Whether it's called "healthcare reform" or "Obamacare," the multi-year march toward an overhaul of the nation's healthcare delivery system begins this week. Thoughtful people may agree to disagree on the merits of the Patient Protection and Affordable Care Act signed into law six months ago. But the effects it will have on physicians, hospitals, and payers will be stressful for all. Expect some discomfort.
An in-depth analysis published this month by the Intelligence Division of HealthLeaders Media examines the relationship between physicians and hospitals at a critical moment. Healthcare leaders were surveyed for the report just before the first provisions of the new law were about to take effect, while anticipation and speculation about the reform provisions were in high gear.
Those surveyed had one big number on their minds: 32 million. That's the number of people expected to be newly insured between 2014 and 2016 as a result of Medicaid expansion and federally subsidized insurance coverage through soon-to-be-mandated health exchanges.
Here's where the discomfort sets in. Nearly half of the healthcare leaders surveyed in the HealthLeaders Intelligence Report, Physician Alignment in an Era of Change expect that the increased numbers of insured patients will strain hospital-physician relations. Twenty-two percent said it will have no effect, and 35% said more patients will improve relations. (Why they thought so is a topic for another day.)
"In my view, these differences simply reflect the fact that some see seismic change as a tragedy and others see it as an opportunity," says Craig E. Samitt, MD, lead advisor for the Intelligence Report.
Indeed, one survey respondent noted that "collaboration between hospitals and physicians will be the only way to survive." I would add payers to that pair. Payers—both public and private—are an integral piece of the healthcare system and must be part of any reform-related collaboration.
It's not just the volume of patients that will strain the system. More patients means provider organizations need more physicians, and hospitals and systems are willing to fill the void by employing, acquiring, or contracting as necessary. Over the next 12 to 36 months, 74% of hospital leaders surveyed said they plan to employ a greater number of physicians. Many MDs are already seeking employment, while news of physician groups being acquired is now a regular occurrence.
Change, of course, begets change. Under PPACA, there will be shift away from the fee-for-service model, and providers will be tasked with delivering better care at lower costs. Figuring out how to do that is another pain point, and the work is just getting underway. The patient-centered medical home model and accountable care organizations, may deliver on both fronts, but are largely untested.
Samitt, for one, who is president and CEO of Dean Health System in Madison, Wisc., believes ACOs could facilitate increased collaboration, better patient outcomes, and a better value.
And Paul Keckley, executive director, Deloitte Center for health Solutions wrote in a memo this week: “It’s plausible to believe that alignment of physicians, hospitals and long-term care providers into local integrated delivery systems, a shift from volume to outcomes-based payments and adoption of a national standard of care based on evidence might bend the curve. Time will tell."