Cavale notes the public’s employers need to listen up and take action, as “the consumer is not really the consumer of care. They’ve delegated that option to their employers. … You must pay attention as an employer.”

This means performing due diligence when shopping for healthcare, says Madden, which she claims many employers don’t do. “You have a lot of employers just trying to keep costs low, and not really paying attention to quality of care. They leave it up to insurance companies. There needs to be a much bigger awareness of what are you buying and why you are buying it. It’s not a valuable proposition just because you saved $10,000 on Aetna over Cigna. [With employers and employees] working together, you’d be surprised how effective it is with insurance companies. It really forces their hand.”

How low will it go?

If trends continue, reimbursements will theoretically hit bottom in a few years, akin to an asteroid striking Earth while the dinosaurs munched happily on flora, fauna, and each other. “We’re in a changing world right now,” says Breeze. A growing movement of physicians are soliciting large groups and hospitals, looking for a stress-relieving salary payment structure, for example. Something’s gotta give, and soon.

Will we move to a single-payer system? Hard to say, although even if we do, “the devil’s in the details,” says Fabrizio, and implementation would take years. He suggests that only a major political shift will cause any major change in the current reimbursement slide. “There has to be changes by all the constituents. Unfortunately, I don’t see any movements to have everyone talking at the same table — the AMA, physicians’ groups, no one.”

Shirley Grace is a senior writer for Physicians Practice. She can be reached at sgrace@physicianspractice.com.

This article originally appeared in the January 2008 issue of Physicians Practice.