Throughout a physician’s career, uncertainty is a constant, but it is something we learn to manage using our training, professional expertise and input from colleagues. Yet, the uncertainty experienced by physicians over the last seven months, and the potential disruption we may well see until the public health emergency around COVID-19 ends, will lead to one of the most consequential years in modern medical history.
Physicians are standing on shifting sands in an environment out of their control. The upcoming election, recent decisions on telemedicine and delayed finalization of Centers for Medicare & Medicaid Services regulations are only adding to the uncertainty buffeting physicians. If physicians are to weather this storm, more needs to be done by policymakers to clarify their policy proposals.
The rise of the COVID-19 pandemic has had a huge impact on physicians. According to a recent study by The Physicians Foundation, 24 percent of physicians lost 51 percent or more of their income, with another 8 percent closing their practices in the first four months of COVID-19. The federal government took quick action to stabilize the loss of revenue, including making Paycheck Protection Program and Economic Injury Disaster Loans loans available and approving reimbursement for telehealth services.
The ability to treat patients via telemedicine was a major benefit to physicians and their patients. It allowed physicians to engage with patients, monitor their conditions and make critical decisions about elective procedures until such time care environments could be made safe. Yet, in recent weeks Anthem and United Health joined Aetna in shifting their approach to telehealth by establishing cost sharing for non-Medicare/Medicaid patients who are receiving non-coronavirus visits.
Although the federal government is maintaining coverage for Medicare and Medicaid patients, the uncertainty created by the insurers’ actions represents disruption to a new care modality while causing unnecessary concern about physician payment. This is happening at a time when insurers are making record profits. To prevent further economic harm to physician practices, policymakers need to identify mechanisms to push private insurers to continue covering telemedicine until such time as the country’s public health emergency has passed.
Over the last several years, the Trump administration has pursued two rule-making initiatives that are important to physicians — especially those in independent practice like me. Failure to advance the administration’s work on price transparency or, more importantly, Stark Law Reform, will create significant uncertainty for physicians.
For too long independent physicians have been caught between the forces of monopolistic hospital systems that take over smaller, independent hospitals, surgical centers and physician practices, and dominant insurers that are able to squeeze small practices, which do not have the market share to obtain better reimbursements. Independent physicians have long seen price transparency as a way to level the playing field between themselves and these twin anti-competitive forces.
The election has the potential to throw the price transparency agenda into doubt. While the Trump administration’s position on hospital price transparency is clear and its deadline of Jan. 1 firm, the Biden-Harris plan states it will “work to increase price transparency in the health care system across all payers.” Across America, independent physicians need more. We need to know if a new administration will overturn the transparency rules when it takes control and how it will support physicians in their fight against insurers and hospitals.
In addition, CMS announced in late August that it was delaying the timeline to finalize the Physician Self-Referral Law (commonly known as the Stark Law) until August 2021. Democrats’ historical opposition to changing Stark Law adds more uncertainty to independent physicians’ planning. In order to support a broader shift towards value-based outcomes, physicians need to know they can create agreements and referral networks that will not run afoul of Stark Law.
Delaying implementation and potentially putting it at the mercy of a new administration adds unnecessary uncertainty to physicians’ long-term planning. As physicians continue to advocate for Stark Reform, we need better insight from policymakers about the potential implications if there is a change of administrations.
Finally, physicians need to know more from the current administration how or if its current approach to the pandemic will change if it wins in November. From both Republicans and Democrats, we want to know more about plans to make approved vaccines available and to inoculate front line workers.
After seven months on the front lines of a global pandemic, physicians across the country need policymakers to provide more detail in their policy plans. This will help us make decisions as we go to the polls, it will help us develop business plans for the next several years and it will add some certainty to a practice environment that has been anything but over the last seven months.
Richard G. Harris, MD, is the president of LUGPA and founding member and CEO of UroPartners in Chicago.
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