In the 1990s when hospitals anticipated capitation, they binged on primary care practices. Too many came out of that era with a whopping hangover. Will ACOs merely replicate the worst of the 1990s? Will hospitals gorge on and then disgorge primary care practices?
I'm hoping we can avoid making the same mistakes. There is great potential if we can work together and much misery if we continue our fragmented-silo approach. There are some excellent examples of physicians, health plans, and hospitals working together. Let us learn from them and learn how to avoid the mistakes of the past.
We can't afford to put primary care through another round of what Kathy experienced (below). If we want to build high-performing health care delivery we need good primary care. Good primary care will be more likely when the primary care workforce is supported in their work and not forced into big-box treadmill care. This will happen when the financing of health care aligns with improved outcomes and experience of care and not just doing more and more stuff for money.
It may be hard to believe, but many experts believe the days of the independent family doctor, running a small, highly personal private practice, may be coming to an end. An estimated 2,910 physicians were involved in mergers or acquisitions last year - nearly double the number in the previous year - according to a new report from PricewaterhouseCoopers. via www.midcapadvisors.com, October 22, 2010
To me this is like déjà-vu all over again. The hospitals just want to make sure they are part of the equation. So they are doing the same thing the did in the mid 90’s saying that solo and small practices can’t survive and our lives will be so much better if we let them handle this difficult job for our nonbusiness little brains. I was part of a successful practice in the early 90’s; before capitation fees were ratcheted down to peanuts as well as everything else. The hospital was buying up primary care practices or offering management contracts. WE knew we didn’t want to be owned but the management contract sounded too good to turn down. We were also expanding and needing to build out a new office, etc.
It was a total failure. None of the economies of scale they promised. None of the taking away management issues so we could just practice medicine. Staff were constantly being hired and leaving. We still had management meetings and would be handed 100 page reports of detailed accounting saying “see more people”. Billing dropped to poor performance. Layers of management were added to our practice that we didn’t need and all these new fees assessed. The build out probably cost twice as much as it should have and took months to make every decision.
I don’t see what is happening now as any different. The hospitals know they need to create a new profit center. They don’t want to be left out so they are trying to become the foundation. They are running around pronouncing that this will be our only hope. We don’t have to listen. I don’t see it as being any more successful today than it was 15 years ago. Just keep your fingers in your ears until they go away.
Kathy Saradarian, MD