Posted on 02/16/2014 7:03:26 AM PST by SeekAndFind
Doctors are leaving private practice to become employees of hospitals, according to this story in the New York Times. The decline in private practice physicians actually began a few years ago when changes to Medicare forced many physicians who practiced individually or in small group offices to make the move to a salaried position in a hospital.
But there is no doubt that Obamacare has exacerbated the problem. The onerous recordkeeping is one big reason why private practice physicians are becoming extinct. Private physicians can’t afford the extra employees to meet the demands of Obamacare paperwork.
Dr, Paul Hsieh explained in a PJ Media series we published on the rollout of Obamacare:
The second component of Big Medicine is the shift of doctors away from independent private practice and towards becoming hospital employees. Doctors face many of the same pressures as hospitals. As eWeek reported, “Doctors are abandoning their private practices to join large health organizations so they can lower their costs and meet government mandates on electronic health records.”
By becoming hospital employees, doctors lose autonomy, but enjoy more regular hours and a more predictable salary. In return, hospitals gain access to a guaranteed supply of patients from their employee-physicians. Last year the Washington Post reported, “[T]he number of physicians who own their firms dropped from 57 percent in 2000 to 43 percent in 2009, and it’s projected to continue falling to 33 percent by 2013.” As oncologist Patrick Cobb recently told CNN, “We have a joke that there are two kinds of private practices left in America. Those that sold to hospitals and those that are about to be sold.”
[...]
In contrast, the shakeup in health care is towards greater — not lesser — consolidation. This is because the government — not patients — will be increasingly in charge of the money. Under ObamaCare, government is projected to account for a whopping 66% of overall health spending. More centralized control of health spending will inevitably mean more centralized control of health care.
Nor is this centralization of health care some “unintended consequence” of ObamaCare. Rather, it is an explicitly desired goal. In 2010, Obama health advisor Nancy-Ann DeParle wrote in the Annals of Internal Medicine that the health law will “accelerate physician employment by hospitals and aggregation into larger physician groups” and that “physicians will need to embrace rather than resist change.”
Whether physicians resist the change or not is beside the point. The precipitous decline of private practice physicians will allow hospitals to jack up their prices — exactly the opposite effect of what the government intended with Obamacare.
The New York Times reports:
Health economists are nearly unanimous that the United States should move away from fee-for-service payments to doctors, the traditional system where private physicians are paid for each procedure and test, because it drives up the nation’s $2.7 trillion health care bill by rewarding overuse. But experts caution that the change from private practice to salaried jobs may not yield better or cheaper care for patients.
“In many places, the trend will almost certainly lead to more expensive care in the short run,” said Robert Mechanic, an economist who studies health care at Brandeis University’s Heller School for Social Policy and Management.
When hospitals gather the right mix of salaried front-line doctors and specialists under one roof, it can yield cost-efficient and coordinated patient care. The Kaiser system in California and Intermountain Healthcare in Utah are considered models for how this can work.
But many of the new salaried arrangements have evolved from hospitals looking for new revenues, and could have the opposite effect. For example, when doctors’ practices are bought by a hospital, a colonoscopy or stress test performed in the office can suddenly cost far more because a hospital “facility fee” is tacked on. Likewise, Mr. Smith said, many doctors on salary are offered bonuses tied to how much billing they generate, which could encourage physicians to order more X-rays and tests.
I can’t believe that this switch is ultimately in the patient’s interest. A private practice physician is independent and the decisions he makes for your care are based on what’s best for you, not what some green-eye-shade hospital bureaucrat thinks is “efficient” or “cost effective.” Those goals are very nice — as long as the patient’s health is not sacrificed in their name.
In the end, I want a doctor making decisions in consultation with me regarding my health. You can’t be sure if that will hold true when all doctors are working for Big Medicine.
And when the whole system is so mucked up no on in their right mind would become a docter?
Give it 10 years the new physicians are being trained for the new system. They will not know another way. It is already over. Some just do not know yet. Those over 40 know. I predict physicians will be forced to take .gov patients and the physicians will eventually be members of a Union living off .gov and griping. Very few will be in Private Practice except those that accept cash only. If I can just make it 9 more years as an employee I plan on doing that to end out my days.. Do not have enough money to do that now..
If she had not been diagnosed and operated the appendix would have ruptured converting a 24 hour stay in the hospital to a 7 day stay for generalized peritonitis, possible abcess sequestration and development, bowel obstruction or worse. I live in Texas 250 miles from Shreveport La. Most people do not have a father who are general surgeons and who has a high index of suspicion for acute surgical abdomens. So……..you conclude what will happen. This taking down the best (not perfect) health care system in the world will cost lives and marked increase morbidity for patients. What a shame.
I would suggest there is a second phenomenon. That is Dr’s, GP’s and specialists, are becoming part of large group practices.
The groups offer economies of scale and can deal with the documentation and billing with more skill and efficiency than a small practice. This trend is not all the fault of Obamadon’tcare and was in process before.
Just as mom and pop stores and established distributors bacame uncompetative, so it is with health care.
And how much it is. Around here as soon as the hospital buys up the physician's group they tack on a "facilities fee" to the bill from the doctor. In the cases I have seen that fee exceeds the charge from the doctor in many cases. And we're not talking about seeing a doctor in the hospital, just sitting in the same waiting room the doctor's office always had now costs over $200.
Yet another way for hospitals to capture more revenue and reduce competition.
That has been going on for years and Obomacare is just the last mortal stab. We have been doing the insurance and .gov paper work for them free for years. That is a consequence of .gov and people in General. Now,with elec medical record costs it is just too much. When I started Practice our overhead was 54% now it in the 70’s% range. Not worth it.
And when 0bamacare causes the hospitals to shut down, or turn into hellholes that no one wants to work, the doctors that abandoned their private patients will be SOL.
Another difference is that telephony technology has become much more complex and expensive and cheap. I mean, who dreamt phones could make and send movies? While it's true that medicine requires personal services, whereas telephony is highly automated, I think it's a mistake to attribute medical cost inflation to technological advances. It's more like, the market system keeps smart phone prices in line, whereas it's totally broken for medical services.
It's damned near impossible to tell what's a fair price for medical services anymore.
For instance, I just got a bill for some blood/urine lab tests. I had seen the doc (at her home office) for a foot infection. She prescribed an antibiotic and, for good measure, whipped out a lab requisition for the local hospital, checked off a bunch of boxes, printed out a list of clinics belonging to the hospital, circled the nearest one, and told me to go in and get stuck and take a piss.
The bill lists over two dozen tests, most costing in the $25-40 range and adding up to close to $1100. My Medicare Advantage company (BCBS) allowed only $108, about 10%. My copay was $20.
The most expensive line item was a vitamin D test, priced at $210. I googled that one and quickly found an independent lab offering the same test for the bargain price of $59. However, the insurance benefits statement allowed a mere $26.77 for that particular test. If your smart phone could perform that test, how much would it cost?
“They will not know another way.”
Except that the cost of med school is still astronomically high. Take it in the shorts going in and coming out.
-— I think it’s a mistake to attribute medical cost inflation to technological advances -—
I just meant that it’s a factor. Medical technology and hospitals have come a long way from when I was a kid, in the 60s.
Obamao’s plan is working, comrades! Eventually all doctors will work for the state run hospital system. The really good ones will be at the private hospitals reserved for the regime.
“-— My Mom is on Medicare so when she goes to our doctor its $175.00 when I go to the same doctor and pay cash its $40.00 -—”
Medicare has what they call Medicare approved payment the Dr bills $175, Medicare then pays the Dr. about $70 this is the approved amount. Your mother will only co-pay 20% of the approved amount which is $14.00. Your mother gets an EOB (Explanation of Benefits) statement from Medicare every 3 months, read those and you will see what I am talking about.
If you mean by that they don't want to spend 20-30% of their time doing paper work and electronic record conversions in private practice, and deal with declining reimbursements and collection problems, and insurance companies shafting them, I agree.
My family and and associates have utilized urgent care clinics since the mid-80s...really no problems to report. Often the physicians are hired right out of private practice or rotated out of hospitalist or PCP clinic positions. Medical scandals in this area have overwhelmingly involved private practice positions over the years, not employees of hospitals. I'm pleased that the urgent care facilities continue offering their services in this area (PNW), can't speak for Louisiana.
But if you decided wrong, you were not seeing ten ads a day for lawyers to get you a lot of money from the doctor for your mistake!
Part of UN Agenda 21 is the reduction of the human population by about 85%. Obamacare will be helpful in that regard.
“Health economists are nearly unanimous that the United States should move away from fee-for-service payments to doctors, the traditional system where private physicians are paid for each procedure and test ....”
FWIW, Canada’s “one-payer” system uses mostly fee-for-service payments to doctors in private practice.
Which is why many doctors decline to accept Medicare patients.
I hear you. Largely agree.
Saw what was coming and quit a hospital-employed practice (primary care IM) about a year ago. Glad I did. Fed up with the changes even then. But am keeping my irons in the fire for now—working part time in a specialty clinic a few shifts per week. Not sure what the future will bring, and I think keeping credentials up to date may provide me useful flexibility when the SHTF. Have you considered Locums?
BTW—largely agree with your analysis of UC clinics. Most around hear staffed with mid-levels. A few are OK. Sorry to hear of your daughter’s experience. Every doc should know when and how to evaluate an acute abdomen. Physical diagnosis 101.
The date should read 02/15/2014—this is not a column from a year ago. The link has the date as 2014.
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