Home Forums Discussions General Discussion selling out to hospital

1. In my area, the local hospitals are trying to form ACOS and buying out all the solo practioners.

My thought on this is what happens in 2 years if they go under or they want to replace you with a cheap PA or NP. Then you have to start over again and try to build up a practice. Does anyone else have any thoughts on the advantages and disadvantages of becoming an employee again.

Booooooooo!

This seems to go in cycles. It seems they may be starting to get into a buying cycle again.

It too shall pass.

Then you are left in the cold.

This based purely on business observations and my gut after attending several meetings on behalf of practices, but if your practice, as you run it, is satisfying to you [financially, professionally, emotionally, etc] then I would hang tight.

At least in the West where it has come up, hospitals are hustling to get Docs to join ACOs without being hired, offering a rev-share of "saved costs".

Although I have never heard it stated quite this way, it seems that the thing that the ACOs need the most is practices with patients; they don't get "cost-savings" otherwise. Thus, they need you far more than you need them at the moment.

I have also talked to a few folks who share the concerns that I have that the funding for ACOs will never see the light of day, which raises serious questions about whether you want to put yourself through all that if it ends still-born. As you have already alluded to, the rebuilding of a practice takes time and effort.

There is a metaphor used in the development community that fits the dynamic of hospitals and independent docs from my perspective: Pigs and Chickens cooking a breakfast of Bacon and Eggs. The chickens have the effort to produce an egg, but the pigs has to give their all. Members of a development team have a healthy disdain for 'chickens', just as I suspect independent Docs do for those 'chickens' trying to leverage their practices without making a significant contribution.

One of the recent "Medical Economics" throw aways had a series of ACO articles. These look like mutated HMOs. No one was optimistic about how they would work in rural areas. Hospitals buy Doc's for control. They initially pay them more than the Doc's can earn and once the Doc's settle in, the rules change. They move to a eat what you kill and you will never ever see a bonus attitude. Doc's become employees, lose a few degrees of professionalism and then the hospital starts to treat them like employees. These are also money losing situations for the hospitals. Add the cost of most overpriced EMR's and you'll see the hospitals and large clinics losing between 100-200K per doc! Hospitals have laid off doc's who either didn't fit the mold or were not in a proceedurally oriented specialty. I'm solo, independently owned and poorer than most, but it is my ship....or canoe.

From what I have read there is no reason a doc should rush to sign up with an ACO as we should be in a fairly strong position to pick and choose (assuming you have a decent patient population already).

On a somewhat related note, my local hospital offered to pay 90% of costs for a "big name" EMR for my office. Luckily I did the research and found the EMR they contracted with had the worst reviews. Hospitals are not necessarily on the same page as office-based docs and you can't assume they know what they are doing when it comes to outpatient practices.

At one of those ACO meetings, I talked with the organizer about the logistics, and explained that the practice I was representing had a ~6700 patients, an EMR with ~ 5 yeas of data, and how was the ACO going to connect to the practice?

His response was first that the hospital in their magnanimous-ness would provide access to their hospital EMR "at no additional charge to the provider". I replied that was all great, but that the practice had no reason to change EMRs, so who was going cover the costs of building an interface? He started to avoid answering by explaining how difficult ... blah, blah, ... and I cut in after a bit and explained to him that I had built enterprise system interfaces for some 20 years, and knew that it could be done, it was only a question of who was paying. He excused himself shortly thereafter. Perhaps it is relevant that he was a specialist with hospital permissions, you folks can tell me.

ACO is a scam.

Possibly Kaiser or Mayo could form an ACO -- they already have the administrative infrastructure and a physician group that "plays well together" since they have been assembled over decades of time and generations of physicians.

For everyone else (that includes me) there will be much gear-grinding and teeth-gnashing before we can achieve any "cost savings" -- any group that is put together will not have any reliable data for years, and since the ACO is about "saved costs", there can be no demonstrable savings without some baseline data. And there will be much travail in getting rid of the "high cost" doctors and patients in order to demonstrate "savings."

The only winners in the ACO game will be the administrators and the lawyers and consultants who put it together. The losers will be the doctors, the patients, and of course the government, which will be required to subsidize the whole enterprise, or it won't happen.

If it does goe forward, it will be as industrial medicine provided by giant insurance companies (United Health Care, Regence Blue Cross, etc.), and giant hospital chains, under administrative, legal and financial rules -- not medical judgement. Maybe that's what the upcoming generations want from their doctors -- Wal-Mart medicine. Or maybe they just don't care.

So far, they aren't willing to fight for "old-time medicine", however much they are faux-nostalgic about the "family doctor" -- they just want whatever is either: 1)what insurance will pay for, or 2) whatever is cheapest. My instinct (and 3000 years of medical history) tells me this is not going to work in the long run.

I always like refer to Hippocrates First Aphorism-- those Greek guys were brilliant:
"1. Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate."

Physicians are not just actors -- they are also the directors in the patient's personal drama. If we cede control of the stage to administrators, insurance executives and lawyers, then everyone will suffer from a degraded form of medical care.