The coming months represent a crucial period for physician executives. And in no place are the stakes higher than in the discussions about the effort to reach a balanced-budget accord in Washington.
More important than the dollars involved is that the tenor of budget discussions is likely to create passions that color what happens in the private healthcare marketplace. With trade groups prepared to duke it out to protect member interests, the fallout could be corrosive.
Despite much hoopla last month, the serious work of reaching a five-year balanced-budget deal is just beginning. So far the White House and Congressional Republicans have simply agreed to agree that they have a deal: $115 billion in Medicare spending reductions--about $105 billion of which will come from restricting the growth in healthcare provider payments.
Now the issue must run a gantlet of legislative committees to fill in the spaces of the outline. The wacky world of partisan politics leaves ample room for substantial mischief by lobbyists and interest groups seeking to sway the hot and heavy discussions. As the process goes forward, physician executives should be mindful that:
Physician organizations need the cooperation of other healthcare providers to succeed in a tumultuous environment. Only a small minority of physician-owned health plans launched in recent years have been able to meet the high expectations that they could offer a competitive, physician-directed product. Most recently, Physician Health Plan of New Jersey has found it can no longer survive as a stand-alone HMO and has hired an investment banking firm to identify strategic options. Among the problems: lack of adequate capital, limited business acumen among physicians and, all too often, big egos.
While medical leaders want to assure control of their destiny, they need to recognize that some of the most successful organizations are amalgams involving both physicians and hospitals. Names that spring to mind include Detroit's Henry Ford Health System; Sutter/CHS, one of Northern California's largest integrated systems; Lovelace Health System in Albuquerque; Allina Health System in Minneapolis; and Scott and White Clinic in Temple, Texas. Even groups where physicians are pre-eminent know the value of linkages with other providers.
Fairness must prevail as formula changes shift money to primary-care doctors and office-based specialists and away from surgeons and other procedure-oriented specialists who practice in institutional settings.
All these legislative issues present a formidable challenge to medical leaders: Minimize the friction or emotions may spill over and poison the well for years to come.