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Physicians Shut Out of ACOs Seek to Merge Practices

Greg Freeman, June 12, 2013

Physicians are challenged now because they have so much on the line but so few clear paths from which to choose, he says.

"Healthcare reform is literally upon us, with certain portions already in effect, and there is a lot of experimentation going on at this point," Halley says. "If you've seen one accountable care organization, you've seen just that—one. It will be very interesting to see how many of them actually turn out to be financially viable."

One thing is clear, however. Reimbursement for physicians is going to be lower in the future.

"There is no scenario in which we see reimbursement going up. The federal government is very clear, state governments are going bankrupt, and they're all worried about the fact that we have many more enrollees under the Affordable Care Act that will come on to the Medicaid rolls," Halley says.

"Regardless of the shenanigans on Capitol Hill and whatever else goes on, reimbursement is going to go down and we know we're going to have to do more for less. Not just what we're doing now, but more for less."

Healthcare also is increasingly under the microscope for regulatory compliance. The cost of compliance for a medical practice continues to rise, Halley says, and many physician practices are not even aware of some of the requirements.

The aging population and the wave of retirees also is changing the future for physician practices. For the next two or three decades, baby boomers are going to play a major role in healthcare in terms of demand, Halley says. As a group, those retiring baby boomers tend to expect more from healthcare providers and are willing to spend more for what they want, he says.

"Those factors—decreased reimbursement, increased expenses, and increased demand for services—will be what we call the perfect storm as we move forward in this healthcare arena," Halley says. "Healthcare reform will determine how we get paid, but those other factors are still the main drivers in healthcare."

Choose your path carefully
The right choice for your practice, if you decide that any move is necessary, will require careful analysis of the options available to you and the particular factors that are important to your success.

"Depending on the specialty of the physician, you may move in a certain direction," Fanburg says. "If you're a specialist, you'll want to keep an eye on where your primaries are going. If the primaries are forming a large group, then either you can join that group as a specialist or you can form a specialty group and still receive those referrals. A lot of that will depend on your particular specialty and how you interact with other practices, how you get most of your referrals."

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