Readers in New England are familiar with the old adage, “If you don’t like the weather, wait a minute.” The same could be said for reports on the rate of change in healthcare. This week, two reports in one publication contradicted themselves on the trajectory of changes in healthcare and their potential impact.
One report said that healthcare is changing at a rapid pace and as a result, fewer physicians have a true ownership stake in their practices. Another report said that change in healthcare has slowed “steadily” since 2015 and it needs to pick up. Both reports appeared in Forbes magazine. That may seem like a head scratcher at first, but both articles make valid points.
Here’s what is going on.
Fluctuating numbers of independent vs. employed physicians
The Pharma and Healthcare section of Forbes reported that the share of “patient care” physicians with an ownership stake in their practices “…dipped to 47 percent in 2016 compared to 53.2 percent in 2012. Meanwhile, the share of employed physicians jumped to 47 percent in 2016 from 41.8 percent in 2012.” 65 percent of doctors under the age of 40 were employees in 2016, compared to 51 percent in 2012.
The AMA’s analysis on practice arrangements attributes the change to the increasing number of larger health systems that are buying up smaller physician groups, individual practices and ambulatory care centers. In the majority of cases, those practices aren’t being absorbed against their will. The analysis shows that physicians are taking jobs with larger healthcare groups – or selling their practices to those systems outright – for financial benefit and protection:
- Stronger reimbursement negotiation positions with payors
- Added capital for IT improvements they might not otherwise be able to access
- Access to larger patient populations
- Easier compliance with quality mandates
Larger systems are also more apt to lend additional muscle in billing, coding and revenue cycle management. As the trend toward outsourcing these functions increases, large systems can choose RCM partners that offer best practices.
On the other hand, change in healthcare is slowing down
Meanwhile, the leadership section of Forbes offered a contradictory view. It said that the pace of change in the healthcare industry has “… slowed steadily since 2015.” As evidence it published a survey by Bain that seemed to lament the fact that change has slowed. It found that engaging doctors and bringing them back into the decision making process would “create greater momentum for change” and “lead the industry forward”. Talk about a head scratcher.
We thought that healthcare professionals had wanted change to slow down for a while. However, the confusion clears when you review the details of the report. The doctors surveyed aren’t talking about change “for change’s sake”, they are talking about change for the better.
- Doctors are worried about the quality of care, with 65 percent indicating it will be more difficult to deliver quality care over the next two years.
- They are also skeptical that new models can improve the quality of care. 73 percent prefer a fee-for-service model over value-based care, in which payments are based on quality and outcomes.
Doctors are also increasingly unhappy with where they work. They may be employed in increasing numbers, but they aren’t necessarily happy about it. When the survey asked doctors if they would recommend their organization as a place to work:
- In physician-led organizations, 35 percent said yes
- In management-led organizations, only 11 percent said yes
The point is this: engaged doctors in physician-led groups are more satisfied and more willing to lead change (50 percent), than those in management-led organizations (43 percent).
So what’s the truth?
At the bottom line, we think this is one more indication that physicians are tired of crunching administrative tasks. We think that physicians are exhausted and increasingly burned out from wading through the daily mire of coding, billing and chasing reimbursements necessary to keep a practice alive.
If doctors want to be more engaged to pave the way to better healthcare, they’ll need workflow automation support systems that take those RCM headaches off their desks.