Patients today are overwhelmed by the complexity of medical bills. Physicians regret their patients' frustration, but they often don't realize how much it can impact a practice's revenue.

As the HealthLeaders Media intelligence report ­Service Lines Grow Amid Strategic Challenges shows, most ­healthcare leaders anticipate that their service lines will grow over the next few years, with a big baby boomer-fueled push for oncology, orthopedic, and cardiology needs. And younger patients will generate the demand for wellness or neurological care, with new service lines to come.

Yet hospitals shouldn't automatically count on return on investment. There's great angst among hospital leaders, the survey shows, in plans to integrate physicians to deliver that bottom line.

One common complaint about the transition from fee-for-service reimbursement to value-based schemes is that such groundbreaking changes cannot be done overnight and must be phased in. That's a problem for healthcare ­organizations that seek to be forward-thinking yet must ­continue to exist under current rules. A common refrain is that senior leaders feel as unsettled as a person with one foot on the boat and the other foot on the dock.

But there may be a way to bridge that transition through vehicles such as the physician hospital organization (PHO), which many hospitals and health systems formed under capitation more than a decade ago-and which many subsequently discarded as HMOs gave way to preferred provider organizations and as government payers continued to use fee-for-service reimbursement. However, the PHO, or at least something like it, is making a comeback as payers and the government make slow progress toward accountable care.

In March 2011, CMS announced its esMD (­Electronic Submission of Medical Documentation) tool, which is an option for providers to electronically send medical documentation that is requested of them by Recovery Auditors and other government entities' contractors. Phase 1 of esMD kicked off on September 15, 2011. During this period, providers will still receive medical documentation requests via paper mail but will have the option to send their documentation to the requesting review contractor electronically.

Conduct an internal cost analysis of your Medicaid patients to determine whether you could receive double the reimbursement for primary care services to them in 2013 and 2014. A CMS proposed rule would bump Medicaid rates to at least Medicare levels for those two years, providing $11 billion in federal funding under health reform to bolster state Medicaid programs.

Do not read too much into an HHS Office of the Inspector General (OIG) report released this month that shows an increase in high-level E/M billing over the past decade. The report shows no evidence of improper billing, and only a small number of extremely high-billing practices are likely to face a Medicare administrative contractor (MAC) review as a result.

Prepare to manage more part-time physicians as doctors strive for work-life balances and seek more traditional employee-employer relationships, moving away from long hours spent building practices. Many younger doctors are shying away from putting in 80-hour work weeks to start their businesses.

CMS overlooked some key provider issues in its proposed rule for stage 2 of CMS’ Electronic Health Records (EHR) Incentive Program, according to comments by physician advocacy groups on the meaningful use rule.

This chart shows the utilization of each E/M service level for established patient office visits in 2001 through 2010. Located in the HHS Office of the Inspector General’s (OIG’s) recent report, Coding Trends of Medicare Evaluation and Management Services, the data is based on PBAR National Procedure Summary files. The data represent the percentages of E/M services billed for established patient office visits that were billed for each E/M code (99211-99215). The number above the 10-year set of percentages for each code is the difference in code utilization from 2001 to 2010.

Physicians who successfully attested to meaningful use in 2011 performed similarly on the mandatory “core” measures and often chose the same menu measures to meet the CMS requirement of 20 reported measures (15 core, five menu). Primary care practices were by far the specialty with the most attestations, making up 41% of attesting practices in 2011, and they differ from other specialties on measures reported, according to a Part B News analysis of 2011 CMS attestation data, the latest available. A total of 28,954 physicians attested under the Medicare program in 2011; another 15,060 have attested in 2012.