What Keeps Physicians, Practice Managers Up at Night?

New Payment Models, Greater Financial Risk Top the List

July 26, 2011 05:05 pm Sheri Porter

A recent survey on work-related challenges physicians and their medical practice managers are encountering in 2011 revealed some surprises, with the issues that respondents identified as their top two challenges appearing on the list for the first time.

The Medical Group Management Association, or MGMA, released the results from its fourth annual survey, "Medical Practice Today: What Members Have to Say," on June 30. According to a company press release(www.mgma.com), the top five challenges respondents reported are

  • gearing up for new payment models that result in practices taking on a greater share of financial risk;
  • taking part in CMS' Medicare or Medicaid electronic health record, or EHR, incentive programs;
  • managing rising operating costs;
  • choosing and implementing an EHR system; and
  • implementing and/or optimizing an accountable care organization, or ACO.

The list includes a total of 44 items, but the change in top concerns since last year's survey, which includes the No. 5 concern about ACOs, as well as the top two concerns, seems to indicate unease among survey respondents about the changing direction in U.S. health care, according to MGMA President and CEO William Jessee, M.D.

"It just goes to show that whatever the feds have done to you lately changes your priorities," Jessee said in an interview with AAFP News Now. "It's sort of a commentary on how rapidly the world changes for those of us in health care."

Story Highlights

  • The Medical Group Management Association released its fourth annual report detailing tops concerns for medical practices around the country.
  • The No. 1 challenge reported was preparing for new payment models that give practices a greater share of financial risk.
  • The second biggest challenge was taking part in CMS' Medicare or Medicaid electronic health record incentive programs.

According to Jessee, "The concern about ACOs -- and obviously the opportunity to earn some extra money through meaningful use -- drives (those issues) up near the top, but the flip side of that is dealing with rising operating costs, which was still very much on peoples' minds." He pointed out that rising operating costs was the No. 1 issue in 2010, and the issue's continued high ranking indicates that "it's become a chronic issue for practices, as operating costs continue to go up every year."

Nearly 1,200 individuals responded to the MGMA's Web-based questionnaire. Respondents ranked the 44 issues and identified the degree to which each issue presented a challenge to the practice. Issues were rated according to a five-point scale with "5" indicating an extreme challenge and "1" no challenge at all.

For example, every item in the top five list was ranked by more than 60 percent of respondents as an extreme or considerable challenge.

Rounding out the top 10 issues in 2011, survey participants said they worried about were

  • managing finances with the uncertainty of Medicare reimbursement rates,
  • modifying the physician compensation formula to more heavily emphasize quality measures,
  • recruiting physicians,
  • negotiating contracts with payers, and
  • maintaining physician compensation levels.

Jessee said the annual survey, which is available only to MGMA members, measures "hot items," or the things that people are worrying about and struggling with right now. With that premise in mind, he made a prediction about what would be red hot in a couple of years. "I would bet in 2013, everybody is going to be really, really worried about ICD-10," he said.