Medicine
A friend and family physician colleague of mine owns a private practice with three other primary care physicians and a physician assistant. Not long ago, she mentioned that she and her partners have been struggling to maintain their incomes in the face of rising equipment, personnel, and administrative costs, combined with declining payments from health insurance plans. Basically, she said, everyone's salaries have been going up except the physicians' - she takes home about the same amount she made after graduating from residency more than a decade ago. In order to boost the practice's income, she and her partners explored an agreement with one insurance plan to receive a bonus for providing care coordination services (which they do anyway, for free), only to be told that their practice was too small to qualify.
My friend's story, I think, is not atypical of the challenges facing small family practices today. Although last year's health reform law contains some programs designed to support primary care, including more funding for training programs and significant (albeit temporary) increases in Medicare and Medicaid payments to improve access, there is widespread concern in family medicine that the law did little to support the small practices (those with 5 or fewer clinicians) that see the majority of patients in the U.S.
An editorial authored by White House officials in the Annals of Internal Medicine suggested that small practices would eventually be absorbed by "vertically integrated organizations" and prompted the president of the American Academy of Family Physicians to send a letter to the White House defending the ability of small or solo practices to provide high-quality primary care in the new health environment.
More recently, the health reform pilot program that shares Medicare savings with physicians who meet certain quality-of-care goals in accountable care organizations (ACOs) has come under fire from physicians who fear that small practices won't have sufficient resources to form ACOs and will therefore be left at a competitive disadvantage against large hospital-owned practices or health corporations.
So is the future of primary care in the post-health reform era destined to be one in which small private practices become extinct, and family doctors who don't practice at community health centers or enter concierge medicine are all salaried employees for hospital systems or health maintenance organizations? And if so, will it be possible to persuade medical students to make this their career of choice?
- Integrating Health Systems Must Be To Improve Quality, Not Increase Cost
The February 13, 2014 article in the New York Times by Elisabeth Rosenthal, “Apprehensive, many doctors shift to jobs with salaries”, more or less just presents the facts. It notes that the medical placement firm, Merritt Hawkins, says that 64% of...
- It’s Definitely Not About The Bike – But Is It Even About Acos?
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- Public / Private Funding: We're All In This Together
. I have written a great deal about the shortage of primary care physicians in the US, both at present and probably worsening in the future. One of the main reasons is that they make less (much less!) money than many other specialists. This has led to...
- Family Physicians Are Natural Health System Leaders
Last week, the subtitle of a JAMA editorial on accountable care caught my attention: "the paradox of primary care physician leadership." The authors observed that although a typical family physician's or general internist's patient panel accounts...
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The buzzwords of cutting-edge primary care reform - the medical home, coordination of care, electronic health records - have usually been associated with large integrated health systems such as Intermountain Healthcare, Group Health, and Kaiser Permanente....
Medicine
Will small primary care practices survive health reform?
A friend and family physician colleague of mine owns a private practice with three other primary care physicians and a physician assistant. Not long ago, she mentioned that she and her partners have been struggling to maintain their incomes in the face of rising equipment, personnel, and administrative costs, combined with declining payments from health insurance plans. Basically, she said, everyone's salaries have been going up except the physicians' - she takes home about the same amount she made after graduating from residency more than a decade ago. In order to boost the practice's income, she and her partners explored an agreement with one insurance plan to receive a bonus for providing care coordination services (which they do anyway, for free), only to be told that their practice was too small to qualify.
My friend's story, I think, is not atypical of the challenges facing small family practices today. Although last year's health reform law contains some programs designed to support primary care, including more funding for training programs and significant (albeit temporary) increases in Medicare and Medicaid payments to improve access, there is widespread concern in family medicine that the law did little to support the small practices (those with 5 or fewer clinicians) that see the majority of patients in the U.S.
An editorial authored by White House officials in the Annals of Internal Medicine suggested that small practices would eventually be absorbed by "vertically integrated organizations" and prompted the president of the American Academy of Family Physicians to send a letter to the White House defending the ability of small or solo practices to provide high-quality primary care in the new health environment.
More recently, the health reform pilot program that shares Medicare savings with physicians who meet certain quality-of-care goals in accountable care organizations (ACOs) has come under fire from physicians who fear that small practices won't have sufficient resources to form ACOs and will therefore be left at a competitive disadvantage against large hospital-owned practices or health corporations.
So is the future of primary care in the post-health reform era destined to be one in which small private practices become extinct, and family doctors who don't practice at community health centers or enter concierge medicine are all salaried employees for hospital systems or health maintenance organizations? And if so, will it be possible to persuade medical students to make this their career of choice?
- Integrating Health Systems Must Be To Improve Quality, Not Increase Cost
The February 13, 2014 article in the New York Times by Elisabeth Rosenthal, “Apprehensive, many doctors shift to jobs with salaries”, more or less just presents the facts. It notes that the medical placement firm, Merritt Hawkins, says that 64% of...
- It’s Definitely Not About The Bike – But Is It Even About Acos?
One of the major features of the Affordable Care Act (ACA) is the idea of Accountable Care Organizations (ACOs). The final regulations from Medicare were issued in October, 2011, so the creation of ACOs seems to be moving forward. ACOs will be groups...
- Public / Private Funding: We're All In This Together
. I have written a great deal about the shortage of primary care physicians in the US, both at present and probably worsening in the future. One of the main reasons is that they make less (much less!) money than many other specialists. This has led to...
- Family Physicians Are Natural Health System Leaders
Last week, the subtitle of a JAMA editorial on accountable care caught my attention: "the paradox of primary care physician leadership." The authors observed that although a typical family physician's or general internist's patient panel accounts...
- Solo Practice: A Disruptive Innovation?
The buzzwords of cutting-edge primary care reform - the medical home, coordination of care, electronic health records - have usually been associated with large integrated health systems such as Intermountain Healthcare, Group Health, and Kaiser Permanente....