New Obamacare Surveys of Docs, Patients and Healthcare Execs Surprises

While waiting for the Supreme Court to decide the latest constitutional challenge to the Affordable Care Act (ACA), a.k.a. Obamacare, Congress dithers and Obamacare gets cheaper as healthcare cost increases slow.

The ACA has tossed old healthcare business models on their heads and spawned new challenges and opportunities in the form of Accountable Care and Physician Hospital Organizations, distribution disintermediation and the end of fee-for-service.

For patients, physicians and medical device makers, the disruptions are coming fast and furious. More patients have health insurance, but higher deductibles. Physicians are getting more tools, but quickly losing their practice independence. Device makers are returning steady profits for shareholders, but are under increasing pressure to consolidate and reduce costs.

Everybody’s boat is rocking.

Survey Says…

So, how are those patients, physicians and healthcare executives feeling? Are they anxious? Optimistic? Angry? Satisfied?

Three recent independent and unrelated surveys have the surprising answers.

We’re Not #1

First, according to a Zogby Analytics poll called America Speaks, Volume 15, supported by the American Medical Association and published by Research America on February 23, 2015, only 24% of Americans believe the U.S. has the best healthcare system in the world. A plurality of those in the poll think the Food and Drug Administration (FDA) should move more quickly in order to get new treatments to patients, even if it means there may be risks. They’re even willing to pay $1 more in taxes per week if they were certain that all of the money would be spent on additional research.

If more is not spent on shoring up medical science funding, about two-thirds of the respondents doubt that by 2020 the U.S. will maintain its current leadership in science and technology.

A plurality of Americans also believes that the 1.5% of government spending currently allocated for biomedical and health research is not enough. Surprisingly to us, by a wide margin, Americans favor expanding federal funding for research using embryonic stem cells.

Zogby polled about 1, 000 Americans over 18 years of age at the end of 2014. The maximum theoretical sampling error was +/- 3.2%. The data are demographically representative of adult U.S. residents.

Healthcare Execs Are Smiling

Second, also a little surprisingly, given the anecdotal complaints about the medical device tax, a burdensome FDA and belt-tightening payers, a big majority of senior executives from healthcare companies across the industry are optimistic and predict a stronger year ahead. Only 3% predict a weaker year, according to a GE Capital Healthcare Financial Services survey of 521 executives.

Physicians Crave Independence

Finally, a recent survey of dozens of independent physicians indicates that many of them are nervous and unsure of their future.

According to the 2015 Independent Physician Outlook & Sentiment Survey, conducted by ProCare Systems, a Michigan-based consultancy that advises independent physician groups across the country, 44% of surveyed physicians say they anticipate being forced to sell their practices to a larger player at some point in the future. A full 73%, however, would prefer not to sell—“a clear indication that doctors are feeling pressured, ” stated the survey.

To summarize, Americans want more and are willing to pay for it, physicians are nervous about losing their independence and healthcare executives are optimistic about their future.

Below is a more detailed look at the three surveys.

Patients/Taxpayers

According to the America Speaks poll:

• 70% of Americans agree basic scientific research that advances the frontiers of knowledge, even if it brings no immediate benefits, is necessary and should be supported by the federal government.
• 80% of Americans say it’s important that elected officials at all levels listen to advice from scientists.
• 78% of Americans say it’s important that our nation supports research that focuses on improving how our health care system is functioning.

The poll’s researchers wrote that their results; “underscore the expectation of Americans that elected officials will enact smart policies to ensure our nation’s preeminence in science and technology. Americans strongly believe that research will unlock the mysteries of major health threats.”

They add that Americans also believe that research in an economic driver that fuels smart business and creates high-quality jobs.

Leaders of Research America urge Congress to support proposals to “advance precision medicine, combat antibiotic-resistant bacteria, repeal the anti-innovation medical device tax” and increase funding for federal health agencies.

Physicians

Shrinking reimbursements and skyrocketing operating and regulatory costs have left many smaller physician groups strapped for cash, says the GE physician survey.

A full 94% of those surveyed believe market dynamics ought to give rise to new practice models that foster physician independence. That led to 72% saying they envision a significant number of physicians returning to independent practice in the future.

Fred N. Davis, M.D., co-founder and president of ProCare Systems, wrote, “Physicians can thrive in their practices, rather than becoming employed by larger health care institutions, by embracing innovative practice models designed to meet the increasing complexity of today’s health care environment while keeping their practices sustainable and profitable.”

While the physicians ranked escalating costs and downward reimbursement pressure as the most challenging aspects of running their businesses, followed by the difficulty of maintaining referral streams, 88% see a future in which reimbursement is driven by their ability to provide value, defined as the intersection between quality care and cost management.

Whereas models based on increasing patient volumes have long been strength of larger providers, Davis says “smaller physician groups—with their agility and natural inclination toward quality, innovation and efficiency—are well positioned to gain ground in a marketplace increasingly driven by consumers and focused on outcomes. This trend could not only help small practices remain independent, but allow others to reclaim their autonomy as well.”

New Clinical Models

He adds that independent specialists must adopt new clinical and administrative systems that allow for “seamless integration with emerging organized systems of care.”

Nearly all the physicians surveyed recognized the emphasis the Affordable Care Act has placed on preventative care and wellness management along with whole-person care. “For those same physicians to thrive in the new market, they will need to reorganize elements of their practice to deliver on this paradigm.” Some have described the specialist primary care physician and the Centers for Medicare and Medicaid Services is experimenting with new ways to pay specialists, starting with oncologists.

A huge (91%) majority of respondents said they could envision a future where “whole-person care” will play a significant role in how their practice operates. Finding a way to blend their specialization with the treatment of “whole” patients will be a necessary step toward innovation, says the survey.

Nearly half of respondents said that being a part of an independent practice association—a co-op style alliance of physician practices—was attractive for the increased scale it would provide in negotiating with payers and larger organized systems of care.

The physician survey continues that any solutions the market provides “will allow smaller practice groups to mimic the support infrastructure and scale of large institutions, while maintaining the qualities that have long been hallmarks of smaller, more nimble organizations.”

Healthcare Executives

Each tweak of the law and each change of a regulation can have a major impact on the device industry. But according to the GE survey, despite knowing the challenges ahead of them, healthcare executives are less concerned about healthcare reform and regulatory oversight than they were just a year ago.

According to the results, 43% of those surveyed put the ACA as the greatest challenge the healthcare industry will deal with in 2015. Rounding out the top three challenges are regulatory oversight (30%) and the U.S. economy (17%). In last year’s study, ACA also topped the list, cited by 57% of respondents, with regulatory oversight (20%) and the U.S. economy (13%) also getting consideration.

“We agree with the optimism shown by our customers and other healthcare industry leaders about 2015. Though less than last year, implementation of the ACA is still top of mind across the industry, ” said Al Aria, senior managing director of GE Capital, Healthcare Financial Services’ corporate finance team.

The GE survey also considered these additional areas of interest to healthcare executives:

Business Growth

There are three main ways for expanding business in the coming year. The most popular option, listed by the survey respondents, is to revitalize or upgrade an existing part of the business (38%). Other options include a merger or acquisition (37%) or launching a new arm of the business (25%).

Financing

Only 6% of respondents are expecting their capital needs to be lower in 2015 than they were in 2014. Sixty-seven percent expect them to be the same and 27% expect them to be significantly higher.

ACA Changes

One of the few areas where expectations are divided, according to the survey, is changes to the ACA. While they all acknowledge change is happening, 43% expect them to the moderate while 41% expect them to be insignificant.

Short of the Supreme Court intervening, Republicans winning the White House in 2016 and capturing a 60-vote, veto-proof majority in the U.S. Senate, the ACA train appears to have left the station. Patients and physicians still see much work to be done to speed up innovation and maintain physician control but device makers have adapted and are thriving.

Below are links to the three surveys described in this story.

America Speaks PDF
http://revcycleintelligence.com/2015/01/14/healthcare-leaders-express-confidence-for-2015/
http://www.physiciansnews.com/2015/01/16/physicians-under-pressure-to-remain-independent/