Physi­cians: on the pay­roll

Modern Healthcare - - Special Report - —An­dis Robeznieks

Un­til a per­ma­nent fix is made to the Medi­care re­im­burse­ment for­mula, what lies ahead for physi­cians is un­clear. But ex­perts be­lieve change is com­ing in the way physi­cians get paid, in the way their re­la­tion­ships with hos­pi­tals are struc­tured, and the way they use health­care in­for­ma­tion tech­nol­ogy.

Sharon Con­klin, a vice pres­i­dent at Premier Con­sult­ing So­lu­tions, part of the Premier health­care al­liance, says more physi­cians will be­come em­ployed by hos­pi­tals and health sys­tems, and their re­im­burse­ment and in­cen­tives will re­flect a greater em­pha­sis on teamwork and pa­tient out­comes. She added that this will dif­fer from past com­pen­sa­tion for­mu­las, which were driven more by vol­ume than by re­sults.

Ryan O’Con­nor, vice pres­i­dent of mem­ber­ship and mar­ket­ing for the Amer­i­can Med­i­cal Group As­so­ci­a­tion, calls this “verti- cal in­te­gra­tion” and says that, as a sur­vival strat­egy, prac­tices are work­ing closer than ever with hos­pi­tals. But he added that it was a strat­egy based on pro­vid­ing bet­ter pa­tient out­comes rather than just per­pet­u­a­tion of the prac­tice it­self.

Physi­cian “groups and hos­pi­tals will come to­gether as one sys­tem,” O’Con­nor says, rather than co-ex­ist­ing as two stand-alone en­ti­ties. He adds, how­ever, that con­trol is­sues will emerge as doc­tors seek an own­er­ship stake or a role in gov­er­nance.

Though O’Con­nor also says this will come mostly from older physi­cians, as younger physi­cians are more in­ter­ested in a steady, high-pay­ing job and will view be­ing a hospi­tal em­ployee as be­ing lit­tle dif­fer­ent than be­ing part of a large prac­tice.

A sched­uled 21.5% Medi­care pay­ment cut for 2010, how­ever, is keep­ing many peo­ple in limbo. “Be­cause physi­cian pay­ment cuts have not been ad­ju­di­cated, most groups are bud­get­ing for no growth in rev­enue,” he says.

William Jessee, pres­i­dent and CEO of the Med­i­cal Group Man­age­ment As­so­ci­a­tion, says “there could be a whole lot of scram­bling go­ing on” in 2010 to take ad­van­tage of sub­si­dies ap­pro­pri­ated in the Amer­i­can Re­cov­ery and Rein­vest­ment Act of 2009 for the pur­chase of elec­tronic healthrecord sys­tems and other health IT in­vest­ments.

“The stim­u­lus ef­fect of the stim­u­lus money is likely to be felt in 2010,” Jessee says. “Frankly, I think it’s go­ing to be dif­fi­cult for the EMR ven­dors to keep up with EMR de­mand.” But, if the Medi­care pay­ment for­mula isn’t fixed, he says prac­tices will be ask­ing “Where am I go­ing to get the money to take ad­van­tage of the money?”

Jessee: Look for “the stim­u­lus ef­fect of the stim­u­lus money.”

O’Con­nor: New pay for­mu­las seen as a sur­vival strat­egy.

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