Page 10 - Delaware Medical Journal July 2015

PRESIDENT’S PAGE
The “evolution” of physician practices in Delaware mirrors the national trend. The days of Marcus Welby, MD, portraying a solo physician and his solo capable nurse are long gone. Even the number of is dwindling. However, this does not necessarily mean that every physician will be employed by a hospital or health care system. The rise in developing patient-centered medical homes has moved physicians into larger groups
to accommodate the need for multi- disciplinary teams to make a Patient Centered Medical Home (PCMH) successful. This approach is also fundamental to an Accountable Care Organization (ACO) which marries the clinical responsibilities of physicians to their utilization of costs and a payment model. In the Rand studies the payment models for both PCMH and ACO models could incorporate more than
one payment model, whether the model be payment for performance, shared savings, or bundled costs. It is important for physicians to recognize that these are three different payment model types, as the blending of them by payers, including the state, could be confusing. However, the physicians with the greatest satisfaction and sustainability in that particular study were those who moved into group organizations which successfully negotiated with all three payment models.
Interestingly, the Accenture study predicted that for physicians who want
Physicians need to proactively develop the practice that is most successful and sustainable for them. Empowering ourselves with the knowledge to do so may be the real “revolution.”
to remain independent, they will be predominantly using a “subscription- based” payment model which in the Rand studies was categorized as a retainer model and is commonly referred to as
a “concierge” model. This particular model is also on the rise in Delaware.
It allows solo physicians to maintain independent self-employed practices for a smaller group of patients while providing services the patients might be willing to pay for outside of traditional insurance coverage, such as increased access and seeing their physician instead of whoever the time of this survey, there was not quite the shift towards patients assuming the cost of care through deductibles
and increased premiums. Whether this becomes the predominant independent practice model as predicted by the Accenture study is yet to be seen.
In the end, the “new revolution” might mean changing how physicians view that independent practices are still sustainable and that not all physicians need to be employed. However, physicians need to proactively develop the practice that is most successful and sustainable for them. Empowering ourselves with the knowledge to do so may be the real “revolution.”
Nancy Fan, M.D.
President, Medical Society of Delaware
REFERENCES
1. Clinical Transformation: New Business Models for a New Era in Healthcare, Accenture, October 31, 2012.
2. Factors Affecting Physician Professional Satisfaction, Rand Corporation, 2013.
3. Effects of Health Care Payment Models on Physician Practices in the United States, Rand Corporation, 2015.
202 Del Med J
| July 2015
| Vol. 87
| No. 7