Health Reform May Endanger Independent Physician Practices

Healthcare reform will dramatically change how physicians conduct business and likely will mean the end of full-time, independent, private practitioners accepting third-party payments, according to a new report.

Instead, the survey and report commissioned by Boston-based The Physicians Foundation predicts that physicians will become employees, part-time workers, administrators, operate cash-only "concierge" practices, or leave medicine altogether.

"The private practice physician is rapidly disappearing," said Lou Goodman, president of nonprofit The Physician Foundation. "Both market forces and the healthcare reform law are forcing physicians to find new ways of running a practice.  We are extremely concerned about how this will affect patient care."
The report, Health Reform and the Decline of Physician Private Practice, conducted and compiled by physician recruiters Merritt Hawkins, includes results from a national survey of 2,400 physicians, only 26% of whom said they would continue practicing the way they are in the next one to three years. The remaining 74% said they would retire, work part-time, close their practices to new patients, become employed and/or seek non-clinical jobs.

The survey also found that a majority of physicians did not support health reforms, which they believe will increase patient volume while decreasing revenues.
Based on the discontent made plain in the survey and other data, the report's advisory panel, which included seven physicians, also predicts that:

• The federally mandated reforms will have a transformational effect on healthcare delivery, with substantive and lasting change, unlike the "false dawn" of the healthcare reform movement in the 1990s.
• Independent, private physician practices will be largely, though not uniformly, replaced.
• Most physicians will be forced to consolidate with other practices, become hospital employees, or align with hospitals and health systems for capital, administrative, and technical resources.
• Emerging practice models will vary by region, with a proliferation in larger accountable care organizations, private practice medical homes, large independent groups, large aligned groups, community health centers, concierge practices, and small aligned groups.
• Reforms will drastically increases compliance obligations and potential liability under federal fraud and abuse statutes. More funding for enforcement, more whistleblowers, and the suspension of the government's need to prove "intent" will exacerbate compliance issues for physicians.
• Reforms will worsen physician shortages, and will not address primary care shortages or physician distribution issues.
• The demand to care for more patients, with higher quality, less cost, increased reporting and tracking demands, with enhanced liability and reimbursement issues, will put more stress on physicians, particularly those in private practice.
• Congress' refusal to provide a permanent fix to the Sustainable Growth Rate formula will be a disincentive for physicians, who will likely limit patient access.  
• Despite its many problems, healthcare reform was necessary and inevitable and many of the changes mandated by the "formal" reforms likely would have occurred on their own with the "informal" delivery of care, owing to economic and demographic forces.