Sunday, November 25, 2012

A Morning’s Work on Health Reform

Reform that you may preserve.
Lord Macaulay (1800-1859), Debate on the First Reform Bill
November 25, 2012 -  I spent the morning working on the foreword and  introduction to my new book,  The Physicians Foundation: A New Voice of American Medicine.
The book will be out in a week or two.
Here is the tentative foreword foreword and introduction
Foreword

The Physicians Foundation – A New Voice of American Medicine
With this Survey of America’s Physicians, The Physicians Foundation has endeavored to provide a “state of the union” of the medical profession. The survey was sent to over 630,000 physicians – or over 80 percent of physicians in active practice – and represents the Physicians Foundation’s efforts to provide as many physicians as possible with a voice.
A Survey of American Physicians, The Physicians Foundation, September 24, 2012
This second little book in as series of 12 books on health reform consists of Medinnovation interviews and blogs relating to the Physicians Foundation over the last five years.

My title A New Voice of American Medicine is testament the fact that the Physicians Foundation is relatively new. The Foundation is a nonprofit, non-lobbying organization founded in 2003 as the result of a settlement between 19 state and country medical societies and major HMOs.
The Foundation is acutely aware that American Medicine is in state of profound transformation. The Foundation’s voice is objective, analytical, rational, and nonpartisan. It fears the legacy of health reform will be a deep and lasting shortage of physicians with limited access for patients.
The Foundation’s mission is to advance,  defend, and salvage  private practice. This is a worthy cause. Private physicians provide 80% of America’s health care. Indeed, private physicians are the very foundation of American medicine. The Foundation issues grants, commissions white papers, does research studies, and conducts far-reaching surveys on the state and direction of American Medicine.
Introduction

One voice for the Physicians Foundation  that is particularly compelling is that of Phillip Miller. Vice-President of Communications for Merritt Hawkins and Associates.   This national recruiting firm is close to the ground and to reality.  It speaks ever day to physicians seeking a job and to hospitals, medical groups, and other organizations seeking physicians.
Phillip knows the lay of the physician land, and he is beautiful writer. He has written a series of books on physicians – their needs, wants, and  dilemmas   His books include Will the Last Physician in America Please Turn Off the Lights, A Look at the Looming Physician Shortage, In Their Own Words: 12,000 Physicians Reveal Their Thoughts on on Medical Pratice in America.
Three  years or so ago,  I put the Physicians Foundation in touch with Phillip for the purpose of conducting a national survey of physicians.   Philip helped Merritt Hawkins survey 100,000 physicians  The survey appeared in October 2010.  Phillip served as the principal  author. 
Here is his summary of the White Paper based on the survey.   His summary captures perfectly the quandary in which  practicing physicians find themselves. The White Paper, prophetically, is entitled Health Reform and the Decline of Physician Private Practice.  An alternative title might have been American Physicians – Victims of Their Own Success.   In any event, here are Phillip’s words  

The words will serve nicely as an introduction into the works of the Physicians Foundation.
“Like society itself, medical practice has been evolving rapidly in the United States over the last 50 years, in response to technological, economic, demographic, political and related influences.  Passage of the Patient Protection and Affordable Care Act (“health reform”) promises to acceleate this evolution in a variety of ways.
The Physicians Foundation called upon Merritt Hawkins and an Advisory Board of healthcare experts to assess how health reform is likely to affect practices in the United States.

This White Paper reflects the results  of Merritt Hawkins and the Advisory Board’s analysis.
"1)Health reform is comprised of two elements” “Informal reform,” (i.e. societal and economic trends exerting pressure on the current healthcare system independent of the Patient Protection and Affordable Care Act) and “formal reform," (i.e. The provisions contained in the Act itself).
2)The current iteration,  both formal and informal, will have a transformative effect on the health system.  This time, reform will not be a “false dawn,” analogous to the health reform movement of the 1990s but will usher in substantive and lasting  changes.
3)  The independent private physician private practice model will be largely, though not uniformly replaced.
4)      Most physicians will be compelled to consolidate with other practitioners, become hospital employees, or align with large hospitals and health systems for capital, administrative, and technical resources.

5)      Emerging practice  models will vary by region – one size does not fit all.  Large, Accountable Care Organizations (ACOs), private practice medical homes, large independent groups, community health centers (CHCs), concierge practices, and small aligned groups will proliferate.

6)      Reform  will drastically increase physician legal compliance and potential  liability under federal fraud and abuse statutes.  Enhances funding for enforcement, addititional latitude for “whistle blowers,” and suspension of government’s need to prove “intent” will create a compliance environment many physicians will find problematic.

7)      Reform  will exacerbate physician shortages, creating access issues for many  patients. Primary care shortages and physician maldistribution  will  not be resolved.  Physician will  need to redefine their roles and rethink delivery models  in order to meet rising demand.

8)      The imperative to care for more patients, to provide higher perceived quality, at less cost, with increased reporting and tracking demands, in an environment  of high potential liability and problematic reimbursement, will put additional stress on physicians, particularly those in private practices. Some physicians will  respond by opting out of private practice or by abandoning medicine altogether, contributing  to the physician shortage.

9)      The omission  in reform of a “fix” to the Sustainable Growth Rate (SGR) formula  and of liability reform will further disengage physicians from medicine and limit patient access.  SGR is unlikely to be resolved by Congress and will probably be folded into new payment mechanisms  within the next five years .

10)  Health care reform was necessary and inevitable.  The impetus of informal reform would likely have spurred many of the changes above, independent of formal reform.  Net gain in coverage, quality and costs are to be  hoped for. But the transition will be challenging  to all physicians and onerous for many.”

Conclusion

For physicians, the future is not what it used to be.  For the present,  as revealed by the Physicians Foundation's research, and White Papers, the majority of physicians have responded unfavorably to the passage of health reform and  are experiencing  increased patient loads with decreased financial viability.  They are altering their practices to reduce patient access, and are taking steps to minimize 3rd party influences through  hospital employment, part-time work,  locum tenens,  or concierge practices.  What the future holds no one knows for sure,  nor do we know the fate of Obamacare. 
What follows in this 2ns book in a series on health reform  are  interviews conducted and blogs written over the last five years into insights the Physician Foundation. has contributed to knowledge of the reform process.

Tweet: Private American medical practices are in a state of decline and transition to other models of health care delivery.

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