As 2024 unfolds, physicians across specialties face unprecedented challenges, many of which center on the financial and administrative pressures stemming from reimbursement cuts.
Four physician leaders joined Becker's to share their perspectives on how these issues impact their practices and what this means for the future of medicine.
Editor's note: Responses were edited lightly for clarity and length.
Quentin Durward, MD. Neurosurgeon at the Center for Neurosciences, Orthopaedics, & Spine (Dakota Dunes, S.D.): The biggest obstacle to physicians in practice in 2024 is the ratcheting down of insurance payment for physician services by all the payers in the face of progressive and uncontrollable practice costs. More and more physicians in my specialty of neurosurgery are being driven out of independent private practice because of this unsustainable mismatch. Our practice at CNOS remains currently healthy only because of our ownership in ancillary businesses such as a surgical-specialty hospital, imaging technology and a physical therapy department. Will this business model be sustainable in the long term? I wouldn’t bet on it!
Cory Koenig, MD. Anesthesiologist at Providence Anesthesiology Associates - Charlotte (N.C.): The biggest obstacle to anesthesia remains the ongoing battle to be properly reimbursed for providing anesthesia services — from the continued decrease on the anesthesia conversion factor by CMS to the unchecked, unilateral decisions that private insurers are being allowed to make like bundling of ultrasound fees, not paying for anesthesia modifiers and the latest attempt to cap the amount of anesthesia time that can be billed for each surgery.
Beyond that, the No Surprises Act and arbitration process continues to be ineffective, inefficient and expensive for physicians despite winning the vast majority of cases. The entire insurance network system is stacked in the insurers favor and it will take dramatic action to level the playing field. There is no reason for insurers to negotiate in good faith efforts when they save money being out of network and there is simply no one holding the insurers accountable.
James Leavitt, MD. Director of Clinical Quality and Outcomes of Gastro Health (Miami): Physicians are certainly faced with numerous and mounting challenges. There has been a significant decline in the inflation-adjusted reimbursement for our services. At the same time, our costs continue to rise. Administrative burden in things like prior authorizations and claim denials, just to name two, have never been more burdensome. (Certainly, the recent events in New York City seem to show that physicians are not the only ones frustrated with these issues). These big problems are not totally under our control. Like most issues, they can be somewhat managed but not solved. Physicians are used to solving and resolving things, so this creates great conflict and frustration on our part.
Perhaps insight into the answer to these questions can come from Walter Kelly, an American cartoonist best known for his classic comic strip Pogo. He said, "When we become negative and ungrateful, it is important to remember… We have met the enemy: and he is us." So the biggest obstacle to physicians in 2024 is ourselves. We feel compelled to work harder which often leads to more frustration and dissatisfaction. The key is to work smarter, not just harder.
Sean Overton, MD. Associate Professor of Anesthesia and Critical Care at the University of Utah School of Medicine (Salt Lake City): Reimbursement cuts in the face of an aging population are quickly becoming our greatest challenge. There is a limit to how much productivity we can squeeze out of providers. Continuing in this direction will make the medical field less appealing, further exacerbating provider shortages.