It will be a long time—if ever—before the healthcare system moves completely to value-based purchasing, according to a panel of experts at AMN Healthcare’s workforce summit last week in Grapevine.
Dr. Peter Plantes, chief executive officer of Houston-based Christus Provider Network, estimated that physician compensation based on production could move to as low as 70 percent, compared with about 95 percent currently.
John R. Thomas, chief executive officer of Irving-based MedSynergies, said VBP is too “touchy feely” to accommodate the reality of healthcare economics, which he said requires practicing physicians to see patients to be paid.
Richard Johnston, MD, executive vice president of Irving-based USMD, said future physician compensation could be based more on panel size. He said an efficient care team of two physicians, two physician assistants, and three medical assistants could handle 5,000 patients, or about half that number of high-acuity Medicare Advantage patients. If physicians handled smaller panel sizes, they might be paid less, he said.
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Plantes said there is a sense of déjà vu between managed care in the 1990s and current delivery reform. The difference is that there is a greater emphasis now on evidence-based care and electronic health records have improved significantly, he said, which will inevitably lead to consolidation.
“There are thousands of health plan approaches right now,” he said. “They won’t be there later. Instead of jumping into chaos, we [at Christus] are concentrating on how we can build our care structure and develop leadership tools. About 85 percent of reimbursement is on sick care, not accountable care. The question is how we keep things going until we get [to VBP].”
Thomas said physicians began seeking “a safe harbor” during the 2007-2009 recession. Physicians needed $300,000-$500,000 to start a practice, and they found it difficult to borrow money to do so. Instead, they turned to health systems, payers or larger practices to merge or be acquired to reduce financial risk and maintain income.
“It is becoming clear whoever aligns with physicians owns the market,” he said. “That’s where the patients are.”
The panelists acknowledged there are significant obstacles to physician-hospital alignment.
Plantes said there are cultural communication barriers. He said health systems need to identify physicians who have a broader sense of business issues who can work with nonclinical administrators. On the other hand, he said there are many healthcare executives who do not know how to work with physicians. Plantes said he has never worked in a system where there is a true leadership parity between doctors and administrators.
Johnston said 70 percent of Texas physicians work in practices of five or fewer physicians, and tend to be independent-minded.
“The last thing they want to do is become employees,” he said. “In your own practice, you can control your compensation. But reimbursement rates have not increased in 10 years, and you can’t staff an office like you did 10 years ago. It’s become more complex.”
Asked to describe the healthcare system five years from now, Plantes said there will be a significant percentage of physicians retiring.
“There is going to be a group of doctors [with stock portfolios that have recovered from the recession] who are going to look at the system and say, ‘I didn’t sign up for this.’ ”
Johnston said he believes providers will take on risk to the point that insurance companies will serve only as claims administrators. He also foresees a lack of physician labor.
“We have lots of primary care doctors in their 60s working 60 to 80 hours a week, and they are ready to check out,” he said. “The new doctors want to work 32 hours. In negotiations [with job prospects], we are hearing a desire for part-time, job sharing, no weekends, and no on-call duty. No one talks about how each new doctor is .6 or .5 of what is being replaced.”
Date: November 18, 2013