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.”
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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.
How does one “go to the hospital” to see a doctor? Walk in the emergency room? Do hospitals actually have family physicians and GP’s? I thought hospitals only had specialists? How does this work?
In other words, we are going back 2,000-3,000 years in our health care. Either you cannot afford it, or you will be turned down. If you are over 50 your chances of getting major surgeries will go down. It costs more to keep you alive. Younger people, who normally do not need all these things done as older people do as our bodies break down, will pay for it only to not get to use it when then get older. ANYONE stupid enough to think the government is going to take care of you when you get old is simply stupid. The government does not want to take care of a bunch of 65-80’s people. They want us gone. Off the books. Not using up medical services. Not getting social security. Not using medicare. Simply gone and OFF the books.
Most of the new doctors coming in to the Veteran’s Medical Center here in Maine are mid-age doctors who closed their private practices to work for the VA.
My family also have 2 specialists who closed shop and are now on the payroll of hospital groups.
One of my elderly Swedish relatives went blind waiting for cataract surgery. While crying at again being moved down on the list a nurse told her, “Look, you’re elderly, you have no social value. You will never get this surgery.” She became so depressed that she died shortly after. Think of how much money the government saved to give free care to their new Muslim immigrants.
Most doctors are now government employees. Or might as well be, given all the laws and regulations that our “limited” government has put in place for them.
If the govt at 30% of the economy won’t be allowed to grow to 100%, they’ll accomplish the equivalent with regulations.
“Death Panels” are alive and well.
It's the opposite. In the hospitals the doctors come to see you. For example, if you in for a head injury you will be seen by a dozen doctors including a podiatrist. This is a true story BTW. The reason is that each doctor can bill the government (in this case medicare) for the full cost of a visit after spending just 5 or 10 minutes checking the patient. Medicare only pays part of the amount of course, and the medicare supplemental only pays a bit of the rest. But it's better than the alternatives at this point.
The Democrat's plan is working.
A few months ago, I stopped by the office of my late parents' M.D. to say hello to the ladies; they filled me in on the fact that the doc had chosen to forego all the hassles of "private practitioner" (billing, insurance, malpractice, etc., etc.), and that the office gals had to get schooled to do their duties the way the hospital proceeds.
I was thinking we need to go back to pay the doctor when you go to the doctor like when I was a kid. There were no co-insurance payments. You went to the doctor you paid the doctor. Insurance was for catastrophic events.
-— I was thinking we need to go back to pay the doctor when you go to the doctor like when I was a kid. There were no co-insurance payments. You went to the doctor you paid the doctor. Insurance was for catastrophic events -—
Yes. Bit one important difference is that medical technology has become much more complex and expensive.
This can be accounted for with Rand Paul’s suggestion to sell 40-hear health insurance policies, like 25-year life insurance policies.
“Yes. Bit one important difference is that medical technology has become much more complex and expensive.”
The main reason its more expensive is due to insurance. 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
“Yes. Bit one important difference is that medical technology has become much more complex and expensive.”
The main reason its more expensive is due to insurance. 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
After 21 years in “Private Practice” I saw the writing on the wall. I quit and now work in a Hospital. There is NO Private Practice. Has not been for a long time. Obamacare was the breaking point. The practice I left is now having severe financial problems as I knew was coming. I left before the fall.
And the doctor worked for you. You scrutinized the bill. You made the decision about what course to take for treatment.
When the insurance I had through work switched to an HMO, that all changed. I never liked it. The HMO paid for the doctor's visit, but the downside was they determined my treatment.
The new medicine is more about public health than providing for individual differences. A patient is a data point, to be evaluated accordingly.
There was a TV news segment a few months ago about an innovative medical practice that was scheduling annual medical checkups for groups of people. Can you imagine the pressure to get tests and vaccines etc without thinking about it when one is part of the group?
We basically already have “government” healthcare. It’s where most of the money is coming from after being taken at gunpoint from the taxpayers.
-— 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 -—
In a truly free market, third party payments drive up costs, but not that much. Hospitals bill the insurance companies more to cover the costs of non-payers.
“How does one “go to the hospital” to see a doctor? Walk in the emergency room? Do hospitals actually have family physicians and GP’s? I thought hospitals only had specialists? How does this work?”
What I’ve seen locally is doctors going to work for large “health corporations”. There are a few near me operated by Health Quest. They also own 4-5 hospitals in the area. The days of the one man or several doctor practices are disappearing.
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