Gregory W. Hufstetler, CPA, MBA, FHFMA: I’d say adapting to all of the changes brought about by the ACA would be the generic answer. My number-one concern would be the prevalence of the high-deductible health plans (HDHP) being offered through the exchanges. What you really see is simply a new form of self-pay when you have $2,000 and $3,000 deductibles and higher, shifting patients from uninsured to the high-deductible plan. A second concern would be the morphing of the Physician Quality Reporting System into a penalty phase in the next couple of years coupled with the arrival of value-based purchasing modifier systems, which arise out of the ACA. Those two things, in combination, bring exceptional complexity, and when you see the flow chart of those two things together, it introduces almost a sense of despair and skepticism to the house of medicine. In terms of early arrivals, the GOT in 2013, this past calendar year, has resulted in major national commercial payers systematically lowering their non-par reimbursements and justifying it from the GOT regulation. Of course, two of those three rates in the GOT criteria are set by the payers and are thus in a black box unknown by providers. So payers have realized, and their legal counsel has sanctioned the systematic ratcheting downward of these payments, and that poses serious challenges this year and beyond.

Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC: One of the things that I think we are all still reeling from is this ICD-10 schizophrenia. We had physician groups gearing up for it and hospitals paying millions of dollars to get ready for all of the big change that didn’t happen. So do we continue to prepare for it? Do we wait until the last minute and see if we want to spend some more money keeping people’s skills sharp and then take a chance it’s going to get put on the back burner again?

Additionally, somehow the patients have become customers, and with them as customers, the hospitals are driven to assure top levels of patient satisfaction. You have your door-to-doctor time; you have your patient comments about the care they’re receiving. Many times, none of that has to do with the quality of medical care that’s being provided, and I think we’ve seen physicians who take a little bit more time with their patients and are a little bit slower than everyone else get called to the carpet for that. I see that happening more and more as we talk to more groups across the country. Patients have been given more power, but I’m not sure they’ve been educated on how to use it, and that concerns me a lot.