Physicians skeptical of ACO payback

Surveyed physicians skeptical of ACO and EHR paybackPhoto used with permission from

It may be a grand understatement to say physicians are feeling stressed when it comes to healthcare industry changes and challenges. With the Aug. 12 release of findings from its annual Physician Sentiment Index (PSI) report, health IT services firm athenahealth noted that 78 percent of surveyed physicians are not optimistic about the survival of independent/small groups.

The company used its Epocrates physician user base to deploy the survey to 1,200 providers. Independent doctors accounted for just over half of the physicians surveyed, according to athenahealth.

The PSI revealed a skeptical view among independent physicians regarding accountable care organizations (ACOs) and other models that offer incentives to doctors and hospitals to reduce the cost of care. Surveyed physicians acknowledge that shifting reimbursement models away from fee-for-service arrangements will positively affect the quality of care. However, the majority of respondents said emerging care models will negatively impact profits and create more burden to get paid.

In addition, respondents indicated a rather startling unfamiliarity with the ACO model. Nearly 75 percent of surveyed physicians said they have either only "heard of" or are "somewhat familiar with" an ACO, and 26 percent said they "don't know" if they are participating in any pay-for-performance programs.

In general, the surveyed doctors reported an unfavorable outlook on the future of healthcare:

  • More than 60 percent of surveyed providers believe the current healthcare climate is "somewhat to very" detrimental to care.  That trend has been consistent over the past four years of the PSI survey, according to athenahealth.
  • Nearly 60 percent think the quality of medicine will decline over the next five years.
  • More than 50 percent do not believe the government's involvement in healthcare will lower costs or improve outcomes.

"Doctors are besieged by change and requirements, and it's incredibly difficult for them to keep up," said Todd Rothenhaus, MD, the chief medical officer of athenahealth, in a prepared statement. "The findings of the 2013 Physician Sentiment Index send up a number of warning signals. As an industry and country, we need to pay attention to the fact that doctors are overwhelmed and challenged in areas they shouldn't be."

Rothenhaus added, "Physicians lack the time and, in too many cases, the resources to thrive through change. They need better support and need to know there are tools and services to remove the 'busy work' so they can focus on patient care."

In a related blog post, Rothenhaus pointed out that independent physicians reported being increasingly pessimistic on the value of EHRs. The PSI showed that 55 percent of independent physicians believe the costs of an EHR outweigh its patient care benefits (compared the 38 percent of hospital-employed physicians), and 60 percent of the same group believe the costs of an EHR outweigh its financial benefits (compared to 45 percent of hospital-employed physicians).

"Clearly, physicians who actually invest their own money in technology see less value, wrote Rothenhaus. "I for one think that these physicians have a more balanced view of technology investment and reward, and perhaps more clarity in return-on-investment than hospital executives and IT leaders."

He continued, "Change is something healthcare so badly needs, but even right-minded policy yields unintended consequences. Independent physicians are indispensable. Not only do they represent a vital access point for patients, but also a crucial counterbalance within the healthcare ecosystem, that serves to keep care local, honest and affordable, and [to] direct the patient without bias. We must do everything we can to lower the burden on this group of entrepreneurs and redirect a future these caregivers currently see as bleak."

Click here to access the entire 2013 PSI survey and results.

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