What Issues Will Most Affect Physicians, Patients in 2013?

The Physicians Foundation, a national not-for-profit organization dedicated to helping physicians deliver health care to their patients, recently released a list of the top five issues it considers most likely to affect physicians and health care consumers in 2013.

The list, titled "The Physicians Watch List for 2013," identified the top five issues based on the foundation's own studies and on policy papers published in 2012, according to a press release from the organization.

Foundation President Lou Goodman, Ph.D., said in the release that 2013 would "be a watershed year for the U.S. health care system."

Goodman, who also serves as CEO of the Texas Medical Association, said that "lawmakers need to work closely with physicians to ensure that we are well prepared to meet the demands of 30 million new patients in the health care system and to effectively address the impending doctor shortage and growing patient access crisis."

No. 1 on the foundation's list was continuing uncertainty surrounding implementation of the 2010 Patient Protection and Affordable Care Act. Key areas of the law -- such as health insurance exchanges, the Medicare physician fee schedule and the independent payment advisory board -- "remain nebulous," said the foundation.

Physicians will have to "closely monitor developments around the implementation of these critical provisions to understand how they will directly affect their patients and (their) ability to practice medicine."

Second on the list was the rapid rate at which large hospital systems and medical groups continue to snatch up small private medical practices. According to the organization, physicians indicated in foundation surveys that the desire to attain a certain degree of income security and reduce the pressure of administration burdens was driving them to seek the security of practicing medicine as employees rather than as business owners.

However, the foundation cautioned that as the trend toward consolidation continues, it will be "vital to monitor for possible unintended consequences related to patient access and overall cost of care." The foundation questioned whether bigger organizational structures would translate to the provision of better health care for patients.

Third, the foundation expressed caution about the soon-to-come introduction of more than 30 million new patients to the U.S. health care system. The patient population is set to expand as a direct result of full implementation of the health care reform law.

"This provision has considerable implications relative to patient access to care and physician shortages," said the foundation. For example, the equivalent of nearly 47,000 full-time physician positions could be lost from the workforce during the next four years as physicians cut back on their work hours. Adding to this dilemma are reports that 52 percent of physicians already have -- or plan to -- limit access by Medicare patients to their practices.

A fourth issue of concern for physicians to ponder in 2013 is the loss of physician autonomy due in part to decreasing payment, liability concerns and "an increasingly burdensome regulatory environment." According to the foundation, "Physicians will need to identify ways to streamline these processes and challenges to help maintain the autonomy required to make the clinical decisions that are best for their patients."

Finally, the foundation expanded on the topic of administrative burdens. It cited its 2012 Biennial Physician Survey (128-page PDF; About PDFs), in which many physicians said excessive administrative and government regulations -- described as "red tape" -- were top reasons contributing to "pervasive physician discontentment." According to a previous foundation report (70-page PDF), the creation of a federal commission for administrative simplification in medicine could provide relief on this front by identifying and reducing physician reporting requirements that don't save money or reduce risks to patients.