According to Medscape (login required), a dozen changes coming in 2015 could affect physician income and practice workflows. Here’s the list:

1. Rise of High-Deductible Health Plans – According to the Kaiser Family Foundation, 18% of insured patients have at least a $2,000 deductible.   Higher deductibles often mean more paperwork for practices, the need to provide cost estimates in advance, and increasing involvement with collection agencies.
2. Declining Malpractice Premiums– For three benchmark specialties, ob/gyns, internists, and general surgeons, malpractice insurance premiums decreased by 13% since 2008. Some experts attribute the declines to tort reforms that were enacted many years ago, but most expect that premiums, which have proven to be cyclical, will start rising again.
3. ICD-10 Really Coming– Many experts are saying the Oct. 1, 2015 deadline for the new ICD-10 coding system is for real this time, after repeated implementation delays. Although ICD-10 is supposed to cut down on errors and speed reimbursement, many physicians are skeptical that the technology will work.
4. ACOs Enter a Crucial Year – 2015 marks the end of the 3- year shared-savings Medicare ACO contract, which shielded ACOs from losing money. Those that stay in the program will face financial penalties if they don’t hit certain targets. The Centers for Medicare & Medicaid Services (CMS) said that only one quarter existing Medicare ACOs received a shared-savings bonus.
5. Concerns about Telemedicine– More patients may start using web- and phone-based physician services in 2015. The three largest telemedicine companies more than doubled their volume from 2011 to 2013 and continue to grow. Telemedicine does seem to be siphoning some patients from traditional practices, but the main concern is the quality of telemedicine-based diagnoses and treatments.
6. Competition from Retail Clinics– Visits to walk-in, retail clinics skyrocketed by 400% from 2007 to 2009. Consultant Thomas Charland advises doctors to forge reciprocal referral relationships with retail clinics, rather than fighting them.
7. PCPs to Lose Enhanced Medicaid Payments – At the beginning of 2015, Medicaid reimbursements for PCPs will fall back to their pre-“enhanced” levels, which average 40% below Medicare. Unless Congress extends the funding, some PCPs may be forced to reconsider how many Medicaid patients their practices can afford to take.
8. Meaningful Use: Carrot Becomes Stick – In 2015, penalties for not entering the Medicare Meaningful Use program begin, starting at 1% of Medicare payments and moving to 3% in 2017. A survey by Medscape shows that 3 out of 4 doctors who have an EHR are attesting to Meaningful Use.
9. Penalties Start under PQRS– In 2015. The Physician Quality Reporting System turns from voluntary to penalty-eligible. The penalty for not reporting quality data is 1.5% in 2015 and rises to 2% in 2016.
10. New Physician-Payment Websites– Open Payment and Medicare payment websites report payments made to doctors either from Medicare or from drug and device manufacturers. Both websites have had technical glitches and have posted inaccurate information.
11. Medicare Will Pay for Chronic Care Outreach –Medicare will pay physicians in 2015 for managing patients with two or more chronic conditions by phone or email. Doctors will receive $40.39 per patient per month for providing a minimum of 20 minutes of care. To qualify, doctors need to have an EHR system and be able to exchange patient information with other caregivers.
12. New CPT Modifiers for Greater Specificity – Starting in January, instead of the catch-all, amorphous modifier 59, CMS will implement four new subset modifiers – XE, XS, XP and XU. The intention is to increase efficiency of payments to doctors.