The 2016 Survey of America’s Physicians (SAP) indicated an 8% decrease in the number of independent private practice providers since 2012. Many of these providers were frustrated with having to manage their practices while dealing with compliance, regulatory, and revenue cycle management issues; 80% of these doctors were suffering from burnout due to feeling overextended with running their practices. 27% had become so frustrated with the process, that they had begun to limit the number Medicare and Medicaid patients that they were seeing and some declined to see these patients altogether. Much of their frustration was due to the low reimbursement rates and the feeling that they could not provide patients with a quality experience. Some of them were having to double book patients, for example, to ensure that they were bringing in enough revenue to maintain their practices.
Some doctors decided to leave private practice to work for a larger facility that would cover the cost of malpractice insurance and provide them with a salary without all the hassle. Despite this, additional 2015 data from the Centers for Medicare and Medicaid (CMS) indicated an overall 6.3% increase in spending on physicians and clinical care and a 6% increase in the number of healthcare providers opening private practices. The CMS numbers did not distinguish sub-specialty practices from primary care providers, but it did point out that the growth spurt was in alignment with a steady rate of hospital growth and an increase in demand for services.
This growth spurt only reaffirms the need for private practice doctors that provide comprehensive, coordinated care for patients. There is no indication, however, that physicians are returning to private practices in massive droves. Many doctors opt to practice in a subspecialty area because they can increase their revenue, and these are the doctors who appear to be moving into practices of their own. Despite the growth of subspecialty practices, there is still an overall shortage of providers across the spectrum. The Association of American Medical Colleges predicts, that by 2025 there will be a shortage of:
- 12,500 to 31,100 primary care doctors
- 28,000 to 63,700 specialists
As a result, there will be increased utilization of advanced practice nurses (APRNs), delayed physician retirements, changes in payment delivery, and greater use of alternative settings such as telemedicine to deliver care.
The primary care practice provider serves as the foundation of all efforts to improve the delivery of patient care in the U.S. To improve continuity and coordination of care, patients must have a single starting point that can help them to navigate the process. In the past, lawmakers have favored large, well-funded healthcare organizations, because of their ability to track and report massive amounts of data and have not always been considerate of the role that primary care providers play. An article published by JAMA Internal Medicine points out that improving care coordination is a priority for key players within the healthcare industry; it will help to enhance quality and lower healthcare costs. Recently, CMS has tried to re-engage primary providers through several values-based, patient-centered care initiatives such Chronic Care Management, MACRA, and the Quality Payment Plan, but are they too late?
What will it take to encourage primary care providers to remain in their field and continue to offer these vital services to patients? These doctors should be supported, paid well, and adequately trained to run their practices. They need to know that their input is valued and appreciated. It is also necessary to help them to learn how to maximize their revenue by creating a value chain with many of the incentives offered by CMS. Healthcare providers do not control the CMS payment system, but the SAP data also indicated that 80% of them were unaware of such programs as MACRA and the QPP. While these types of incentives are not a comprehensive solution to an ongoing problem, doctors can still leverage them as a resource for additional income. What do you think needs to be done to encourage private practice physicians to remain in business and expand their practices?
Our answer: As a consulting firm, we believe that by pointing out these gaps we can help to encourage a conversation around the issue and provide training support to help doctors leverage these incentives. But we are only one part of the conversation, we would love to know your thoughts on the topic! Please share your thoughts on our blog: www.healthcaretrainingandperformance.com.