Posted 5/23/13 on Medscape Connect’s Care & Cost Blog
Several physicians have reached out recently to discuss attractive employment offers from health systems. They are invariably conflicted. They understand the trade-offs, that they’ll give up the autonomy they’ve become accustomed to in exchange for more money and fewer practice management headaches. On the down side, they’ll be accountable for generating significant revenues, sometimes independent of care appropriateness.
Most also are aware that the same care services they provide now will be considerably more expensive once they’re part of a system. Many appreciate that because health systems are corporations with a heavy focus on optimizing short term gains, their future employer’s loyalty is suspect. And then there is the question of whether the health system’s management team is competently preparing to be sustainable in a market that could change dramatically.
As health systems maneuver to dominate regional markets, driving utilization and gaining more leverage over contractual pricing, physician employment has become their principal lever. Primary care physicians (PCPs) are now precious commodities that can manage populations and steer patients into the system’s services. Other specialties – e.g., cardiology, orthopedics, neurosurgery and even gynecologic oncology – are desirable if they’re high yield, driving lucrative, intensive use of inpatient and outpatient services.
Continue reading “Physicians, Health Systems and the Drive For Market Dominance”
Posted 4/21/13 on Medscape Connect’s Care and Cost Blog
What is the path forward for physicians who want to remain in private practice, outside the constraints of health system employment? How will the environment change and what new demands will that place on practices and physicians? What follows are the observations of one industry-watcher who has worked on all sides of health care, but who now spends most his time focused on the interests of those who pay for it. No crystal ball, but several trends are clear.
There are now concrete signs that health care’s purchasers are exhausted and seeking new solutions, that a competitive marketplace is emerging and getting increasing traction. As they abandon ineffective approaches, the paradigm that has dominated the industry for the past 50 years will be upended. The financial pressure felt by buyers will transfer to the supply side health industry that has come to take ever more money for granted.
For decades, fee-for-service payment, inclusive health plan networks, and a lack of quality, safety and cost transparency have been enforced by health industry influence over policy, effectively neutralizing the power of market forces.
Without market pressure, physicians have felt little need to understand their own performance relative to that of their peers. The variation of physician practice patterns within specialties has been high, with some physicians’ “optimizing their revenue opportunities” by veering wildly away from evidence-based practice. Even so, until recently in this dysfunctional environment, it has been nearly impossible to identify high and low performers.
Continue reading “How Physician Practices Can Prepare for a Health Care Marketplace”
Posted 4/26/12 on Health Populi
One-half of physicians believe they’re not fairly compensated for their work – in particular, those working in primary care. Only 11% of doctors considering themselves “rich.”Medscape’s 2012 Physician Compensation Report compiled data from over 24,000 U.S. physicians across 24 specialties and found the bulk of physicians to see themselves working harder and 1 in 4 making less money than last year.
This has led to growing frustration and worry, where some physicians are resenting the large pay gap between specialists and primary care. That frustration looks poised to increase with doctors concerned that accountable care will further eat into incomes, and increased regulation and administrative hassle “take the joy out of medicine,” as Medscape coined the feeling.
In 2011, pediatricians earned on average about one-half of what radiologists took home in pay: about $150K versus $315K. The top physician earners along with radiologists were cardiologists, urologists and orthopedic surgeons. The lowest-earners were pediatricians, internists and family medicine doctors. Still, while they are top-earners, orthopods’ and radiologists’ income declined an average of 10% between 2010 and 2011.
Physicians in single and multispecialty group practices, and those within healthcare organizations, earn higher incomes compared with colleagues in academia, outpatient clinics and solo practitioners.
If they had to do it all again, would physicians choose to be physicians? 54% would still pick medicine as a career…the other 46? Not so much…
Health Populi’s Hot Points: Economics is driving physician discontent in the United States. Not only are at least half of medical specialties seeing falling incomes, but the future potential for money looks dire in at least two respects: accountable care is seen by at least one-half of physicians as a cause for income to decline; and, regulations and paperwork eat further into profit margins for physician practices.
Continue reading “The Economics of Being a Practicing Physician: Greater Frustration, Lower Income, More Defensive”
Posted 3/12/12 on The Doctor Weighs In
Recently, The Doctors Company (TDC), the country’s largest insurer of physician and surgeon medical liability, decided to survey doctors to determine what they are thinking and feeling about health reform. The results are pretty gloomy.
To put this in context, it is important to understand a bit about how TDC conducted the survey. First of all, the universe of doctors they reached out to were doctors insured by The Doctors Company. That means large self-insured medical groups, such as those affiliated with Kaiser Permanente, were not included. Nor were doctors whose insurance was provided by their employers or doctors using other insurance carriers. This matters because if the TDC insured physicians are not representative of doctors as a whole, the results of this survey would not necessarily reflect the attitudes of all doctors.
Continue reading “Surveyed Physicians Are Gloomy About Health Care Reform”
Posted 3/1/12 on Not Running a Hospital
I remain relatively new to the health care field, but even in that short time, it has become evident to me that the pace of quality and safety enhancements and front-line driven process improvement in hospitals is inadequate given the scale and scope of harm that occurs to patients. Indeed, it can be viewed as a paradox that the doctors of America, a group of dedicated, well-intentioned, intelligent, and highly trained individuals, constitute one of the top-ranked public health hazards in the county when as they work together in the nation’s hospitals. That they collectively have not made much of a dent in the problem of reducing harm is, I believe, a product of their training.
As Brent James, Jay Kaplan, and others have noted, doctors are trained to be artists, to apply their intellect, creativity, intuition, and judgment to the care of each patient. That is well and good when the case is complex, but the vast majority of medical care is not complex. It calls for standardization, adoption of protocols, and scientific experiments of process improvement to modify those protocols to enhance care and reduce harm.
Continue reading “Hope Lies with Residents”
Posted 1/11/12 on Cracking Health Costs
According to a nearly breathless article in CCN, some doctors in the U.S. are going broke. Read it here. I feel sorry for anyone who goes broke, but why all the gnashing of teeth when it happens to a health provider?
According to the author, some doctors have unsustainable debt and are facing reimbursement reductions by insurers. A good question is whose fault is unsustainable debt? After all, many of our institutions have become bloated and can’t adapt to the economic downturn.
Continue reading “Doctors Going Broke. So What?”
Posted 1/10/12 on Health Populi
To doctors working in eight countries around the globe, the biggest benefit of health IT is better access to quality data for clinical access, followed by reducing medical errors, improving coordination of care across care settings, and improving cross-organizational workflow.
However, except for the issue of health IT’s potential to improve cross-organizational working processes, American doctors have lower expectations about these benefits than their peers who work in the 7 other nations polled in a global study from Accenture‘s Eight-Country Survey of Doctors Shows Agreement on Top Healthcare Information Technology Benefits, But a Generational Divide Exists. Accenture polled over 3,700 doctors working in Australia, Canada, England, France, Germany, Singapore, Spain and the US.
Continue reading “US Doctors Less Sanguine About Health IT’s Benefits”
Posted on Zocalo Public Square on 12/30/11
Brian’s Note: This article was alluded to in a NY Times blog post called “When Doctors Face Death.” In a clear and rational tone, the author, an experienced family physician, points out that, when American physicians face death, they often don’t want the excessive care that their patients generally receive. As I understand it, the article, part of a series for Zocalo Public Square, has gained tremendous traction. Rightly so. Read it below.
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
Continue reading “How Doctors Die: Its Not Like the Rest of Us, But It Should Be”
Posted 12/21/11 on The Disease Management Care Blog
Don’t underestimate the physician dismay over the looming “Doc Fix” debacle. Unless some budget compromise gets hammered out, Medicare is about to stick it to a lot of docs.
Ever since the passage of the Balanced Budget Act of 1997, Congress has been repeatedly delaying a yearly mandated cut in Medicare’s physician fees. That statutory reduction has been slowly accumulating through no fault of the physician community and is now estimated to be more than 27%. Assuming most physicians’ practices are made up by a majority of Medicare beneficiaries, that represents a huge hit to their cash flow. KHN has a good summary of the partisan mutual assured destruction that has led us to this crisis here.
Continue reading “Why Medicare Access Is In Jeopardy In Both Salaried and Physician Owned Settings”
Posted 11/16/11 on Health Populi
There is broad consensus among doctors, patients and health administrators that the current U.S. health system is broken and unsustainable; preventive services is under-utilized and -valued, quality is highly variable from region to region and patient to patient, and costs continue to spiral upward without demonstrating value.
Continue reading “Sustainable Health Care: Patients, Doctors and Hospital Executives See Different Futures”
Posted 11/10/11 on Gooz News
Matt Yglesias at Think Progress took a look at some OECD data comparing U.S. physicians to their international counterparts and concluded we need more doctors. The evidence? There’s only 2.4 practicing physicians per 1,000 population in the U.S., second lowest in the OECD and somewhat below the 3.0 median (the range is from 2.2 physicians per 1,000 population in Japan to 4.0 in Norway). At the same time, the average U.S. medical consumer sees a physician only 3.9 times a year compared to the 6.3 OECD median. Yes, we pay a lot for health services including physician services (he reprints a chart showing average pay for U.S. physicians, whether highly paid orthopedic surgeons or relatively poorly paid primary care docs, that shows they are the highest paid among six well-off OECD countries). But his conclusion that America therefore needs more docs is off the mark.
Posted 10/20/11 on Forbes
In a high-stakes political, clinical and economic poker game that goes by the name of Accountable Care Organizations (ACOs), the Centers for
Medicare & Medicaid Services (CMS) has just issued a call for doctors and hospitals to grab some chips and ante up.
The set-up goes like this: one of the biggest potential changes in how health care is actually delivered contained in the Accountable Care Act was ACOs.
They’re voluntary, but they allow doctor- or hospital-led organizations that take responsibility for coordinating the care of at least 5,000 Medicare beneficiaries to get reimbursed at a higher rate for providing better-quality, lower-cost care. It’s supposed to be a win-win-win for providers, patients and taxpayers and part of a more general move towards “value-based purchasing.”
Continue reading “CMS Wants Docs To Ante Up To CMS Poker Game”