Physicians, frustrated by declining incomes and using their increasing market leverage, are aggressively increasing prices and service volume while providing traditional services that are less lucrative, according to an analysis of 12 metropolitan markets by researchers with the Center for Studying Health System Change. The study, conducted between September 2002 and May 2003, found that most physicians continued to participate in Medicare and Medicaid but were shunning other traditionally provided community service activities, such as accepting on-call duty without extra pay. "Doctors are very rational creatures," said Hoangmai Pham, a physician, senior health researcher with the center and study co-author. "Their financial distress is real." In addition, more physicians were avoiding inpatient care to maintain office volumes and refusing to accept new patients admitted through emergency departments because of liability concerns. "A common theme across markets was that harsh business realities had left physicians feeling financially beleaguered, forcing them to become more business-oriented," reports the study published in the March/April issue of Health Affairs. The authors suggested policymakers review antikickback and self-referral laws and consider how physicians' financial interests could be aligned with the larger goals of cost control and quality.
Declining doc income leads to price hikes
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