The old order is fading and a new order is starting to take its place. That new environment will reshape medical practice in ways that can be only glimpsed at present. But here are a few predictions for 2011.
Insurance companies are unlikely to have much more impact on spending growth than they’ve had for the past few decades. The real question about insurers’ role in health care is why they’ll be needed if providers can form organizations that are accountable for the cost and quality of care.
Many doctors try to help out patients who can’t afford to pay the full amount for an office visit or the copay for a pricey medication. Now along comes a study suggesting that physicians in one Texas community treat patients differently, depending on whether they are on Medicare or have private insurance. The study in Health Affairs re-examines the health cost data from McAllen, Texas.
A staggering 40 percent of physicians say they plan to leave patient care within the next three years, according to a recent poll by the Physicians Foundation. That spells big trouble for healthcare reform and for medicine in general. If even half of that number of doctors retire, find administrative positions, or leave healthcare entirely, we’re going to have medical assistants taking care of patients and the remaining doctors tearing out their hair in frustration.
The studies are coming thick and fast on the dismal state of safety in American hospitals. It’s clear that little if any progress has been made in the decade-plus since the Institute of Medicine released its alarming report on medical errors, “To Err Is Human.” Yet our leading medical societies are relatively mute on the issue, while being quite vocal on the need to reform malpractice liability. Perhaps tort reform is a prerequisite for real progress on safety, but I think much more is involved.
Hospitals need not control ACOs. There are clinically integrated IPAs and PHOs that could easily become ACOs, and 50 to 75 other physician-led organizations are on the same path. Among these entities is the Beacon IPA of Manhasset, NY. Formed last summer, the IPA already has about 200 physician members, and the IPA’s long-term goal is to become clinically integrated and ready for whatever healthcare reform brings, including ACOs.
The AMA’s new policy on accountable care organizations (ACO) will undoubtedly please many physicians, but it doesn’t recognize the reality of the market or of healthcare reform. Once again, it shows how unprepared the leaders of medicine — and many of their followers — are for the massive changes that lie just ahead.