Five of the top concerns for the medical industry in 2015

Here are some of the key aspects to watch in in the coming year:

1. The Affordable Care Act and Payment Structure

The current payment structure system (fee-for-services) will likely change, but why?  Many of the ACA mandates will take effect in 2015, and most will impact the way physicians get paid for medical services.  Payers are consolidating networks and repositioning markets in order to move to a new payment structure.  Traditional fee-for-services are moving towards a compensation based outcome.

  • Bundled services
  • Episode of care
  • Physician quality reporting system
  • Shared savings
  • Patient-Centered medical home

2. Government mandates

  • ICD-10

The requirement to use the ICD-10 coding system will probably have the greatest impact.  ICD-10 requires a greater level of specificity and training than the current ICD-9 system, making this a financial burden for many practices.

  • Meaningful use

This government incentive program is a challenge that many physicians will face in attesting for MU.  In addition, there will be financial penalties that many will face by not participating in the program.

  • PQRS penalties

Beginning in 2015, this incentive turns into a penalty equal to 1.5 percent of covered part B PFS (Physician Fee Schedule) services.  This penalty rises to two percent in 2016.  To date, physician participation in PQRS has been fairly low.  It remains to be seen whether the threat of penalty will cause more physicians to report.

  • HIPAA, Risk Analysis

Among other things, HIPAA requires medical practices to conduct and document risk analysis for their PHI. (Review of procedures, training requirements, etc.) 2015 brings new penalties and stiffer dollar amounts for violators.

3. Staff turnover

As we move towards efficiency-based medicine, recruiting and retaining becomes a challenging aspect and, possibly, the key to survival in an ever changing environment that requires a team-oriented culture.  Success will depend on practices functioning as a team as we move to reimbursements that are tied to performance and patient outcomes.

4. Exterior Environment

Perhaps the most challenging aspect of 2015 is the constant evolution of new industries trying to grab a piece of the healthcare market.  With the evolution of ACOs and the industry moving into a partnership of integrated networks (CIN), physicians are more vulnerable to contracts and partnerships with outside consultants/organizations that may jeopardize their future.  In my experience, a partnership with a local hospital and local consultants has been proven to be the way to better patient care and physician success.  Don’t jeopardize your integrity and the care of your patients, and remember “Every challenge is an opportunity for better patient care.”

5. Leadership

I can probably expand the challenges (technology costs, payers, etc.), but the reality is that this industry is in a period of a rapid transformation and the only practices that are going to succeed are those willing to adapt, innovate, and respond to these challenges.  Change requires leadership.  For the past few years, we have heard concepts such as efficiency, care coordination quality, managing risk, etc.  I expect more of the same concepts throughout 2015 and more hospitals reaching out to physicians in order to improve the delivery of healthcare.


story by DR. RATNAMANI LINGAMALLU, Central Florida ENT Associates

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