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Primary Care Docs Average More Hospital Revenue Than Specialists

John Commins, for HealthLeaders Media, May 20, 2013

"It's one more example of the changing balance of power from specialist to primary care, whether you see that as market driven or regulated or however you see that happen," Singleton says. "But as government and payers start to favor that gatekeeper—more preventative primary care practice of medicine—we are going to continue to see these primary care providers ascend over specialists, at least on an average basis."

Singleton says the shift is largely due to the migration of primary care physicians away from private practice and toward the employed model.

"We recognize that the majority of this bump is because more of their physicians are employed now so there is greater control," he says. "These health systems have formulated these vast employee networks and it is no secret that an employed physician is going to be much more apt and even directed in some cases to push a lab or a test or a procedure or a referral down the hall and not down the street. They aren't going to send it to an independent imaging group or an independent lab like they used to. In essence that is not really creating new money. That is just pulling that money within the hospital walls."

"As the primary care physician evolves into this quarterback of the medical home model and if they truly do what they are being designed to do, which is to control the entire flux of that patient, in theory they would dictate what tests happen and what procedures are necessary, what specialist are brought in, what preventative care or home health measures are used," Singleton says.

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4 comments on "Primary Care Docs Average More Hospital Revenue Than Specialists"


RB (5/21/2013 at 12:49 PM)
Misleading conclusions, I agree. One conclusion I drew without knowing more facts than published in this article is that primary care doctors order more tests compared to specialists who perhaps practice more cost-efficient medicine. I'm a cardiologist and once, in a past life employed at a local hospital, I was told during my review that I didn't order enough echoes (based on what they expected when they hired me). Not every heart problem requires an echo to diagnose or treat.

Mary O'Brien (5/20/2013 at 3:04 PM)
"We recognize that the majority of this bump is because more of their physicians are employed now so there is greater control," he says. "These health systems have formulated these vast employee networks and it is no secret that an employed physician is going to be much more apt and even directed in some cases to push a lab or a test or a procedure or a referral down the hall and not down the street. They aren't going to send it to an independent imaging group or an independent lab like they used to. In essence that is not really creating new money. That is just pulling that money within the hospital walls." This comment also raises the issue that all these ancillary services being driven into the hospital setting by employed physicians will increase the cost of health care . The same service performed in the outpatient settings of independant providers are in most cases much more cost effective than when performed in the hospital setting.

P.Yadav (5/20/2013 at 2:16 PM)
Acquisition of small practices by bigger hospitals is the norm leaving the combined revenue unquestionably greater. It is important to point out that it takes a lot (time,energy,capital,risk)to establish a specialty clinic/practice hence, fewer available for acquisition. Most specialists like to work as employees from the beginning of their career. The difference in revenue may have to do more with market forces playing out than the so mentioned automatic shift of power towards PCPs in healthcare. I agree with the comment above- Several questions are left unanswered like how the revenue was calculated, did it include the referral cut for in hospital PCPs?