For the medical professional, 2015 presents another year of changes and continued challenges. From meaningful use struggles to Medicare physician payments, the AMA has identified the following 10 key issues for physicians to monitor in the year ahead:
1. The administrative load and competing regulatory programs.
According to the AMA, time and expense devoted to administrative and regulatory requirements is one of the top frustrations to physicians.
In 2015, the AMA noted they will be taking many of these barriers to providing high-quality care head on, including:
• EHR and Meaningful Use Requirements. At the top of many physicians’ lists of things that need to change are unhelpful EHR systems and unachievable meaningful use requirements. More than 50 percent of eligible professionals will face payment penalties next year because they could not fulfill meaningful use requirements, according to data released by Centers for Medicare & Medicaid Services (CMS).
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, 2015 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.
Despite push back from other professional organizations, 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. Prior authorization rules continue to interrupt care delivery and place undue administrative and financial burdens on physicians. Efforts are currently underway at the AMA to mitigate the burden of preauthorization and other utilization review tactics health insurers require.
• Federal fraud and abuse programs. 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. In 2015, 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.
Limited provider networks has necessitated physician action to ensure patients have access to the care they need. The AMA has plans to bolster 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:
Featured image credit: adrianclarkmbbs