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Is there hope for independent physicians?

MedMan Jim Trounson hi-resIt’s not easy being a physician in today’s environment.  I especially feel sorry for Idaho doctors in private practice. They are demoralized by superfluous regulations, the cost and hassle of electronic medical records, the threat of litigation, and pressure to solve the healthcare supply / demand imbalance by seeing more patients. Then they see their hospitals hire their colleagues to now compete against them with better insurance company contracts.

Sadly, for the first time in history we now have more physicians who are employed than who own their own practices, according to a recent American Medical Association study.  Idahoans want a medical ecosystem that is diverse enough to include physicians who don’t work for a hospital or large company. They want physicians who have the freedom to refer to any high quality, cost-effective lab, imaging center or specialist.

Help is on the way, oddly enough from Washington, D.C.  I was actually uplifted by a recent pilgrimage to our nation’s capital.  I went there to advocate for improving the lives of independent physicians by reducing regulations and unfair competition.  I wanted to test the anti-regulatory mood of our current administrative and legislative branches.  And I found an audience — including Idaho’s four congressional offices — that was knowledgeable, understanding and sympathetic to the plight of private physicians and the cost of administrative complexity driven by government regulation.

I see a fairer environment unfolding for doctors who want to run their own practices and retain control of their patient-physician relationships.

I asked our friends in Washington just what was being done that would make it easier for private physicians to care for their communities.  Here’s what I heard.

While it will take awhile for the future of Obamacare to play out, relief will come, not from whatever happens to the Affordable Care Act, but from the reduced administrative complexity that had been demanded at the agency level.  Officials at Health and Human Services are quietly looking for ways to help independent practicing physicians.  And Seema Verma, the new Administrator of CMS, the division that oversees Medicare and Medicare, was selected because of her interest in freeing up physicians to focus on patient care.

The Obama years were hard on private docs.  Most notably, the Medicare Access and CHIP Reauthorization Act (MACRA) applied new pressure on independent physicians to enter salaried employment by hospitals to escape federal record-keeping requirements.  However, HHS recently proposed exempting most practicing physicians from the Merit-based Incentive Payment System (MIPS) reporting requirements of MACRA for 2018.  It also proposed reducing the amount of hospitals’ 340B subsidies for drug purchases, which had the unintended consequence of fueling a boom in hospital purchases of medical oncology practices.

And lately CMS ended two mandatory hospital-centric bundling programs that conveyed control over physician incomes to hospitals.  Restrictions are being lifted on the use of  telemedicine and on reimbursement for telehealth.  And “site neutrality” rules are being put into place so independent physicians will be reimbursed as much as hospitals for the same services in the same community.  And expect the Feds to offer independent practice associations financial help in sponsoring Medicare Advantage plans.

The healthcare integration / disintegration pendulum continues to swing.  Independent practitioners are being re-advantaged, perhaps at the expense of hospitals.  Even those hospitals are looking for options, sobered by the economic and PR cost of employing physicians.  Meanwhile physician-controlled medical groups are demonstrating a nimbleness to innovate improved quality while lowering cost, often by leveraging “big data” that has been democratized to be more affordable now for smaller practices.

We at MedMan are of late getting more calls than we have in the past from hospital-owned-groups (we call them HOGs) asking for help as they convert to doctor-owned-groups (DOGs).  I predict a new wave of HOG to DOG migrations.

So yes, there is hope.

Jim Trounson is the president of Boise-based MedMan, America’s first physician practice management company.  MedMan improves physicians’ lives by helping them better manage their clinics. Contact him at Jim@MedMan.com.

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