Late last month, leaders at the New York-based Deloitte Consulting published the results of the Deloitte 2013 Survey of U.S. Physicians, which late last year asked over 600 physicians their perspectives on the rapidly changing U.S. healthcare system. This was the second annual survey of U.S. physicians; Deloitte has also published five annual U.S. healthcare consumer surveys.
Among the 613 physicians who completed the survey, 146 described themselves as primary care physicians; 142 as surgical specialists; 197 as non-surgical specialists; and 128 as “other.”
Among the key findings from the survey were the following:
> A broad majority of U.S. physicians believe that capitation will replace fee-for-service payments in the next one to three years (57 percent versus 44 percent).
> At the same time, half (51 percent) of all physicians believe that physician incomes will fall dramatically in the next one to three years.
> Under episode-based (bundled) payment structures, nine in 10 physicians report that their greatest concerns about financial viability will be receiving inadequate payment (93 percent), and being penalized for factors out of their control.
> With regard to their perceptions of the Affordable Care Act (ACA), 44 percent of survey respondents described it as “a good start”; 38 percent described it as “a step in the wrong direction”; and 18 percent didn’t know which of the two it was. Still, the percentage who believe the ACA is a step in the wrong direction declined from 44 percent in 2011.
> Overall, physicians are critical of the performance of the U.S. healthcare system, with only 31 percent reporting a favorable grade of “A or B”. Still, the percentage of those who believe that defense medicine has a major influence on overall healthcare system costs declined from 91 percent saying so in 2011, to 71 percent saying so in 2012.
With regard to the use of electronic health record (EHR) systems, two-thirds of physicians reported that they use EHRs that meet meaningful use Stage 1 requirements, while fully three in five physicians, in a result that proved even across primary care and specialist doctors, are satisfied with their HER system.
Among the numerous benefits that the majority of survey respondents cited, in using EHRs, are the following:
> Faster and more accurate billing for services (74 percent)
> Time savings through e-prescribing (67 percent)
> Improvements in communication and care coordination capabilities arising out of interoperability (67)
Mitch Morris, M.D., a principal at Deloitte Consulting, has been with Deloitte for six years; previously, he had practiced clinically, as an oncologist, for over 20 years; and also worked as a senior executive at M.D. Anderson Cancer Center in Houston. The Los Angeles-based Morris spoke recently with HCI Editor-in-Chief Mark Hagland about the results of the survey, and his interpretation of those results. Below are excerpts from that interview.
From your perspective, what were the most interesting findings coming out of this survey?
One thing that’s interesting is that we’re starting to see increasing acceptance of change on the part of physicians. And acceptance doesn’t mean they’re happy about it; in fact, the converse is true. But whereas in past years, there was this feeling of, “Maybe this won’t really happen,” now there’s the sentiment, “I understand this change is happening, even though I won’t like it.” Primary care physicians in particular are concerned about not having time to spend with their patients, and that patients won’t have a choice.
Across the board, physicians highly value the physician-patient relationship, and that that is being directly threatened by some of the changes around healthcare reform. In addition, they’re concerned about income. Reimbursements are going down, and at the individual physician level, they’re worried about their personal income. The more established, more senior physicians actually have more anxiety about it. We found that people believe that physicians will retire earlier. But in fact, the economics are such that they may not be able to retire as soon as they might have hoped.
How would you describe U.S. physicians’ overall feelings about the new forms of reimbursement?
I think their feelings are variable, and the fact remains that many physicians and many others in healthcare don’t yet have a full understanding of the nature of the changes in reimbursement that are emerging right now, or the pace of the change. Overall, there’s a feeling that the new forms of reimbursement are positive in theory, but they’re worried about what they’ll be like in practice. I think there’s a lot of anxiety about how some of these things will work out, hand I think some of that anxiety is well-founded, because reimbursement change will be a part of reducing costs. And physicians think, if the unit value of colonoscopy goes down, I’ll do more of them. But the reality is that many have tapped out how much volume they can produce; and it’ll hit the primary care physicians first.
What are your perspectives on the accelerating trend of physicians choosing employment?
There’s a combination of factors involved. The younger physicians are choosing employment out of preference, because life and the hours they work will be more predictable. When you see more established physicians choose that model, it might be because of what’s happening in their market and their region, with them seeking a safe haven during the change, particularly if you’re looking at care that’s managed; your best chance of contracting will be through an employed model, or some form of employment or affiliation model. You need scale in order to survive in the current (emerging) environment. And historically, referral patterns have been established over a period of decades; in the new environment, referral patterns are being disturbed rapidly. So being employed is something they feel they need to do to maintain a supply of patients.
With regard the questions about EHRs, what’s your read about physicians’ growing acceptance of working in an automated environment?
The data is interesting. Our survey results surprised me a bit in that there was a higher level of acceptance of the potential benefits of electronic health records and automation than I’ve seen in some other surveys, so I took that as a positive sign. The acceptance level is very high. I like to talk about the art of implementation; I think there’s tremendous variability in the quality of implementation and usage. And those who use products poorly tend to blame the product or principle rather than their own usage. And the percentage of physicians using it to an advantage is thriving, though still rather slow. You still hear, ‘It takes too long to document or write a prescription.’ But in our survey, we saw a fairly high level of satisfaction. And one example is the percentage of physicians who are satisfied with e-prescribing. So I think we’re moving in the right direction overall.
What about c-suite executives? In your ongoing conversations with those leaders in healthcare, are they saying that the physicians in their organizations are moving more towards acceptance?
I think so, yes. Clinician adoption, particularly in an acute-care setting, used to be a big barrier; but it’s just not that big a deal anymore. Managing change is still a big deal, but clinician adoption is less of an issue than it used to be. It’s not what it was.
What advice would you give to healthcare IT leaders regarding the healthcare reform-, policy-, and practice-driven changes now taking place? Having the right tools to manage one’s medical practice will be absolutely essential in the emerging environment, don’t you agree?
Yes, I would agree, having the right tools to manage your practice day to day is very critical. And the advice for healthcare executives and those who lead large practices, is to spend the time to make those tools friendlier to practicing physicians. Some of those tools aren’t entirely there yet, and a good example of that is in the area of population health or accountable care. Those programs are still largely what I would call ‘hand-managed.’ And how we coordinate beyond the relatively narrow piece of the pie that each of us has, we don’t have such great tools to do that yet. And those are under development right now, and I haven’t seen anything that knocks my socks off yet. At HIMSS, the labels were thrown around all over the place, but no one has the entire picture on that yet.
On a scale of one to 10, with 10 being the most optimistic, where are you right now, with regard to physicians successfully moving towards the new healthcare? Are the doctors now beginning to accept the new reality?
I would say I’m around a 7; I don’t know that they like it, but the message has been received. And it’s like in “Star Trek,” where “resistance is futile” to the Borg. So there’s acceptance, but I don’t think people are particularly happy about it. And we’re all going to go through some pain before we come out at the other end—as providers, payers, consumers, etc. Everyone recognizes that our healthcare system is fragmented and needs to be fixed. But I would give it a 7 that we’re going to move things along.