How Healthcare Will Change

October 19, 2010

It's been a wild year in healthcare. And you ain't seen nothing yet.

The year that's almost over was a miserable one in many ways, but for better or worse it was also the most important year for American doctors since the passage of Medicare in 1965.

The life of a typical U.S. physician, especially in private practice, is about to change fundamentally. How? Here are some of my predictions:

Solo doctors will become about as common as payphones. I'm not predicting the total obsolescence of the solo physician, as some observers are. But the economic forces squeezing solo docs will force almost all of them to sharpen their business plan or choose another mode of practice. (Our Physician Compensation Survey, this month's cover story, helps clarify the nature of those forces.) Those who chose a solo life simply because they like doing things their own way will, in the next five years, align with a group practice, get a job with a hospital or some other institution, or retire. A lot of solo docs are just trying to keep their heads above water by doing what they've always done - only more, faster. That's a sucker's game, and it's the 9th inning.

Yet some solo doctors will thrive because they will have forged business models that capitalize on their independence and the value it brings to patients. These doctors will have made their solo status an important part of what they bring to the table, and they will figure out how to get paid for it. Think concierge practices, house-call docs, and niche specialists.

We are not headed for a McHealthcare world. Worried that giant, hospital-owned "integrated delivery systems" will shortly become the only places for physicians to work, with no more than two or three such systems in any given market? Don't be. Yes, size does bring economy-of-scale advantages but too much size also brings its own kind of inefficiencies. Mega-systems will surely grow (and have been growing), but I doubt they'll ever fully dominate healthcare delivery. There will still be a place for mid-sized practices with fewer than 100 physicians. People still want relationships with their doctors.

Value will become the new buzzword in U.S. healthcare. Physicians will be expected to demonstrate their individual value to practices, and practices to hospitals - and everyone to payers and to the government. Value is the answer to the question of whether a service is worth its cost. Americans typically rely on free markets to answer such subjective questions, yet healthcare is resistant to normal market forces because of the way its enormous costs are diffused between consumers, employers, and the government. But the health reform legislation will impose, heavy-handedly perhaps, new ways of measuring physician performance and tracking patient progress. We can argue about whether this is a virtue of reform or a flaw. But the era of endless physician monitoring is about to begin.

Forget EHRs. The new Holy Grail in health IT is mobile technology.
OK, don’t forget EHRs. You still need one if you don't yet have one. But I think almost all practices will get an EHR in the next five years or merge with one that has a system in place. (Sorry, holdouts. You fought a good fight, but it's over. It's like Facebook: There's a point at which resistance is futile, and we're there now.) The next big thing: the development of tools that connect patients, doctors, information, and service in one continuous loop regardless of physical location. I'm not sure what that will mean in real terms. But anything you're doing that doesn't absolutely, positively demand co-location by you and your patient is something that someone, somewhere is working on a way to allow you to do remotely.

The year is almost over, and I'm not sorry to see it go. Let's hope the next one is better.

Bob Keaveneyis the editorial director of Physicians Practice. What are your predictions for the future of healthcare? Tell us in the comment field below.

This article originally appeared in the November 2010 issue of Physicians Practice.