain their authority to regulate their health care professions to shield patients from potentially unlawful practice. TheLitigation Center of the AMA and State Medical Societies will continue to ensure the physician’s voice is heard in these cases.
AMA Wire® will provide timely coverage of these issues and many other important topics for physicians, residents and medical students throughout the year ahead.
