The accountable care movement and the infrastructure requirements of the modern physician office are making it difficult for private practices to maintain their operations as independent small businesses. But, according to William Santulli, executive vice president and chief operating officer of Oak Brook, Ill.-based Advocate Health Care, a lack of interest among young physicians is what might signal the end of private independent practices.
The future is accountable
"As the current generation goes through the pipeline, only a very small percentage is going into private practice," Santulli said at an Association of Health Care Journalists program held Feb. 24 in Chicago.
I couldn't reach a representative from the American Medical Student Association to confirm that assertion, but Santulli spoke convincingly about how primary-care-driven accountable care will be a team effort—and bigger teams will have an advantage.
Most freestanding hospitals and practices don't have the infrastructure and management to put an accountable care organization together, and "very few know how to get to first base," he said, adding that Advocate has been evolving into an ACO for the past 15 years.
Santulli explained that maintaining an information technology infrastructure, processing billing and reimbursement, and performing outpatient management tasks are all "tough to do in a private practice setting."
The AHCJ program was titled "The Affordable Care Act at the One-Year Mark," and Santulli stated that, regardless of some legislators' repeal efforts, the law unleashed "an unstoppable force" called accountable care that has the potential to transform the healthcare industry.
"Some would like to see it dialed back," Santulli said. "But that's not the perspective Advocate has. We want to move the whole thing forward."
The end result will be that, instead of being reimbursed based on "the amount of stuff" they do, doctors will be paid for keeping people well, he said. Santulli added that—in this brave new world—Advocate is determining the value of physician services using such outcomes as reductions in hospital readmissions and lengths of stay as well as other measures that can be found in the system's value reports (PDF).
A key Advocate strategy for becoming an ACO, Santulli said was "expanding primary-care access in a significant way."
Advocate is not alone in this; Santulli said that all over the country, large systems are acquiring primary-care practices at a "faster pace than I've seen in 25 years." Other aspects of Advocate's expansion include increasing the system's ranks of physician assistants and nurse practitioners, using electronic health records to improve efficiency, extending facilities' hours of operation and making wider use of retail clinics, he said.
"We can't do it fast enough," Santulli said.
Also speaking was Chiquita Brooks-LaSure, the HHS health reform office's director of coverage policy. She said that HHS is exploring different ways to increase the primary-care workforce and encourage more medical students to choose primary-care specialties, such as by offering loan forgiveness and other financial incentives.
They can't do that fast enough, either.
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