Shift happens. That’s what a
lot of worried hospitals, physicians, insurers (and probably patients) are
thinking as they contemplate the uncertainties of health care reform. It’s
like we’re all going to reform school together. Recently I pointed out that clinging
to the status quo was going to take the nation down a black hole of rising
national debt, unaffordable premiums for individuals and small businesses, and
an unsustainable world of hurt.
we’re already feeling that in all the price controls being slapped on the
practice of medicine by all public and private payers happened before reform passed. The SGRrrr debate about whether or not to cut
physicians another 21 percent in Medicare is a poignant and decade-long example
its warts and all, the PPACA (Patient Protection and Affordable Care Act)
forces us into an environment of forced change. I hear a lot of grousing about
it, but it’s here and it’s not going away. There are quite a few things we
don’t like in the bill; and quite a few needed elements not included, but
things have to change to expand access, to increase overall quality, and to
align increasing costs to more closely track GDP.
Even if we don’t yet know
precisely how that needed change should manifest to best accomplish those
things, we still need to get at it. Importantly, as reform progresses we also
need to make sure that we protect health research, science and innovation,
which are significant contributors to the health of the American economy we
can’t afford to undermine.
It’s all very tricky, and as I've stated before, there
will be winners and losers. My question to each of you is: Do you know which
you want to be? (Duh)
Hospitals are scrambling faster than doctors at present to build networks and prepare for
integration. Not suffering apparently from ‘mural dyslexia,’ hospitals see the ‘handwriting
on the wall’ as a need to change their game to prevent their bottom line from
being slashed. PricewaterhouseCoopers broadly advised hospitals this week to
prepare to promote continuous quality improvement strategies or risk severe upcoming
penalties. PWC said appropriate hospital admissions, hospital-acquired
conditions and payments tied to value-based care will be three key areas of
focus on to remain profitable for both public and private care.
Our own ACC cardiologist colleagues are already engrossed
in a migration to hospital employment or contractual integration.
Cardiologists are smart folks, and I do not see this as a migration of lemmings.
But it may be an intermediary step leading toward different future structures.
In California, for example, big news
last week was that more than 20 major hospitals of Southern California have formed a foundation (with physician officers on the
board) to bypass California’s “Corporate Bar on the Practice of Medicine” in
order to create the equivalent of employed doctor networks. The Corporate Bar in California
prevents hospitals from hiring doctors directly, so the new foundation model will
hire doctors who will then exclusively contract with the organizing hospitals
to provide care across the Los Angeles and Orange County
Wall Street investors believe that some of these
changes were bound to occur with or without the PPACA and health reform.
Medical students are not graduating
aspiring to enter private practices, and would clearly prefer to be employed in
groups or networks that minimize on-call, handle the administrative hassles,
produce the flow of patients they will treat, and offer more control of their
lifestyles. Meanwhile, hospitals and insurance companies, according to Wall
Street, need to consolidate to reduce administrative costs and improve
efficiencies. Thus, physicians will also need to consolidate or network to effectively
negotiate with consolidated hospitals and payers. Health reform is just going
to speed these processes up. A lot of these kinds of changes already have
occurred in other industries. All of us recognize that such dynamic changes always
produce winners and losers.
Believe me, I
recognize how difficult all this is to swallow for people out there who are
taking care of patients, participating in reducing morbidity and mortality by
30 percent over the last decade, and working very, very hard to produce
high-quality care now. You have to be
asking, why do we have to endure this crazy process of massive change at the
same time? There’s no easy answer. Change is tough, and unfortunately health
care in this country, to be sustainable, has to change.
Hopefully we can make
the changes necessary to ferret out the waste and ineffective aspects of the
system and still produce the desired ongoing progress in science, quality,
patient-centered clinical improvement and practice vitality. The risks really
are enormous. The College has to be there as a partner with all of you as we go
through these significant times of transition. But the opportunities are
enormous as well.
*** Image from Flickr (worldsislandinfo.com). ***