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View Diary: In 'seismic shift,' primary care physicians creating revenue for hospitals (28 comments)

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  •  Specialty reimbursements likely to decline further (9+ / 0-)

    Even for physicians not employed by hospitals, the new models of coordinated care CMS is encouraging will make physician groups more responsible for spending health care dollars wisely.  Specialists won't have control over these payments, except to the extent that they join or contract with groups employing primary care physicians.  Open access to any specialist in a market will decline, as specialists have to become more flexible in pricing and procedure location in order to save money and keep those contracts.  

    The new models of care will encourage increasing resources for outpatient care, coordinated through primary care providers, to keep patients healthier and out of the hospitals.  That's where the money gets saved.  Keeping elective procedures out of hospitals will also cut their costs.  

    To survive, hospitals will have to specialize and/or become primary care aggregators, buying up networks of primary care groups.  They already have competition in this, though, as other health care organizations have the same ideas.

    If you want to cut Social Security, you're not a real Democrat.

    by Dallasdoc on Mon May 20, 2013 at 03:05:37 PM PDT

    •  Thanks for giving us a window on these (6+ / 0-)

      changes Dallasdoc and putting them into perspective.

      We saw this in Austin last year with both of us having colonoscopy/endoscopies down at two different outpatient clinics owned by docs.

      My wife also had a port a cath put in by a general surgeon in a clinic instead of a hospital.

      Last week met a guy in Santa Fe on a hiking meetup who said he was moving his mother to SF from Seattle and into assisted living.  He said he was thus far unable to find a primary care physician for her, and that more than one office had told him that they were not taking new patients because of Obamacare.

      I thought to myself 'wonder if this guy is a tea bagger. '

      I told him that I had read [on DailyKos] that there was a national shortage of primary care docs.

      He was adamant that more than one office had turned her away because of Obamacare.  

      I didn't probe as I was running out of breath on the he was.


      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Mon May 20, 2013 at 03:20:50 PM PDT

      [ Parent ]

      •  divineorder - if his mother is on Medicare (7+ / 0-)

        that's common in the SF bay area. An increasing number of primary care physicians will not take new Medicare patients. Mine stopped five years ago. We have a very good relationship and I believe him when he states that he loses money on Medicare patients, even on a marginal revenue/cost basis. If the mother is on Medicaid (Medical in CA) his task will be even more difficult.

        "let's talk about that"

        by VClib on Mon May 20, 2013 at 04:53:55 PM PDT

        [ Parent ]

      •  He may not have been a teabagger (4+ / 0-)

        ... but the doctors might be.  A distressing number of doctors are just as stupid about the ACA as any other conservatives.

        VClib's speculation that they didn't want to take Medicare patients is probably on the mark.  Rather than admit they're cherry-picking patients, they'll blame Obama.  If it's any consolation, most docs like that will not fare well with the fundamental changes to health care that are coming.  Most of which started before Obamacare.

        If you want to cut Social Security, you're not a real Democrat.

        by Dallasdoc on Mon May 20, 2013 at 06:29:37 PM PDT

        [ Parent ]

    •  Fascinating stuff. (0+ / 0-)

      Thanks for the perspective.

      You should diary your thoughts on all this.

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