Managed Care - July 2008 - (Page 23) willing to enter into an employment relationship “Younger physicians are much more interested in where they just practice medicine and they get a finding a job and working a 40-hour week and havcheck every month in return for someone else picking time off to spend with their families,” Jessee says, ing up the headaches of making sure the employ“so they’re often looking for an employment relaees are paid, making sure the insurance coverage is tionship as they start practice.” in place, fighting the hassles with the health plans, all the business aspects that physicians really don’t What’s to come like to do.” The list of reasons for widespread hospital and When physician practices were profitable enterphysician integration is so long that it is easy to forprises, the challenges of small-business ownership get that U.S. physicians are highly fragmented — 52 were worth the effort. But that’s no longer the case. percent practice in groups of three or fewer cliniOver the past decade, MGMA reports, operating cians — and, in many communities, physicians expenses for multispecialty group practices have inand hospitals are at one another’s throats. creased about 65 percent — more than double the Traditionally distrustful of one another, physiConsumer Price Index. cians and hospitals have not held hands in recent Meanwhile, Medicare payment rates are, on avyears as payers have reduced compensation. Rather, erage, up less than 2 percent from 1998. many physicians have sought to increase their inMany private payers base their rates on Medicare come by opening facilities to provide same day surrates, so even though commercial rates are higher gery and other outpatient procedures, competing than Medicare, they are not high enough to make with hospitals. Some physicians refuse to take emerup for cuts from the federal government. gency room call duty, saying they cannot afford “The way physicians compensate for it is the liability risk, leaving hospitals scramby increasing volume, and then the payers bling to provide coverage. have made it harder and harder to increase “There are some institutions where advolume because they put, for example, ministrators see physicians as the problem more prior authorization requirements on and some where physicians see adminisfor imaging studies and so forth” Jessee says. trators as the problem,” says Crosson, de“The physicians are running out of ways to claring that a cultural integration based on generate enough revenue to stay even.” shared decision-making and mutual goals Another important factor is a dramatic is required for hospital-physician integradifference in the values, lifestyles, and protion to be successful. The benefits of an fessional goals of young physicians comPhysicians’ refusal to take call duty actuintegrated provider pared to their older colleagues. McCartie system are evident, es- ally drives hospitals to hire physicians. points out that 53 percent of today’s med- pecially during a drug When neurosurgeons, for example, charge ical school students are female. recall. “Within 15 min- hundreds of dollars for a call shift, hospital The MGMA has found that as a group, utes, we can tell how administrators start looking at other opfemale physicians generate less money for a many patients had tions. “At some point the hospital might as medical practice than their male peers, in that drug,” says David well hire its own” specialists to provide covTaylor, vice president part because of practice styles and in part of CoxHealth. erage, McCartie says. because of their work hours. Meanwhile, he and others see physicians Beyond that, McCartie says, younger physicians as less interested in developing ancillary services, of both genders have different values than their such as imaging or endoscopy centers, as payment older colleagues, which makes them less willing to policies make them less attractive. work the long hours of an older generation. “Where I believe we ultimately will end up is a Whereas doctors of the baby boom took pride in very few small private practices, many more covering three hospitals and in the income and stahospital-employed physicians, and a much more tus symbols that went with a busy successful private coordinated multispecialty model that offers anpractice, younger physicians want more balance in cillary services and controls the referral processes,” their lives. he says. JULY 2008 / MANAGED CARE 23
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