Here are three disruptions to healthcare delivery and growth that are challenging physicians.
Declining transparency and reimbursement
Physician pay cuts continue to put increasing financial strain on physician practices and ASCs. CMS finalized a 2.83% physician pay cut for its 2025 Medicare hospital outpatient prospective payment system and ASC payment system, marking the fifth consecutive year of cuts to physician reimbursements.
Beyond the immediate pressure these continuous cuts place on the healthcare organizations, the lack of transparency regarding reimbursement rates and billing processes
“Unfortunately, physicians are losing money in multiple scenarios in medicine,” Taif Mukhdomi, MD, interventional pain physician at Columbus, Ohio-based Pain Zero, told Becker’s.
The most prominent loss of physician revenue is Medicare’s consistent decreasing of physician reimbursement in office settings while supporting hospital-setting healthcare services. This trend affects all insurances, as Medicare is the benchmark of most if not all healthcare insurance reimbursement.”
Susan Baumgaertel, MD, an internal medicine physician in Seattle, recently told Becker’s that the often opaque nature of payer billing processes has created friction in the relationship between physicians and their patients.
“Most people are annoyed and irritated by the now-transactional nature. … [T]hat bleeds [together] and they can’t separate it out,” Dr. Baumgaertel said.”If they feel like they’re being gouged by by their insurance company because of pricing, the cost of medicine, care or [if] things are being denied, et cetera … the average person, the consumer, is not able to tease that out, because they lump the physician into that equation.”
Stark law
For physicians in specialties with significant outpatient and ASC development, Stark law remains a significant obstacle, according to Neal Kaushal, MD, a gastroenterologist from Sonora, Calif.
“While Stark law has been beneficial in many ways in preserving the sanctity of the physician-patient relationship, it may be useful in the future to revisit portions of the law to better support physician involvement in ASCs,” he said.
The past year has seen a sharp rise in Stark law enforcement. In 2024. There was a surge in whistleblower-driven Stark law enforcement, with seven major indictments contributing to a record-breaking 979 qui tam lawsuits. False Claims Act settlements and judgments reached $2.92 billion by the end of the federal government’s fiscal year on Sept. 30 — an increase from $2.79 billion in 2023 and the highest total since 2021’s $5.69 billion.
Many leaders feel reforming or repealing portions of Stark law could promote ASC growth, particularly in gastroenterology.
“Given that the GI industry — especially with respect to CRC endoscopic screening programs — is shifting dramatically toward the ASC environment, having physician input and buy-in will be essential in forming lasting partnerships between health systems, payers and patients across the GI care continuum,” he said.
Payer denials and delays
Many physicians have identified prior authorization and other administrative burdens related to claims processing as key disruptors to their practice and contributors to physician burnout. As the use of AI continues to broaden in these processes, physicians have raised concerns that AI is increasing the number of denials they receive and making it more difficult to efficiently address them.
“As a physician office, my team is considered an unimportant independent contractor to Insurance companies, and our ‘letters of medical necessity’ are frequently algorithm denied, our [peer-to-peer] calls are not clinical discussions but rather a ‘denier [for] hire’ physician reading from an insurance policy script, demanding nonmedical switches or change to another biologic despite the patient being stable on current therapy,” Julie Baak, practice manager of AiArthritis in St. Louis told Becker’s. “We frequently are dealing with calling offshore call centers that insurance/PBMs hire to slow down the care by inserting yet another layer of middlemen, doing none of the actual healthcare, siphoning direct patient care dollars away from the folks doing the work and into their profit centers, all off the backs of patients, employers and taxpayers.”
In a recently released survey by the American Medical Association, 61% of physicians said they feared that payers’ use of unregulated AI was creating more prior authorization denials, which can cause delays in treatment and harm patients.
“Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care,” AMA President Bruce Scott, MD, said.
The AMA claims that healthcare spending rises under the use of AI in prior authorizations due to the additional office visits, unanticipated hospital stays and out-of-pocket costs for treatment that arise from prior authorization denials.
In the survey cited in the report, 82% of physicians reported that prior authorization sometimes leads to patients abandoning treatment plans altogether, while over 90% said that prior authorization delays care.
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