Tuesday, April 10, 2012

Relative Strengths of Health Reform Physician Counter Trends
They go from strengths to strengths.

Psalms, 4

April 11, 2012 -  The health reform law has ignited counter trends among physicians. 
Here I shall assess the relative strengths of these trends and questions they raise.

One, Strongest Trend – Hospital Employment of Physicians
This trend is the most powerful.  Hospitals are employing more physicians.  Hospital now own more than half of physician practices.   Both primary care and specialist physicians,  driven by decreasing reimbursement and increasing harassment from public and private payers, are rushing to be employed. Hospitals are even buying large physician groups. Reasons behind this trend are multifarious.  Young physicians are seeking regular hours, balanced life styles, economic security, and money to pay off educational  debts.  Older physicians are seeking an escape from the business pressures of running a practice.  Many physicians are seeking an escape from malpractice worries.  Hospitals are seeking greater market presence and more negotiating power to deal with payers.  Will these trends sacrifice physician independence ? Will it compromise the ability to do the right  thing for patients?  What will happen to medical societies,  who  heretofore have spoken for physicians?
Two, Second Strongest Trend – Accelerating Consolidation  at All Levels of the System – This goes hand in hand with first trend.  It  is proceeding at a rampant pace as hospitals and physicians gather together  to afford the  administrative, technological,   and informational strengths required to function in a regulatory environment.    The strength lies in a unified and standardized  approach to reducing costs and meeting government  regulations.  Consolidation raises these questions:  At what point will larger organizationss violate or  evoke antitrust laws?  When do the costs of these organizations exceed benefits?   How much will these organizations raise costs?  Will they medicine?  
Third,  Strongest Trend -   Care Migrating outside of Hospitals and Physician Offices to Decentralized Diagnostic and Therapeutic Centers.  This movement is well underway.  You see it in retail clinics, hospital outreach programs, establishment of surgicenters,  specialty groups offering one-stop shopping ,   telemedicine promoting  virtual visits, home monitoring, and home visits via Skype-like  arrangements  with audio-visual connections.   On the whole, this is a good thing, powered by mobile devices and health IT companies, but how does one monitor and regulate these activities?  How does one control fraud and abusive payment schemes? Who provides oversight.
Four, Fourth Strongest Trend -  The Push for  Bundling  Billing  and Capitation for Episodes-of-Care  and Per Person Payment   , and the Phasing Out of Fee-For Service.  This is the basis for Accountable Care Organizations  and promised government  Medicare “savings”.  This may be a weak trend because of bureaucratic barriers,  and resistance of hospitals and specialist physician, , both of whom stand to  lose income under this arrangement.  But at the same time,  I believe ACO variants are inevitable.

Fifth Strongest Trend -   Drift of Physicians into Concierge, Direct Pay, and Other Practices outside the Purview of Third Parties.    This movement is gaining strength every day,  although it remains  marginal. These practices require less overhead,   tend to be more personal, and provide more economical care.   Their weakness is the ability to address major illnesses and major procedures.  Their future depends on attractiveness to consumers, the economic status of the patient base and ability to pay, the region of the country, and  federal and state government regulations of their activities,

Tweet: A number of counter trends among physicians  to the health care law are underway and gaining strength.

No comments: