Hogan Knows

This is a fascinating report that just came out.  It suggests that doctors are responding unfavorably to health reform and that health reform will negatively impact physician private practices.  Curiously, many of health care reform’s prognosticators have focused upon PCPs and private practice as the public policy savior and the ultimate solution to non coordinated care.  Billions in incentives have been created to inspire accountable care organizations, health information exchanges and Medical Home certification for doctors.  Unfortunately, it appears, these initiatives are misguided as PCPs are over-run with new patients without an adequate infrastructure to handle the influx.  Further, these initiatives add a burden to physicians trying to run their practices.  I’ve pasted some highlights of the report below.  Your plan sponsors would likely benefit from becoming informed on this subject.   Jeff

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 accelerate this

evolution in a variety of significant ways.

The Physicians Foundation called upon Merritt Hawkins and an Advisory Panel of healthcare experts

to assess how health reform is likely to affect the ways in which physicians practice in the United

States. This White Paper reflects the results of Merritt Hawkins’ and the Advisory Panel’s analysis.

Meeting over a period of two days, the Advisory Panel delineated some general themes and

projections, concluding:

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 of health reform, both formal and informal, will have a

transformative effect on the healthcare 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 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 will not fit all. Large, Accountable

Care Organizations (ACOs), private practice medical homes, large independent groups,

large aligned groups, community health centers (CHCs), concierge practices, and small

aligned groups will proliferate.

6) Reform will drastically increase physician legal compliance obligations and potential

liability under federal fraud and abuse statutes. Enhanced funding for enforcement,

additional latitude for “whistleblowers” and the suspension of the 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. Physicians will

need to redefine their roles and rethink delivery models in order to meet rising demand.

EXECUTIVE SUMMARY

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 practice. 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 doctors from medicine and limit patient access.

SGR is unlikely to be resolved by Congress and probably will be folded into new payment

mechanisms sometime within the next five years.

10) Health reform was necessary and inevitable. The impetus of informal reform would likely

have spurred many of the changes above, independent of formal reform. Net gains in

coverage, quality and costs are to be hoped for, but the transition will be challenging to

all physicians and onerous to many.

These and other conclusions are examined in more detail in this paper.

Physician Survey

The report includes results of a physician survey conducted by Merritt Hawkins on behalf of The

Physicians Foundation. Some 2,400 physicians who responded to the survey indicated how they

reacted to health reform and enumerated ways in which they may alter their practice plans in the

next one to three years as reform is implemented.

Key findings of the survey include:

1) The majority of physicians responded unfavorably to passage of health reform.

2) The majority of physicians believe health reform will increase their patient loads while

decreasing the financial viability of their practices.

3) The majority of physicians plan to alter their practices patterns in ways that will reduce

patient access to their practices, by retiring, working part-time or taking other steps.

4) Physician practice styles will be increasingly less homogenous. The full-time, independent

practitioner accepting third party payment will largely be supplanted by employed,

part-time, locum tenens, and concierge practitioners.

Complete results of the survey are included in this paper.

The Physicians’ Perspective

Health reform is a large, moving target with multiple working parts. This White Paper focuses on

its potential effects on physician practices. It is intended as a resource that physicians can use to

both consider the implications of health reform and to navigate through the post-reform practice

environment.

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In concert with The Physicians Foundation’s mission, the White Paper also is intended as a forum

for presenting the physicians’ perspective to policy makers, the media and the general public.

How physicians view the practice of medicine, and how they choose to practice, is of fundamental

importance to the quality and access to medical care afforded to all Americans. The Physicians

Foundation is committed to demonstrating the link between a robust, autonomous physician work

force and patient access to the highest quality medical care.

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The majority of physicians believe health reform

will increase their patient loads while decreasing

the financial viability of their practices.

Jeffrey Hogan|Northeast Regional Manager

Rogers Benefit Group

One Forest Park Drive| Farmington, CT  06032

P: 860.606.0370|F: 860.677.5098|C: 860.424.2600

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