Becker's ASC Review

24 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 quality provided. Depending on the competition in your particular geographic area, it simply becomes a game of racing to the bottom to accept the lowest payment just to get a contract. Yet, the days of fighting against insurance companies are over. If we want to see higher reimbursements, we need to find a way to work with them and we must do it as a united front. An independent physician may not get enough recognition to impact real change, but physician groups coming together can make a difference. At DISC, we're leveraging the scope of our entire practice to have meaningful, data-backed conversations with key payer leadership. rough this dialogue, insurers are recognizing that there is an opportunity in optimizing site of service and prioritizing quality to create a savings that benefits payers, patients and providers alike. ey are seeing that the shi of high-quality, minimally invasive, motion- preserving cases to more specialized environments like state-of-the- art ASCs enables better care at lower costs, which, in turn, allows physicians to get higher reimbursements. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Healthcare contract management is all about resolving digital efficiencies and adopting practices to streamline the processes, minimize the risks/costs and meet regulatory compliance. Current recessionary economics and crippling personnel issues will curtail healthcare delivery, as wait times for specialty medicine protracts. is seems to have worsened as patients are more keenly aware of cost, travel and wait expenditures add up. Surety providers will be called upon to facilitate and assist in delivery measures. n "Depending on the competition in your particular geographic area, it simply becomes a game of racing to the bottom to accept the lowest payment just to get a contract." - Grant Shifflett, MD. DISC Sports & Spine Center

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