Reimbursement Uncertainty Tops List of Health Care Leaders' Concerns

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Lack of a permanent sustainable growth rate (SGR) fix for Medicare physician payments and accountable care organization (ACO) payment models that ask practices to share financial risk with payors top the list of concerns of members of the Medical Group Management Association (MGMA)/American College of Medical Practice Executives (ACMPE).

According to 1,252 respondents to the " Medical Practice Today: What members have to say" poll, the top five concerns were:

  1. Managing finances with the uncertainty of Medicare reimbursement rates
  2. Preparing for reimbursement models that place a greater share of financial risk on the practice
  3. Preparing for the transition to ICD-10 diagnosis coding
  4. Dealing with rising operating costs
  5. Participating in the Centers for Medicare & Medicaid Services' EHR meaningful use incentive program

"The threat of a significant cut in Medicare reimbursement continues to plague physician practices and severely hinders their ability to properly plan and assess their financial situations," said Susan Turney, MD, MS, FACP, FACMPE, president and CEO of MGMA-ACMPE in the press release. "The increased regulatory burden brought on by unfunded federal mandates only exacerbates this uncertainly caused by the flawed Medicare Sustainable Growth Rate physician payment formula."

MGMA-ACMPE represents 22,500 members who lead 13,200 organizations nationwide in which some 280,000 physicians provide more than 40 percent of the healthcare services delivered in the United States. For its fifth annual poll, MGMA-ACMPE invited members via e-mail to participate in a web-based questionnaire about their practices. Members rated 54 issues and identified which challenges were most applicable and intense to their daily work. Answers were ranked by practice size, years of experience in medical practice management, and position title.

Challenges for physician-owned medical groups and groups owned by hospitals or integrated delivery systems (IDSs) differed slightly. Merging with another practice posed a bigger challenge for respondents in physician-owned groups than it did for those in hospital-owned or IDS-owned practices.

Medical practice professionals in hospital- or IDS-owned medical groups found preparing for the ICD-10 diagnosis codes more challenging than those in physician-owned groups. Managing finances, implementing and/or optimizing a patient-centered medical home (PCMH), and dealing with the commercial-payer physician credentialing process were also cited as a greater challenge for hospital-owned groups.