Blog post by Colin Hung.
This week I am attending the annual Medical Group Management Association (MGMA) annual conference in Boston. I really love coming to this event as it provides a unique perspective on the world of physician practices – and area of healthcare that often gets overshadowed by hospitals. Since I will be hosting the chat from here in Boston, I thought it would be interesting to have a chat on physician practices.
One of the biggest trends over the past decade is the consolidation of physician practices by larger organizations. According to a report by the Physicians Advocacy Institute (PAI), 5,000 physician practices were acquired by hospitals for the 12 months spanning July 2015 to July 2016. This growth means that as of July 2016, 29% of physician practices were owned by hospitals. During that same period, the number of physicians employed by hospitals grew by 14,000 in the US, bringing the total to over 155,000. That is a 63% increase from the 95,000 hospital employed physicians in 2012.
There are many reasons why this trend will continue for the foreseeable future. From the hospital perspective, acquiring physician practices allows them to offer highly specialized care to more patients. It also helps to keep referrals within the system. From the practice perspective, being part of a hospital system means access to capital, better IT infrastructure (usually) and better pay (on average). It is important to note that there has been increasing financial pressure on practice owners as changes to reimbursements have eroded margins over the past several years.
The positive impact on hospitals and practices seems clear – although it is worth pointing out that integration of new practices can be a long and difficult when acquisitions are not done properly – but the impact on patients is murky. In some cases, according to a post by MedCity News, prices actually increased for patients in the California region even though the hospital supposedly benefitted from cost savings from the acquisition.
A general study by NCCI on hospital consolidation found the same price-increase phenomenon.
However, not all is gloom and doom in the practice world. Commoditization of healthcare technology has made it easier for practices to deploy the applications that make them more efficient and improve overall patient experience. Secure texting, tablet check-in, electronic forms and online payment systems can all be purchased by practices for as little as a hundred dollars per month.
There is also a fierce loyalty that practice owners and managers have to their communities – especially outside of major cities. Here at MGMA’s annual event, I have had the opportunity to speak with many practice managers, and it is very easy to see the passion that they have for helping their neighbors. It is refreshing to see.
So what does the future of physician practices look like? According to Eric Topol, we will soon be heading to doctor offices to collaboratively review a mixture of patient-generated data along with traditional clinical data. In a Forbes article, Topol states
Tomorrow’s visit will include objective, high frequency and real-time streaming data, including blood pressure, glucose levels, activity levels, diet, and social engagement metrics. As many visits will be remote, the physical exam will approach a medical selfie. Smartphone attachments, some of which are already cleared by the FDA, will help perform the physical exam, including taking vital signs, listening to heart sounds, and visualizing ear drums with greater clarity that will enable clinicians and patients to see what was previously invisible to them. Tomorrow’s office visit will be separated by time and space. Asynchronous health communications (e.g., text) will increase. Patients will update their health and pose questions, and clinicians will provide responses and educational content in reply.
Sign me up!
I just hope that all this wonderful technology that Topol envisions helps all members of a practice gain back time in their day – time that they can use to connect with patients on a more personal level. It would be wonderful if we could return to the medicine of the early 20th century where doctors knew the life situation of all their patients and were not rushed to exit them from their office yet have all the benefits of modern 21st century medical technology. That would be my ideal practice of the future.
Join me Tuesday October 2nd at 8:30pm ET (for your local time click here) as we explore physician practices. I’ll be joining you from the MGMA annual event in Boston.
- T1 If you had a choice, would you prefer an independently-owned physician practice or a hospital-owned one? Does it matter?
- T2 Does technology play a role in your satisfaction with physician practice? Ie: the availability of or lack of secure texting, communication via email or a portal?
- T3 What factors should a practice owner consider when debating between investing in new technology vs investing in more people/training to get the job done?
- T4 In your opinion, what does the physician practice of the future look like? What technology is deployed? How are patients treated?
“Updated Physician Practice Acquisition Study”, Physicians Advocacy Institute, March 2018, http://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/2016-PAI-Physician-Employment-Study-Final.pdf, accessed 30 September 2018.
“Evaluating the future of hospital acquisitions of private practices”, Medical Economics¸25 September 2017, http://www.medicaleconomics.com/medical-economics-blog/evaluating-future-hospital-acquisitions-private-practices, accessed 30 September 2018.
Bishop, Tara F. et al. “Trends in Hospital-Ownership of Physician Practices and the Effect on Processes to Improve Quality.” The American journal of managed care, 22 March 2016, https://www.ajmc.com/journals/issue/2016/2016-vol22-n3/trends-in-hospital-ownership-of-physician-practices-and-the-effect-on-processes-to-improve-quality, accessed 30 September 2018.
Gold, Jenny. “As health systems acquire physician practices, what’s the impact on healthcare costs?” MedCity News, 11 September 2017, https://medcitynews.com/2017/09/health-systems-acquire-physician-practices-whats-impact-healthcare-costs/, accessed 30 September 2018.
“The Impact of Hospital Consolidation on Medical Costs”, NCCI, 11 July 2018, https://www.ncci.com/Articles/Pages/II_Insights_QEB_Impact-of-Hospital-Consolidation-on-Medical-Costs.aspx, accessed 30 September 2018.
“When Healthcare Providers Consolidate, Medical Bills Rise”, KelloggInsight, 1 February 2018, https://insight.kellogg.northwestern.edu/article/when-healthcare-providers-consolidate-medical-bills-rise, accessed 30 September 2018.
“Hospital M&A: When done well M&A can achieve valuable outcomes”, Deloitte and Healthcare Financial Management Association, 2017, https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-hospital-mergers-and-acquisitions.pdf, accessed 30 September 2018.
Blumenthal, David. “Do Small Physician Practices Have a Future?”, Huffington Post, 27 May 2017, https://www.huffingtonpost.com/david-blumenthal/do-small-physician-practi_b_10150100.html, accessed 30 September 2018.
Ahlgrim, Zach. “What’s Killing Private Practice?”, Clinician Today, 5 January 2017, http://cliniciantoday.com/whats-killing-private-practice/, accessed 30 September 2018.
Dorsey, Ray and Topol, Eric. “Here’s What Your Future Doctor Visits Could Look Like”, Fortune, 2 May 2017, http://fortune.com/2017/05/02/brainstorm-health-2017/, accessed 30 September 2018.
Old Doctors Office Panorama Glow – Matthew Paulson – https://flic.kr/p/bCU3Ut