Physician Sentiment Index

Preface: What follows is the essence of a press release by Athenahealth and Sermo.com, based on a survey of 1000 Sermo members. In general, physicians are pessimistic about health reform and more government involvement, the future of independent practice, Medicare and Medicaid reimbursements, necessity of doctors to double as businessmen, and current usefulness of electronic health records.

As the country girds for the biggest transformation of health care in a generation, few have bothered to ask the U.S. physicians what they think of all this change. Will their ability to offer quality care improve or be hampered? Is practicing medicine getting easier or harder?

To find answers, Athenahealth partnered with Sermo, the world’s largest online community for physicians, to conduct a first of its kind Physician Sentiment Index (PSI).

In this first annual index, 1,000 physicians – representing a range of specialties, regions, and practice sizes – responded to questions revealing pains and frustrations with the business of medicine, reimbursement protocols, government’s hand in health care, EHRs and other variables.

Top-level Sentiments

• 92% agree getting paid by insurers has become burdensome and complex.

• 83% agree: This is the case with Medicaid.

• 81% agree: This is the case with Medicare.

• 64% believe their clinical decisions are based more on what payers will cover than what is best for their patients.

• 59% think quality of medicine in the U.S. will decline in the next five years.

• 54% strongly disagree that more active government involvement in health care regulation can improve outcomes; less than a quarter feel otherwise

Pessimism about Quality in America Health Care

Among physicians the feeling exists physicians have lost control over their own profession.

• 64% cited the health care climate as somewhat or very detrimental to their delivery of quality care.

• Only 22% are optimistic about the ability of the American physician to practice independently or in small groups.

• 59% say the quality of medicine in America will decline in next five years; only 18% believe the quality of medicine will improve.

• 54% disagree that more active government involvement in health care regulation can improve outcomes; less than a quarter feel otherwise.

• A shift from fee-for-service to pay-for-performance gives hope to almost half (49%) who think it will have a very/somewhat positive impact on quality of care.

.However, 53% believe pay-for-performance will have a negative impact on the effort required to get paid.

Physicians vs. Insurers -- An Uneven Fight

Frustration with payors' changing reimbursement protocols and regulations is universal among physicians. They want to render service and care, not worry about third parties influencing decisions about who they can treat, how they treat, and, ultimately, the kinds of outcomes they can affect:

• 77% agree that time spent with payors and third parties inhibits their ability to spend time with patients (5% feel differently) .

• More than three-quarters believe payors inhibit the care physicians would like to provide their patients; just 7% feel the care they would like to provide is unaffected by payors.


• Only 16% say they are basing their clinical decisions on what they think is best for the patient rather than what payors are willing to cover .

• 83% agree that administrative costs incurred to comply with payor rules and regulations significantly affects their bottom line

MDs Shouldn't Need MBAs

Despite their calling of caring for patients, many physicians are required to step into a front-of-office role if they want to practice independently. Almost a quarter of doctors responding to the survey are primary decision makers with respect to billing and administrative decisions. Yet few exhibit a clear understanding of the business end of their practices. This is extremely telling of the sheer complexity that is healthcare administration:

• Conceptually, physicians struggle to understand cash flow--only 25% could correctly define the term.

• 33% don't know their average length of time for accounts receivable (for 51%, the average length of time is somewhere between 30 and 90 days).

• 82% feel challenged in hiring and retaining qualified staff.

• Though income has been trending lower for many practices, 34% believe their financial situation will be worse or much worse next year versus this year.

• Nearly half (43%) don't know what their insurance submission rejection rate is. Among physicians who know their submission rejection rate, a range of 5-10% was most commonly cited. If one considers that, for the practices of responding physicians who claimed to know their income, the average income is $2.5 million, this rate could mean $125-250,000 in deferred or lost income per practice.

Investing in the Promise of Electronic Health Records (EHRs)

Doctors' opinion on EHRs is highly favorable, but it's clear that current solutions are not where they need to be--particularly given the government's $19 billion push to get physicians to adopt EHRs:

• 81% expressed a very favorable/somewhat favorable opinion on EHRs.

• Yet only just 51% feel EHRs are designed with them in mind.

• 54% strongly agree that EHRs slow down the doctor during patient exams.

• 5% feel EHRs are alleviating the effort to stay on top of changing payment requirements/incentives.

• 60% strongly agree/agree that EHRs distract from face-to-face interaction with patients (21% feel face-to-face time is not being compromised by EHRs)