ARTICLE
The CEO of a large health care network stated: “Market forces don’t apply to healthcare.” Of course, economic and political forces apply to healthcare. Big Medicine’s most powerful entities (insurers, hospitals, medical schools, pharmaceutical companies, pharmacies, and government agencies) formulate health care policy to enrich themselves at the expense of patients and small, independent medical practices. Small physician practices are being devoured by big medical practices, a trend that improves large practices' negotiating positions with insurers. Hospitals buy practices to extend and defend turf. Insurers reimburse small practices (and some professions) at lower rates than large groups. These actions are driving small, independent medical practices out of business at an alarming rate. The CEO went on to argue that limiting patient choice will decrease costs and improve quality. But consolidation has not resulted in lower prices, higher quality, or better care experiences. The maineffect of consolidation is to increase market power, which is used to extract higher prices from payers and to prevent any efficiencies from being passed on to consumers. Consolidation works for some industries, but not for others. Medicine is not a shopping emporium, Medicine is personal. Large medical practices rarely offer patients the convenience, prompt service, and personalized approach they deserve and Americans are worried that the trend toward Big Medicine will be costly and jeopardize their health. A 2018 survey showed that: 69% favor Congressional action to limit consolidation of healthcare 60% view purchasing of independent practices as a threat to affordable care 25% saw consolidation as a direct threat to their health Medicare’s soon-to-be-implemented value-based reimbursement program will penalize 87% of solo practices whereas most large practices will be rewarded, and in a “Robin Hood in reverse” move, a large insurer makes quality incentive payments based on the number of members meeting goals with a big caveat. If the number of patients in a quality measure is under 10, the practice earns only 25% of the money paid to a practice with 30 or more patients in a measure! This discriminatory program costs family doctors and small practices hundreds of thousands of dollars annually. That insurer’s chief medical officer, candidly admitted that the policy is intended to encourage small practices to join larger groups. Small practices are better for patients. A 2014 study showed that small practices provide a greater responsiveness to patient needs at a lower average cost per patient. Patients trust independent physicians more than employed doctors. Small practices are better for doctors. Independent physicians are less likely to experience burnout. Small practices have deeper relationships with their patients. Doctors in small, independent practices are happier and report greater professional satisfaction. Small, independent practices will not survive without a profound shift in the regulatory climate. To ensure fair compensation, promote competition, and protect patient choice, policies must include: 1. Primary care payment rates for small, independent practices at parity with large groups. 2. Decreased regulatory burden. 3. Investigation of hospitals who engage in coercive monopolies, forcing patients to use services within their system, thereby denying patient choice. Small, independent practices offer patients cost-effective, high-quality, and personalized healthcare. If the choice of personal medical care offered by small, independent practices is to be preserved, the rules of the game must change. *Source: https://www.medpagetoday.com/blogs/kevinmd/78975
The CEO of a large health care network stated: “Market forces don’t apply to healthcare.” Of course, economic and political forces apply to healthcare. Big Medicine’s most powerful entities (insurers, hospitals, medical schools, pharmaceutical companies, pharmacies, and government agencies) formulate health care policy to enrich themselves at the expense of patients and small, independent medical practices.
Small physician practices are being devoured by big medical practices, a trend that improves large practices' negotiating positions with insurers. Hospitals buy practices to extend and defend turf. Insurers reimburse small practices (and some professions) at lower rates than large groups. These actions are driving small, independent medical practices out of business at an alarming rate.
The CEO went on to argue that limiting patient choice will decrease costs and improve quality. But consolidation has not resulted in lower prices, higher quality, or better care experiences. The maineffect of consolidation is to increase market power, which is used to extract higher prices from payers and to prevent any efficiencies from being passed on to consumers. Consolidation works for some industries, but not for others. Medicine is not a shopping emporium, Medicine is personal.
Large medical practices rarely offer patients the convenience, prompt service, and personalized approach they deserve and Americans are worried that the trend toward Big Medicine will be costly and jeopardize their health. A 2018 survey showed that:
69% favor Congressional action to limit consolidation of healthcare
60% view purchasing of independent practices as a threat to affordable care
25% saw consolidation as a direct threat to their health
Medicare’s soon-to-be-implemented value-based reimbursement program will penalize 87% of solo practices whereas most large practices will be rewarded, and in a “Robin Hood in reverse” move, a large insurer makes quality incentive payments based on the number of members meeting goals with a big caveat. If the number of patients in a quality measure is under 10, the practice earns only 25% of the money paid to a practice with 30 or more patients in a measure! This discriminatory program costs family doctors and small practices hundreds of thousands of dollars annually. That insurer’s chief medical officer, candidly admitted that the policy is intended to encourage small practices to join larger groups.
Small practices are better for patients. A 2014 study showed that small practices provide a greater responsiveness to patient needs at a lower average cost per patient. Patients trust independent physicians more than employed doctors.
Small practices are better for doctors.
Independent physicians are less likely to experience burnout.
Small practices have deeper relationships with their patients. Doctors in small, independent practices are happier and report greater professional satisfaction.
Small, independent practices will not survive without a profound shift in the regulatory climate.
To ensure fair compensation, promote competition, and protect patient choice, policies must include:
1. Primary care payment rates for small, independent practices at parity with large groups.
2. Decreased regulatory burden.
3. Investigation of hospitals who engage in coercive monopolies, forcing patients to use services within their system, thereby denying patient choice.
Small, independent practices offer patients cost-effective, high-quality, and personalized healthcare. If the choice of personal medical care offered by small, independent practices is to be preserved, the rules of the game must change.
*Source: https://www.medpagetoday.com/blogs/kevinmd/78975