2017 promises to be a unique and challenging year for physicians. With the possible repeal of the Affordable Care Act, the start of implementation of the Medicare and CHIP Reauthorization Access (MACRA) Act, and continued push of value based payment systems there is a lot of uncertainty for physicians in independent practice.
Value-based care is a concept we all try to do for our patients, but never as a part of reimbursement. The change from fee for service will be a significant adjustment for many practices. Even though Medicare gave us a slight reprieve by allowing partial participation, it is still a difficult decision to decide whether to participate in MACRA or not.. Being part of an Accountable Care Organization (ACO) I have no choice, but hopefully the larger organization will be able to fare better in a system that so far isn't looking very favorable to small practices. My goal is to stay active in my ACO board to be able to help navigate the process for the other physicians.
It will take a difficult balance to provide the personalized care my patients have grown accustomed to without being forced to make decisions for financial reasons. I also worry about getting lost in the sea of paperwork and regulations to document the care we provide. Hopefully working as a team with my staff, with everyone working to the level of their degree to streamline work flow, will help the process. Hopefully the EHR companies will continue to enhance systems and look for ways to be more interactive to share information.
With the current state of insurance shifting more of the burden of cost to the patient it's becoming more difficult to collect patient balances from patients who don't have the money. Many of them also delay care and ration their medications due to cost. This will likely only get worse in the upcoming year with increased premiums and companies shifting more cost to employees. We can hope the new administration will help to move the needle the other way, but it will not be an easy job.
My goal for the new year is to continue to build my practice to maintain my independence in this changing environment. The rewards and flexibility of independent practice are well worth it — the relations with my patients whom I have developed over my years in practice make every day worth going to work. Hopefully that is what will keep us all going and as we have adapted to changes over the course of our careers.
Hopefully, I can share tips along the way. I welcome any suggestions from others on successful ways to survive in the new era of medicine.