Primary-care physicians have been riding shotgun quietly in the buildup to population health and accountable care. They've watched health systems prepare by stocking up on specialists or otherwise aligning to contract and care for broad swaths of the population. Soon though, primary care will be in the driver's seat.
With foresight and planning, I believe it is possible to utilize strategic alignment imperatives that will position primary-care physicians for future success. But first, in order to look forward, we need to look backward.
The rear view mirror
Primary-care physicians should be aware of two phenomena of import:
1. Most health systems lose money on the specialists they employ. Health systems have been willing to take short-term losses on physician practices as part of their longer term strategies.
2. Concurrently, physician referrals to other physicians have increased more than 94 percent over the past decade. Put another way, a patient is almost twice as likely to be referred to another doctor today.
These seemly conflicting phenomena may seem counterintuitive, but in healthcare, health systems have leaned on their primary-care physicians to refer to specialists. Specialists order tests, specialists do procedures — in the current fee-for-service world, specialists generate revenue by "doing."
As accountable care takes hold, health systems may jettison superfluous specialists or those that do not play well in the cost-conscious world of population health. Health systems likely will discourage referrals that drive up costs without providing an offsetting value. Remember, quality is doing something well; value is doing something well and consistently achieving expected outcomes within competitive cost parameters. There's a big difference, and being a high-quality specialist may not be enough in the future.
Primary-care physicians will find themselves in the driver's seat as population health management gains momentum. Accountable care cannot and will not be even marginally successful without strong primary-care leadership. Disease management and population management initiatives, including patient-centeredness and judicious referrals, will be important. Primary-care physicians can position themselves for success if they work with specialists who do the following:
1. Listen. Look for specialists who listen to and hear what both your patients and you are saying. Renegade behavior will not cut it.
2. Collaborate. Look for specialists who make time to discuss your patients, offer innovative and collaborative ideas for better patient management, and are willing to modify their behavior as the healthcare environment changes.
3. Treat conservatively, yet proactively. Avoid specialists who follow a "cut once, measure twice" mantra. A stepwise treatment plan aimed at avoiding or preventing unnecessary costs will be important.
4. Adhere. All of us (specialists, primary care, and health systems) will be expected to embrace and adhere to evidence-based medicine. Look for specialists who understand and work within the guidelines within their respective areas.
5. Please and inspire. Patient satisfaction will loom larger in the years to come. Look for specialists who inspire their patients to take better care of themselves.
6. Measure. Finally, look for specialists who track, measure, and report data. Healthcare will be an open book, for better or worse. You will want to align with specialists who can document both the quality and the value of the care they provide.
Yes, we are suggesting you play favorites. The best care for your patients will come from those that work with you and at times for you in providing great care, at a measurable value. Consider in a new light those you entrust to help care for your patients. Specialists who ride shotgun and help navigate while you drive are those you want on your bus.
Lucien W. Roberts, III, MHA, FACMPE, is a Virginia-based writer, speaker, and consultant. For the past twenty years, he has worked in and consulted with physician practices in areas such as compliance, physician compensation, negotiations, strategic planning, and billing/collections. He may be reached at [email protected].