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33 THOUGHT LEADERSHIP CMS pay cuts will push physicians to employed models, Yale professor says By Patsy Newitt S ome physician leaders are worried that CMS' proposal to decrease the physician pay conversion factor by $1.53 to $33.08 will accelerate the migration of physicians to employed settings over independent models. Matt Mazurek, MD, is an assistant professor of clinical anesthesiology at Yale School of Medicine in New Haven, Conn. He joined Becker's to discuss how proposed physician pay cuts will affect patients, physicians and the healthcare industry as a whole. Editor's note: This interview was edited lightly for brevity and clarity. Question: How will declining physician pay alter the healthcare industry? Matt Mazurek: A continued decline in payments will accelerate the current trends for physicians to become employed. Seventy percent of physicians are now employed. By the end of this decade, I predict all physicians will either be employed or remain in academic practices. Even without payment cuts, increases are not keeping pace with inflation and overhead costs. To provide care with fewer physicians and increased demand, healthcare teams composed of APPs, including nurse practitioners and physician assistants, will help fill the gaps in care. If these teams perform efficiently, the administrative burden for physicians will hopefully decrease. My concern is we are not addressing burnout, and systems are layering administrative responsibilities on physicians. It is well known that 60 percent of a physicians' time is spent doing menial, administrative tasks and data entry. The big three EMR companies have not changed their user interface to increase patient care flow and efficiency. They remain primarily billing tools with fragmented information not geared toward bedside care. As payments decline, physicians will demand some accountability for the lack of progress on key drivers of burnout. Q: If CMS follows through with its proposed 4.42 percent physician pay cut, how will physicians and patients be affected? MM: Patients will have fewer options, as physicians will choose to retire earlier or close practices in areas or regions where there is an unfavorable payer mix. The current economic environment has produced the perfect storm for this to occur, as inflation has dramatically increased labor costs and overhead for all healthcare providers. Rural providers and patients will be especially hard hit by these cuts, as patients in these regions rely heavily on both Medicaid and Medicare for care. Reduced payments will make recruitment and retention difficult, and CMS is placing barriers on its own initiatives to improve access to care through these cuts. In summary, these cuts will exacerbate the shortage of physicians and lack of access to care. n another procedure or service line). en add a margin for risk, an incentive to make it worth your while. Aim high, but reasonable; otherwise your credibility may suffer. 4. For existing procedures, you may find those lower-reimbursing cases are weighing you down enough that you are considering closing them down, which will mean they have to be shied elsewhere, quite possibly back to the local HOPD. Attestation from affected surgeons should accompany volumes and cost data so the message is made clear to the payer. 5. Again, not all payers are the same. Some may appear surprisingly unsophisticated, whether through lack of knowledge on the part of the negotiator, or simply a lack of resources to do the homework that you are now doing in support of your proposal. e best payers will actually appreciate the effort — though you should not necessarily expect them to show it. Others are actually highly sophisticated but so bureaucratic that they cannot flex enough to accommodate a reasonable request. We recently had such an encounter where our dataset needed four more cases out of almost 100 presented, but the dates for the reporting period were immovable and the payer will continue having these cases performed at a local HOPD until the next negotiation period, resulting in losses of over $2 million to their system. In these situations, you should appeal as far up the ladder as possible, and perhaps skip over a few rungs if you can get contact information for senior leadership, but it may not avail you in the end. 6. Be aware that, although the companies themselves are oen enormous and professional, they are still run by human beings, so establishing a good relationship with their negotiator is important if there is a chance that they have some flexibility to use their own judgment. Be courteous and assertive, but refrain from expressing exasperation, disbelief, or worse, contempt. If you have to go over their heads, say so plainly and politely and explain your reasoning. ey may not like it, but they will not work against you either. Over the years I have worked with surgeon owners whose demeanor at these meetings was not their best, and I cannot recall any instance where that approach yielded better results. ankfully those days are in my distant past, and for quite some time now it has been my privilege to work with top-quality professionals on both sides of the table. 7. Finally, even if you present an excellent, well-documented proposal in an impeccable manner, you may still not get what you want — or anything at all. ere are oen internal and external factors that have nothing to do with your situation and over which the negotiator has no control. You may exercise every appeal and still come up empty- handed. All I can suggest at that point is to either consult with an outside professional or shelve the initiative for the year, trying to make the best of a suboptimal situation until the next opportunity. is is certainly not the answer you want, but it may be the one you get more oen than not; however, if you do not try, you will never succeed, and these days we need every win we can get to continue to thrive in this increasingly challenging environment. n