If there’s one thing that the leaders of various healthcare sectors can agree on, it’s that the path forward towards the new healthcare is inevitably going to be a complicated, challenging one. That conclusion seemed virtually inevitable to anyone attending the policy-oriented events during the day on Monday, Oct. 22, the first full day of events at the MGMA Annual Conference, sponsored by the Englewood, Colo.-based Medical Group Management Association, and being held this week at the Henry B. Gonzalez Convention Center in downtown San Antonio, Tex.

To begin with, a lively morning discussion attended by a large plurality of the 5,100 attendees at this year’s conference elicited a broad range of views about what the greatest challenges and opportunities are that are facing healthcare leaders right now. Those views were expressed by leaders representing sometimes-collaborative, sometimes-antagonistic stakeholder groups in healthcare. Susan Turney, M.D., president and CEO of MGMA, moderated a discussion with Jeremy Lazarus, M.D., president of the Chicago-based American Medical Association (AMA); Rich Umbdenstock, president and CEO of the Chicago- and Washington, D.C.-based American Hospital Association; Allen Korn, M.D., chief medical officer and senior vice president for clinical affairs at the Chicago-based Blue Cross and Blue Shield Association; and Carolyn Pare, president and CEO of the Minneapolis-based Buyers Health Care Action Group (BHCAG).

When the MGMA’s Turney asked her co-panelists what they saw as the most immediate challenges facing their associations’ constituencies, each not surprisingly provided perspectives strongly based on the collective experiences of their members. The common threads among the responses were around reimbursement and political/policy uncertainty, while panelists diverged on some of the complexities and solutions involved.

Asked about the upcoming presidential and U.S. congressional elections, the AHA’s Umbdenstock said, “I don’t think we’ll know right away how the exact configuration of the House and Senate,” as comprised following the November elections, “will affect the ACA” (the federal Affordable Care Act). “But as you know,” he added, “some of the tracks of the ACA were laid down early, and the [political] parties agreed on 85 percent of this stuff.”

At the same time, said the AMA’s Lazarus, “There is increasing uncertainty about the funding and reimbursement; and that level of uncertainty is unsettling to physicians.” On the one hand, Lazarus lauded the federal government’s investment of $170 million provided for the development of accountable care organizations (ACOs), as well as “the $10 billion made available through the ACA to the Center for Medicare & Medicaid Innovation. It would be sad if that went away” through the repeal of the ACA, were the November elections to lead to that prospect. “But however it turns out, we’ll make it work.”

“This is a very different conversation than we would have had a year ago,” Turney said, commenting on the advances all the panelists cited in the development of new reimbursement and care delivery models. “And it sounds like we’re making very important steps.”

Still, the AMA’s Lazarus warned, he considers potential reimbursement cuts to physicians coming out of both the Budget Control Act and the potential failure to continue to develop a long-term solution to the sustainable growth rate (SGR) problem under Medicare (in which the federal government is obligated, in present terms, to “pay back” to itself $300 billion in “patched” physician payments).

Every one of the morning session’s panelists cited the need for policy and reimbursement certainty to support the ongoing  advances in care delivery and reimbursement model development that many of their constituents are currently pursuing.  Still, said the Blues association’s Korn, “I’m an optimist. I think those advances won’t stop. We need to fix a number of things—accountability, for example. And I think we all know that care is too fragmented, that we collect ‘organologists,’ not physicians,” he added. “That needs to be fixed.” But, he said, the kinds of internal reform being pursued by all the key stakeholder groups are not going to be rolled back, given the broad consensus about the need for moving forward into a more accountable, transparent, high-value healthcare.

Yet the shadow of the SGR-fix problem continued to loom over the proceedings, as was made evident in remarks made by MGMA executives during a press briefing held at midday on Monday. Indeed, reimbursement uncertainty was the main reason cited by the 82 percent of MGMA member-organization executives surveyed who have not yet to date engaged in the development of new care delivery and reimbursement models. Those medical group executives told MGMA that they would be likely to explore new payment and delivery models if a degree of Medicare reimbursement stability could be assured.