The year ahead in medicine, tumultuous as it promises to be, holds several key issues on which physicians should focus their attention. Health insurance coverage and access, prescription drug pricing, the new Medicare payment system and the opioids epidemic all require a strong physician voice present in the conversation.
Health insurance coverage and access
A new administration will enter the White House on Jan. 20 and the president-elect has expressed his intention to repeal the Affordable Care Act (ACA), which could threaten the insurance coverage that more than 20 million Americans gained under President Obama’s signature legislation.
Acknowledging that the health system reform is an ongoing process, the AMA has expressed its willingness to work with the incoming administration and Congressional leaders on addressing the shortcomings of current law while maintaining the insurance enrollment gains of the ACA and expanding health insurance affordability and choice. Read more about the AMA’s vision on health care reform.
Implementation of new Medicare pay system
The Centers for Medicare and Medicaid Services (CMS) released its final rule for implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) in October, which repealed the flawed Sustainable Growth Rate (SGR) formula in 2015. Thanks to physician feedback, the new payment system—the Quality Payment Program (QPP)—should transition the health care system toward one that supports physician efforts to provide high-quality care.
The AMA will continue its work to make sure this implementation offers the best possibility for success for physician practices. To help your practice transition smoothly, the AMA has put together a collection of resources, such as the payment model evaluator, that are housed on its understanding Medicare payment reform webpage. Learn more about the numerous terms and acronyms associated with the QPP.
Reversing the opioid epidemic
The latest data from the Centers for Disease Control and Prevention provide a sobering reminder that more work remains to reverse the nation’s opioid epidemic. From 2014 to 2015, opioid-related deaths increased from 28,647 to 33,091—with significant increases in death from heroin and illicit fentanyl. At the same time, physicians have been using prescription drug monitoring programs with greater frequency, prescribing opioids more judiciously, taking more education, and becoming trained to treat substance use disorders. And tens of thousands of lives have been saved through the opioid antidote naloxone—thanks in part to nearly every state now having improved naloxone-access laws. While physicians must continue their efforts, to truly turn the tide, greater access to treatment for substance use disorders and non-opioid and non-pharmacologic pain care must occur.
The AMA’s Task Force to Reduce Opioid Abuse, a coalition of numerous state and medical specialty societies, will continue efforts to increase registration and use of PDMPs, enhance physician education, reduce stigma of chronic pain and substance-use disorder, enhance access to treatment, and expand access to naloxone through co-prescribing and standing orders.
Prescription drug pricing
Recent increases in prescription drug prices are of major concern to patients. These increases have created higher costs and price swings, making it difficult for some patients to afford much needed medications. The AMA’s grassroots initiative, TruthinRx.org, was launched late last year with the purpose of collecting patient stories about how rising drug prices are affecting their lives. Achieving greater transparency in prescription drug costs and coverage will be significant issues in the coming year as the nation attempts to address these concerns. The AMA’s grassroots network is asking the public to join the initiative to uncover the truth about prescription drug pricing.
Physicians enjoy treating patients. A recent qualitative study found that physicians spend nearly two hours on EHR and other clinical desk work for every hour of direct face-to-face time with patients. One of the major sources of professional dissatisfaction found in the study was poor EHR usability and interoperability. This is a battle physicians have been fighting since the introduction of EHRs and the fight isn’t over. One key step was taken late last year when Carequality and CommonWell, representing more than 90 percent of the EHR marketplace in acute care settings and nearly 60 percent of the office-based EHR market, entered an agreement to advance nationwide interoperability.
This is a step in the right direction, but physicians have also taken matters into their own hands. It will be important in the coming year to continue progress toward interoperability and make sure that these tools, which hold so much promise, are not just another roadblock to the patient-physician relationship.
The regulatory burden placed on physicians is a major component of physician burnout. Physicians spend too much of their time on administrative tasks rather than providing care to patients. The evolving health care system needs easier enrollment, more rational program integrity rules and, overall, fewer reporting requirements.