A number of factors are swirling together to dramatically effect how physicians are paid for their services now and in the future. The question is: Is this as good as its going to get?
A recent survey of physician practices by the American Academy of Family Physicians found that patient volume was down at more than half of the responding practices. As frequent Modern Physician contributor Linda Wilson reports in this issues Top Story, the practices that responded to the survey as well as physician-executives interviewed for the story attribute the drop in volume to the faltering economy. Patients just cant afford to see their doctors, they say. Consequently, the only way to maintain revenue when volume is down is to raise fees to the patients still coming in for care. But thats a difficult sell with health insurers and patients.
Even if practices could wrest higher rates from payers, theres no guarantee that those increases would keep up with rising costs. Thats the economics lesson from another story in this issue by Modern Physician reporter Andis Robeznieks. As Robeznieks reports, a recent study by the Kaiser Commission on Medicaid and the Uninsured and the California HealthCare Foundation found that some states increased their Medicaid reimbursement rates for primary and obstetric services, but those boosts in pay didnt keep up with the rate of inflation.
So whats the answer? Some are experimenting with bundled payments to physicians and hospitals. Under this scenario, as Modern Physician reporter Jennifer Lubell describes in this issues Feature, an insurer would pay one lump sum to a group of providers for all the care provided during one specific episode of care. It would be up to the group to decide how to divvy up the money. Lubell reports that a number of providers have agreed to participate in a Medicare bundled-payment demonstration project that kicks off later this year. We can hear it now: One for you; one for me. One for you; two for me. The only question is: Who will be doing the counting, hospitals or physicians?
We may be a little skeptical, but our hunch is, these are the good old days.
David BurdaEditorModern PhysicianChicago Submit a letter to the Modern Physician Reader Blog. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.