Protect Yourself From Cyber Attacks

In today's world, a day does not pass without a large company being featured on the news because they are suffering from a data breach or hacking incident that has threatened personal information.

Cyber security is a concept that has become a high priority in the past five years. Since this issue is fairly new, demand for cyber insurance is emerging, since most cyber related claims are currently not covered under a standard insurance program. The questions that arise the most regarding cyber security and liability are about understanding the level of exposure a company's data faces and knowing what cyber coverage encompasses.

VP, Property & Casualty

Large companies are not the only ones at risk, it is often small businesses that are most vulnerable simply because they are not prepared. Most small (under 250 employees) businesses do not have the IT staff necessary to help protect a business. Even manufacturing companies are at risk because while credit card information is a large component, it is not the only type of attack. can you afford the risk of not protecting your employee, client and company data?

With 10+ years of experience addressing cyber risks, Hierl's process of approaching cyber security begins with an assessment of client's risk and exposure. This involves knowing what data a client has, who has access to it, how it's stored and how they are backing it up. Hierl can expertly evaluate the coverage that is necessary to keep an organization secure. 

Because it is an emerging coverage, cyber insurance plans are not standard. Hierl advises a three-fold type of coverage including:

  • Business coverage for customers and employees
  • Protection for your company and the data it houses
  • PR assistance of a security breach occurs 

The best policies offer assistance to help you to work through things if something was to ever happen, as well as forensic and technical assistance to determine how the breach occurred.

"Many Organizations that have suffered cyber-crime are sophisticated, big businesses. If they can't stop these attacks from happening, most other businesses can't either."

If it determined quickly that a breach has happened and a good backup exists a company can recover quickly and the attack is much less damaging. However, when a company's data gets out in the wild is when attacks become most expensive.

The 2016 Ponemon Institute Cost of Data Breach study reported that the average cost of a los record rose form $154 in 2015 to $158 in 2016. Even if, you only have 20 employees now and that doesn't seem all that bad... you need to think about how many employee records do you have from the past 10 years? Cyber-attacks don't just affect current records nor do they only target employee data  but client and company data too. This type of insurance is becoming a must have coverage for businesses because of how sophisticated these attacks have become.

Three reasons to explore cyber coverage for your business:

  1. There is a higher incidence of cyber crime
  2. The longer it takes to detect an contain a data breach, the costlier it becomes
  3. Effects of a cyber-attack extend beyond monetary and data losses to losing businesses and customers 

If you'd like to know more about protecting your company from a cyber breach, please reach out to Cathleen at 920.921.5921 or send her an email via

To download the full PDF click here.

Amazon-ize Benefits, Control “Leakage” and Heal “Over Insured Syndrome”

Originally posted by Bill Olson on

If you are a mid-size employer (50-5,000 employees), you are likely considering a private exchange to affordably handle your benefits complexity (eligibility management, payroll deduction, billing and reconciliation, enrollment and claims issues, defined contribution automation, etc.) while reaping the benefits of cost certainty from a defined contribution model. Indeed, beyond the many advantages of private exchanges, they are particularly appealing to those who can’t afford high reliability organization (HRO), human resource information services (HRIS), Benefits Administration outsourcing and other similar services, since these services are all built in.  However, you may not know about three other advantages of private exchanges

  1. “Leakage” control
  2. Reduction in “Over Insured Syndrome”
  3. Amazon-izing the user experience

“Leakage” is when overpaid premiums and under-deducted payroll deductions sap your bottom line. UBA has found that its private exchange program model has proven to decrease this traditional group insurance phenomenon. In fact, an audit discovered that before moving to the program, which included comprehensive benefit accounting services, one 3,000 life company was losing $50,000 per month in leakage!

UBA Partner Firm Hanna Global also studied their traditional group coverage claimants and found that 60-70% have claims under $1,000 and yet they bought plans that cost and cover a lot more—“Over Insured Syndrome!” Private exchanges more effectively provide decision support and, as a result, 80% of employees are migrating to lower cost plans! In fact, UBA recently weighed in on a CFO article detailing how employees are choosing more appropriate coverage levels on private exchanges.

Health care insurance shopping is the last paper dinosaur -- forms to fill out… excel grids showing costs and benefits… a PowerPoint presentation to employees gathered in a conference room. Why is it that way? For the first time, private exchanges allow us to “Amazon-ize” the shopping experience, and employees LOVE it! Finally, HR can offer a “big company experience” without the big company cost!

Evaluating Private Exchanges

Originally posted by Reina O'Beck on (UBA)

There are many private exchanges cropping up and we’ve written before about the risks in this area. However, there is also a tremendous upside when it comes to financial control, budgetary certainty, cost reduction, risk avoidance, employee choice and administrative overhead.  So what should you look for in a private exchange? Consider these areas:

Proven technology. If we’ve learned anything about, we know an established, proven platform already in use with customers is crucial. Furthermore, make sure it is mobile-friendly!

Multiple funding models. Make sure the platform can accommodate all of the funding options and plan types that you need -- fully insured, self-funded, health savings accounts (HSAs), flexible spending accounts (FSAs), etc.

Plan choices. How many medical, dental and vision plans are on the platform and how closely do they match your typical offerings? Can they accommodate your carriers? Do they offer ancillary benefits? Do the carriers bear the full load of compliance?

Decision-making support. How effective are the online and call center support services at enrollment? What alternatives do they offer for those unable to use the website? Is the call center US-based or offshore?

Employee advocacy services. Enrollment support is key, but then what? You need a platform that can handle new hires, terminations, status changes and ongoing claims support capable of understanding the intricacies of your plans.

Defined contribution modeling tools. For many, converting to a defined contribution model is complex. Ask to see what options and tools they have to help you make the best decisions.

Benefits accounting services. Having an enrollment platform is one thing. Reliably transferring data to carriers and payroll platforms is another.

Lastly, it's a good idea to consider the advice of a benefits advisor to understand the different private exchange options and to determine which might best suit your employees' needs. In addition to providing this advice, an advisor can also make the signing-up process easier for individual employees.

The Comfort of a Local Advisor Backed by the Support of a National Organization

Original content from United Benefit Advisors

Navigating the world of employee benefits can be a time-consuming – even frustrating – task. Quality benefits can help retain your best employees and recruit top candidates, but ever-changing compliance requirements and the myriad of choices and decisions that companies face can bog down a company’s benefit strategy. How can you be sure you’re crafting the best benefits package that meets your goals and improves the lives and security of your workforce?

Partners of United Benefit Advisors (UBA) are uniquely prepared to serve busy employers who want the assurance that they are making informed choices that enrich the lives of their employees. UBA Partners actively collaborate with more than 2,000 experienced benefits professionals, forming a network dedicated to helping employers save time and money.

UBA Partners, like Hierl Insurance, can provide state-of-the-art tools, including the nation’s largest benchmarking survey of employer-sponsored health plans – the UBA Health Survey – and a host of other solutions that can boost your benefits and bolster your bottom line.

Because UBA is a national organization, Partner Firms can create unique benefits packages for companies that have locations in multiple states and can help employers who are relocating or expanding. As a combined group, UBA’s annual employee benefit revenues rank it as one of the five largest employee benefit brokerage organizations in the United States.

While UBA lends our firm strength and knowledge, Partners are an independent advisory firms. UBA Partners aren’t franchises or subsidiaries. They are locally owned firms that understand the local marketplace and the unique challenges that individual employers face. They can provide insightful, personalized service that our competition simply can’t match, backed by the knowledge and resources of UBA.

Specialty Areas

15  Actuaries

07 Attorneys

36 Communications/Marketing Designers

01 Compliance Officer

01 Graphic Designer

34 Human Resource Consultants

01 Physician

04 Nurses

01 Nurse Practitioners/Physician Assistant

01 Pharmacist

UBA Partners can provide a wide range of services for today’s busy employer, including:

·         Consultative and Strategic Plan Design Analysis

·         Health and Welfare Plan and Qualified Plan Brokerage

·         Renewal Pricing Evaluation and Plan Cost Forecasting

·         Medical Stop Loss, IBNR and Reserve Calculations

·         Health Care Cost-Containment Strategies

·         Medical Claims Analysis and Individual Predictive Modeling

·         Actuarial Consulting: Medical, Retiree Medical and Pension Plans

·         FSA, HRA, HSA and COBRA Administration

·         HR Consulting

·         HIPAA Compliance Solutions

·         Health Care Claims Auditing Solutions

·         Worksite Marketing Programs and Voluntary Product Placement

·         Executive Compensation and Benefits Planning

·         Personal Financial Planning and Asset Management

·         Customized Employee Benefits Website and Document Library

·         Web-Based Employee Enrollment Systems

·         Web-Based Employment Law Training for Supervisors and Managers

·         Online Compliance and HR News Resources

·         Merger and Acquisition Due Diligence

·         Compliance Webinars, Alerts and Quarterly Newsletters


Workplace Investigation Dos and Don'ts

Original article from

By Dale A. Hudson

It's an event that no human resource professional looks forward to: While balancing performance evaluations, open enrollment, and other daily tasks, you check your email and learn that the secretary to a key executive is complaining she is being sexually harassed by her boss. Now, you need to investigate.

Workplace investigations are challenging because as the investigator you are trying to get at the truth of disputed matters under difficult circumstances. The challenges are numerous: witnesses may be uncooperative or have their own agendas. Witnesses may be afraid to speak candidly. The information available is often confusing or incomplete. Often conflicting accounts are given, putting you in the position of judging credibility. Nonetheless, despite these challenges, you are charged with the responsibility of making a factual determination as to what actually occurred.

These challenges are compounded by the fact that your findings as the investigator generally have no conclusive effect in any subsequent legal proceedings. Despite your best efforts to conduct a thorough and objective investigation, an agency, court, or jury looking at the same facts is generally free to reach its own conclusions. Depending on the context, your findings may receive little or no deference. On the other hand, a poorly conducted investigation can be very damaging to the company in subsequent legal proceedings.

So you need to begin your investigation with care. And while you need to approach each investigation individually, there are some important guidelines that can help you avoid common pitfalls in conducting workplace investigations of all types.

Some investigations will be precursors to litigation. You cannot know which investigations will later be the subject of litigation, so conduct all of your investigations with the potential for litigation in mind. In harassment cases, plaintiff's attorneys will often put the investigation itself on trial, especially if they want to distract attention from a harassment claim that is somewhat weak. The plaintiff may present the testimony of an expert whose de-facto assignment is to find fault with the investigation you conducted. Such scrutiny is never going to be comfortable, but it will be especially painful if you committed a blunder during the investigation.

The first decision to be made is whether to conduct the investigation internally, or to bring in an outside investigator. It is generally more expensive to hire an outside investigator, so companies often prefer to use internal resources when appropriate. Many factors should be considered in making this determination: How serious are allegations? Is it likely that this claim will end in litigation? What are the capabilities and experience of company personnel who are available to conduct an investigation?  How would the internal investigator perform as a witness in the event of litigation? Will an internal investigator be perceived as unbiased?

If allegations of impropriety go to the highest levels of an organization, it is generally best to retain an outside investigator, as no company employee will be perceived as truly independent.

If you decide to conduct the investigation internally, your next step is to develop an investigation plan.  Identify witnesses who should be interviewed, and determine the order of interviews. Generally, it makes sense to interview the complainant first, then the accused, followed by other witnesses. Before conducting the interviews, gather any relevant documents.

Schedule the interviews in a location that affords privacy, avoiding "fishbowl" offices. You should always schedule individual interviews; never conduct group interviews.

Always create a separate confidential file for all materials relating to the investigation. You should assume that the entire contents of this file will be produced in any subsequent legal proceeding, and guard its integrity accordingly. Do not discard or destroy any documents. At best this may create an impression that you are trying to hide something; at worst this can result in sanctions for spoliation of evidence

During the investigation process, it's essential to remember to always remain neutral. Treat each witness with respect and listen attentively when he or she speaks. Even if you are starting to form opinions, keep those opinions to yourself until the investigation is completed -- and there are reasons for this. First, your overall assessment may change as additional evidence is gathered. Second, premature statements about your initial impressions could be cited as evidence of bias, or that the company did not take the allegations seriously. There is nothing to be gained by jumping to conclusions.

All witnesses, including the accused, should be advised that retaliation against the complainant, or any witness, will not be tolerated.

Avoid the mistake of beginning an interview with narrow, focused questions, because such questions may sometimes miss the larger picture. Instead, use the "funnel" approach: Begin with general questions and ask each witness to describe what happened in his or her own words. Then follow up with targeted questions to fill in gaps and clear up ambiguities.

You should ask all witnesses, including especially the complainant and the accused, if they are aware of any other witnesses who should be interviewed. You should also ask if they are aware of documents (paper or electronic) or other evidence that could shed light on the matter. In harassment cases, for example, it is not uncommon for one party to have e-mail communications that tend to corroborate their account of what happened.

During such investigations, employees occasionally request that their attorney participate in their interview. Employees generally do not have the right to have counsel present. However, refusing such a request is generally not advisable, since it can make the investigation look harsh or unfair.

Under the National Labor Relations Act, non-management employees have the right to have a "personal representative" present, even in a non-union workplace. While third parties attending an interview may attempt to disrupt the process, it is generally best to tolerate and work through any obstruction.

Extreme care must be taken to accurately record what is said by each witness during the interview.  Some investigators ask complainants or witnesses to prepare written statements, while others make notes as the witnesses speak. In either case, it is important, wherever practical, to meet with the witness face-to-face and to ask follow-up questions.

Regardless of the method used to memorialize witness statements, it is generally best if the witness actually signs the written record of the interview, affirming that the statement accurately captures his or her account. If a witness later gives contradictory testimony, a signed statement can serve as powerful evidence. If, on the other hand, the witness never approved, or even saw, the investigator's report of the interview, it is easy for the witness to change the earlier story and testify that the investigator did not accurately record the interview. What might otherwise have constituted powerful impeachment will likely become just one more factual dispute.

Conventional wisdom holds that witnesses should be instructed, or at least requested, to keep their interviews confidential and not to discuss the investigation with others. There are good reasons for this approach. First, the complainant (and the accused) may not want company employees discussing highly personal or embarrassing matters. Second, the investigator will always prefer to get the account of each witness before he or she has compared notes with other witnesses.

However, a recent decision by the National Labor Relations Board, Banner Health System, casts doubt on the legality of this practice. In Banner Health System, the NLRB held that an employer violated its employees' rights to engage in "concerted activity" when it advised employees not to discuss matters pertaining to an internal investigation with co-workers. The NLRB held that such instructions are permissible only where the employer can make an individualized showing that such an instruction was necessary to protect the integrity of the investigation.

Your attorney can play a critical role in guiding and enhancing the investigation. If the attorney is acting strictly as your attorney (i.e., not wearing an investigator's hat), he or she can serve as a valuable sounding board. At critical stages in the investigation, your attorney can provide guidance on many issues: Is the investigation truly complete? Are there important questions that have not been sufficiently explored? Do any witnesses need to be re-interviewed? Are there additional witnesses who should be interviewed? Is there documentary or electronic evidence that should be obtained?

In addition, if you prepare your first draft report as a privileged document addressed to the company attorney, that will generally be protected from discovery by the attorney-client privilege. Counsel can often recommend changes that will make the report better and/or less vulnerable to attack. Even minor changes in phrasing can head off potential criticisms of the report. After receiving the input of counsel, you can then issue your final report, and the initial drafts prepared for counsel will generally be protected from disclosure pursuant to the attorney-client privilege. If prior drafts are not privileged, plaintiff's attorney may have a field day cross-examining you on each and every change.

It is critical that the attorney's role be clearly defined and lines observed. If the attorney is acting as the independent investigator, the attorney-client privilege will not be available and sensitive communications could be disclosed in discovery.

It is extremely important that human resources advise both the complainant and the accused of the outcome of the investigation, both verbally and in writing.

Drafting the written communication to the complainant is sensitive. On the one hand, in most states employees have a right of privacy in personnel matters. On the other hand, if the target has been disciplined, the complainant needs to be informed of this, at least in general terms. The written communications to the complainant and the target should be carefully written to balance these concerns. The communications should avoid getting bogged down in details and should summarize the extent of the investigation conducted.

Regardless of the outcome, the written communication to the complainant and accused should always include four critical statements: (1) The company maintains a strict policy against harassment (or whatever is alleged); (2) a copy of the applicable company policy is attached; (3) the company does not permit retaliation; and (4) if in the future the employee believes he or she is being harassed, he or she should immediately report this to Human Resources, or to another appropriate company manager.

Sometimes an investigation will determine that while some inappropriate conduct occurred, it does not rise to the level of unlawful harassment. In such a case, the accused should be advised that their behavior was inappropriate and/or violated company policy. Discipline may be imposed, even if no unlawful harassment occurred.

If an employer takes adverse action against an employee based on an investigation conducted by an outside investigator, the Fair Credit Reporting Act requires that the employer provide  any employee who is disciplined with a  "summary containing the nature  and substance" of the information upon which the adverse action is based. The employer is not required to reveal the sources of information used in preparing the report.

Workplace investigations pose many challenges, but if you conduct them properly, the benefits to the company are legion. In the worst case, the company will be in a stronger position to defend any subsequent lawsuit. In the best case, the investigation may obviate the need for any litigation at all.



A Biz Owner's Legal Guide to Summer Hiring

Original article from

By Aditi Mukherji

With summer just around the corner, now is the perfect time for business owners to refresh themselves on the legal issues surrounding summer hiring.

Before business heats up in the summer, consider these legal tips when hiring seasonal employees:

  • Start your hiring search early. The early bird gets the worm. But more importantly, the early bird doesn't get the lawsuit. Legal disputes can arise from poorly drafted employment contracts and hasty job interviews, just to name a few common pitfalls.
  • Be careful about hiring teenagers. When school's out for the summer, it's convenient for business owners to hire teens to save money and increase temporary staffing for the season. But be careful. Teens are often covered by different employment laws.
  • Be careful about "hiring" unpaid interns, too. In this economy, it's becoming more common for businesses to take on unpaid interns. The experience can be mutually beneficial. But it's important to remember that in the name of labor laws (and common decency), unpaid interns can't just be free labor. If you're concerned about the law, look to the Labor Department. The agency issues and enforces rules for using unpaid interns.
  • Know how to provide a safe working environment. Even though seasonal employees have to hit the ground running, you need to make time to keep them safe. Provide safety training to make sure they understand workplace risks and hazards and what to do if they are injured on the job. And make sure you comply with all OSHA requirements.
  • Don't cut corners. Play by the rules. Part-time, temporary, or seasonal employees are covered by both Federal and state laws. Where your state laws are more restrictive, you will need to follow state law. Generally, all the federal protections regarding minimum wage and worker safety apply equally to full-time and seasonal/part-time workers. The law doesn't have summer hours. No paying seasonal employees under the table!


DOL Audits of Health Plans

Original content from United Benefit Advisors

The Department of Labor has significantly increased its audits of group health plans. These audits now cover compliance with parts of the Patient Protection and Affordable Care Act, in addition to the many other federal laws that apply to group health plans. Now is the time for employers to be sure they understand what they will need to provide if they receive an audit letter and to take steps to fill any gaps they may have.

Tuesday, June 11, 2013 - 2 p.m. ET / 11 a.m. PT

[button color="blue" link=""]Register for the Webinar[/button]

During this 90 minute intermediate level webinar we will discuss what the updated DOL audit letter typically requests and provide guidance on how to respond if you receive an audit letter.  We will also cover best practices for compliance and documentation to help you be as prepared as possible if an audit does occur. The presentation slides will be posted the day before the webinar.


Avery M. Chenin, Of Counsel - Jackson Lewis LLP Mr. Chenin focuses his practice on employee benefit plans, including providing advice regarding the planning, development, implementation and amendment of Employee Stock Ownership Plans (ESOPs), 401(k) plans, defined benefit pension plans and 403(b) plans. He also assists companies with executive compensation,  welfare plan issues and mergers and acquisitions. Mr. Chenin's practice includes representing clients with respect to IRS and Department of Labor examinations and audits, and assisting in the resolution of plan defects, including submitting plan corrections under both the IRS and Department of Labor correction programs. He also provides counsel to clients related to plan fiduciary matters.

Teresa Y. Huang, Associate - Jackson Lewis LLP Ms. Huang's current practice focuses on mergers and acquisitions and employee benefits, including employee stock ownership plans and trusts and merger and acquisition issues involving employee benefit plans. Ms. Huang also provides litigation support and research capabilities to the firm's litigation practice areas.

Employee Benefits Cost Management Lessons from the Public Sector

Wednesday, April 3rd, 2013
2 p.m. ET / 11 a.m. PT


[button color="blue" link=""]Register Here[/button]

Of any industry, the public sector must find a way to simultaneously keep employee health care costs low, yet attractive enough to recruit and retain the best public service talent. However, with exponentially increasing health insurance premiums, this is a daunting task.

In fact, according to the United Benefit Advisors’ 2012 Health Plan Survey, premiums have grown by 134 percent between 1995 and 2012.

The upside though is while costs are indeed soaring, government workers are not likely to see their health benefits disappear, but they are likely to face a lot of other changes as public employers struggle to control costs.  That's one of the key findings in a study by the Government Finance Officers Association and Colonial Life.

The study researched some of the most impactful and effective strategies local governments are using to decrease healthcare costs.  Not only has the research helped the public sector, but these practices definitely apply to any type of organization.

The study, which will be the feature of an upcoming UBA-hosted webinar titled, Lessons in Cost Management From the Public Sector: What Organizations of All Types Can Learn,” researched 17 cost savings strategies in four broad-stroke categories public sector organizations are using to manage benefits costs including:

  1. Cost-Sharing. Structure the health plan so that employees bear an equitable share of benefit costs
  2. Supplier Management. Getting the most bang-for-the-buck and supplier expense shifting.
  3. Plan Governance & Optimization. Maximizing value from your plans and accruing every possible benefit from them.
  4. Wellness. A healthier employee population can bend long term cost-trends.

The webinar will dive into the details on some of the top cost management strategies from each of these categories, identifying which are most widely utilized and recommended, and just as important, which strategies are not being utilized and their hurdles to execution.  Case studies and savings illustrations will also be presented.

Be sure to register for this event, taking place on Wednesday, April 3, 2013 from 2:00 – 3:00 pm ET. 


Want to engage in retirement planning? Watch your words


By Margarida Correia

If you want to engage investors in the retirement planning process, avoid talking about “financial planning” or worse, “retirement income.” Both elicit very negative responses from investors, Timothy Noonan, managing director of Capital Market Insights at Russell Investments, said at a media roundtable this month.

When investors hear “retirement income,” they think they’re about to be sold an insurance product and are reminded of their private retirement “sins,” such as not saving enough or robbing their 401(k)s, he said. And the mention of financial planning is likely to make most investors yawn. The topic is boring and technical, according to a two-year study of major markets in the United States, Canada and the U.K, commissioned by Russell.

HR/benefits professionals should talk instead about “lifestyle design,” a concept that appeals to investors. “If you want a get a disengaged person to re-engage, maybe you should try talking to them about what you can do to help them design a lifestyle that’s sustainable,” Noonan said.

Russell Investments has taken the research to heart, naming its recently launched retirement planning tool the Retirement Lifestyle Solution and the tool’s main software component Retirement Lifestyle Planner. The new tool is based on the concept of adaptive investing, a style of investing that investors are responsive to, according to the two-year study.

Investors see adaptive investing as a middle ground between the investing style extremes of changing asset allocations frequently and not changing them at all. More importantly, it incorporates “asset-liability matching,” which is central in getting “individual investors to engage meaningfully on preparing for their retirement and getting income from their retirement portfolios,” Noonan says.

“Fundamentally, adaptive investing is managing your portfolio and building an asset allocation that is connected to the spending it has to support,” says Rod Greenshields, consulting director of Russell Investments’ private client consulting group.

One of the major roadblocks to getting investors to think about and plan for retirement is their inability to visualize themselves in the future. By matching their assets to their liabilities in the future, the tool helps investors overcome this visualization difficulty, according to Noonan.


Top 5 issues facing physicians, patients in 2013



By Kathryn Mayer

As health reform continues to changes the landscape of our country’s health system, what’s to watch in this new year? A lot, industry insiders say.

Lou Goodman, president of The Physicians Foundation and CEO of the Texas Medical Association, says 2013 will be “a watershed year” for the U.S. health care system. Most of those changes will have a big impact on both patients and the physicians caring for them.

“It’s clear that lawmakers need to work closely with physicians to ensure we're well prepared to meet the demands of 30 million new patients in the health care system and to effectively address the impending doctor shortage and growing patient access crisis.”

The Physicians Foundation identified five issues that are likely to have a significant impact on patients and physicians in 2013.

1. Ongoing uncertainty over PPACA

Despite the Supreme Court decision upholding most of the provisions in the Patient Protection and Affordable Care Act and the re-election of President Obama, considerable uncertainty persists among patients and physicians regarding actual implementation of the act. Much of the law has yet to be fully defined and a number of key areas within PPACA—including accountable care organizations, health insurance exchanges, Medicare physician fee schedule and the independent payment advisory board—remain nebulous, the foundation says. Their research found that uncertainty surrounding health reform was among the key factors contributing to 77 percent of physicians being pessimistic about the future of medicine. In 2013, physicians will need to closely monitor developments around the implementation of these critical provisions, to understand how they will directly affect their patients and ability to practice medicine.

2.  More consolidation

Consolidation means bigger, but is bigger better? Large hospital systems and medical groups continue to acquire smaller/solo private practices at a steady rate. According to the foundation's report pertaining to the future of U.S. medical practices, many physicians are seeking employment with hospital systems for income security and relief from administrative burdens. But increased consolidation may potentially lead to monopolistic concerns, raise cost of care, and reduce the viability and competitiveness of solo/private practice. As the trend toward greater medical consolidation continues across 2013, it will be vital to monitor for possible unintended consequences related to patient access and overall cost of care.

3. A scramble to fix the doctor shortage

In 2014, PPACA will introduce more than 30 million new patients to the U.S. health care system, a provision that has considerable implications relative to patient access to care and physician shortages. According to the Foundation’s Biennial Physician Survey, Americans are likely to experience significant challenges in accessing care if current physician practice patterns continue. If physicians continue to work fewer hours, more than 47,000 full-time-equivalent physicians will be lost from the workforce in the next four years. Moreover, 52 percent of physicians have limited the access of Medicare patients to their practices or are planning to do so. As the 12-month countdown to 30 million continues across 2013, physicians and policy makers will need to identify measures to help ensure a sufficient number of doctors are available to treat these millions of new patients – while also ensuring the quality of care provided to all patients is in no way compromised.

4. Erosion of physician autonomy

The Physicians Foundation believes that physician autonomy – particularly related to a doctor’s ability to exercise independent medical judgments without non-clinical personnel interfering with these decisions – is markedly deteriorating. Many of the factors contributing to a loss of physician autonomy include problematic and decreasing reimbursements, liability/defensive medicine pressures and an increasingly burdensome regulatory environment. In 2013, physicians will need to identify ways to streamline these processes and challenges, to help maintain the autonomy required to make the clinical decisions that are best for their patients.

5. Growing administrative burdens

Increasing administrative and government regulations were cited as one of the chief factors contributing to pervasive physician discontentment, according to the Foundation’s 2012 Biennial Physician Survey. Excessive “red tape” regulations are forcing many physicians to decrease their time spent with patients in order to deal with non-clinical paper work and other administrative burdens. In 2013, physicians and policy makers will need to work closely together to determine steps that will effectively reduce gratuitous regulations that negatively affect physician–patient relationships. According to a recent Foundation report, the creation of a Federal Commission for Administrative Simplification in Medicine could help reduce these regulations by evaluating and reducing cumbersome physician reporting requirements that do not result in cost savings or measurable reductions in patient risk.