Recently, another columnist on this blog posed a very serious and very pertinent question that the healthcare industry has been facing for some time now. The question relates to how the current evolution and changes of the fundamental healthcare delivery model is gradually moving physicians away from the center focus of that system. This was posed in an article that Mr. Olsen alluded to from The Economist titled, “The Future of Medicine: Squeezing Out the Doctor“. Among other topics, the original article and Mr. Olsen on this blog continued to discuss the impact that technology is gradually having on the way healthcare is delivered, such that today much less of a patient’s primary point of care is exclusively provided by their actual physician.
One of the primary drivers that the original article discusses can be summed up with this quote: ”To treat the 21st century’s problems with a 20th century approach to health care would require an impossible number of doctors”. This is where technology really comes into play, since many clinical and information systems boast their ability to add levels of efficiency and quality to the healthcare delivery process, in a manner that can achieve much greater scale than has ever been done in the past.
As someone that works with hospitals and physician-owned entities everyday and has for a number of years now, I can attest to the challenges that physicians are facing as the demand for healthcare outpaces supply, all of which is happening at the same time that major devaluing of healthcare pricing is causing significant imbalances in the fundamental economic model in which the US healthcare system must operate. Further, working day in and day out at ground zero of the consolidation that is currently happening in healthcare has given me a unique perspective as to the actual impact of today’s evolutionary trends within the industry on the organizations and individuals that actually provide health services. But, aside from the economic fundamentals and the role that technology will play in changing the nature of the physician’s role in healthcare delivery, this discussion has really made me start to consider what another dominating trend within our nation’s healthcare system will have on doctors going forward.
Clinical integration is a broad term that can be used to describe a number of specific trends currently taking place within the US healthcare system; however, in a very general sense, this essentially refers to the consolidation of healthcare services in such a manner that attempts to fill as many of the gaps as possible that exist in the system today. Simply put, there’s strength in numbers, and when the various participants involved in responding to growing demand come together in an efficient and effective manner, the system as a whole is more equipped to deal with the pressures from that demand growth. Or another overly simplistic explanation for this is with the old Indian parable that explains how one stick by itself is easily exposed to breaking under pressure. However, a bundle of sticks is strong enough to withstand much greater pressure.
While clinical integration and all that it means is a no-brainer and must-have, in my opinion, it is certainly more easily realized in theory or on paper than in execution. The government has already experienced this numerous times, such as the marginally successful $20 billion healthcare technology stimulus funds that many believed would essentially solve the challenge with electronic health record adoption. The federal government has also struggled with this same challenge in attempting to develop global criteria around Accountable Care Organizations, which have been all but deemed completely worthless, both officially and unofficially by the industry. Nevertheless, I think we are on the right track with the concept of clinical integration, because at the end of the day, the current model is not sustainable and with politics being politics, the chances of wide-scale reform overnight is slim to none. As such, moving towards a model that incorporates market-based principles and solutions makes sense.
However, as we see consolidation dominating the healthcare landscape right now, one has to wonder how this will affect the role of the physician down the road. We know that healthcare provider organizations are getting bigger and more diverse. Today, the number of primary care physicians who are affiliated in some formal structure with a hospital outweighs the remaining number of independents, and a similar trend is growing within many specialty areas of medicine, such as cardiology and OB/GYN. And the reason for all of this is that the system has evolved to a point where it no longer makes economic or business sense for physicians to remain independent, as the majority of them have been up to this point.
When physicians with 15 years practicing are making less than first-year trainees at various corporations – even in today’s markets – you have to wonder if something is out of balance somewhere. Moreover, when a group of cardiologists can no longer maintain their practice independently because of the declines in reimbursement from Medicare, but investment banks that completely mismanaged their businesses for decades are bailed out by the US Treasury and Congress to the tune of hundreds of billions of dollars, again, I have to think we’ve missed something here. Consider it this way … the federal government could essentially “bail out” every single cardiology practice in America by a simple stabilization of rates that are adjusted for the expense of providing care and inflation brought up to 2012 levels, and the cost to taxpayers would not be a fraction of the amounts spent on stabilizing our financial markets since 2007.
Without getting too far off the subject here, I truly believe that clinical integration is the best thing that the healthcare industry has going for itself right now, in terms of a strong and stable model that can sustain itself for generations to come. That being said, I cannot help but wonder what the impact of this consolidation will ultimately end up being for physicians. And more importantly, since numerous studies have shown the correlation between volatility and uncertainty within physicians’ businesses and the satisfaction of patients with their care, this question will ultimately play a key role in the way we measure and expect quality of healthcare services in the future.
For decades now – and particularly within the past few years – we have seen what government-sponsored healthcare is like. I have worked in the UK’s National Health Service, as well as other European health systems, and I can attest firsthand that those types of models will never be sustainable in America. Further, when it boils right down to it, I don’t want the government being responsible for my healthcare any more than I want them to control what happens in the markets that depict the value of my 401K. As such, we have to start thinking about the long-term picture that we have for our healthcare system and where the critical elements of a good system will come into play.