Posted on 02/16/2014 7:03:26 AM PST by SeekAndFind
Doctors are leaving private practice to become employees of hospitals, according to this story in the New York Times. The decline in private practice physicians actually began a few years ago when changes to Medicare forced many physicians who practiced individually or in small group offices to make the move to a salaried position in a hospital.
But there is no doubt that Obamacare has exacerbated the problem. The onerous recordkeeping is one big reason why private practice physicians are becoming extinct. Private physicians can’t afford the extra employees to meet the demands of Obamacare paperwork.
Dr, Paul Hsieh explained in a PJ Media series we published on the rollout of Obamacare:
The second component of Big Medicine is the shift of doctors away from independent private practice and towards becoming hospital employees. Doctors face many of the same pressures as hospitals. As eWeek reported, “Doctors are abandoning their private practices to join large health organizations so they can lower their costs and meet government mandates on electronic health records.”
By becoming hospital employees, doctors lose autonomy, but enjoy more regular hours and a more predictable salary. In return, hospitals gain access to a guaranteed supply of patients from their employee-physicians. Last year the Washington Post reported, “[T]he number of physicians who own their firms dropped from 57 percent in 2000 to 43 percent in 2009, and it’s projected to continue falling to 33 percent by 2013.” As oncologist Patrick Cobb recently told CNN, “We have a joke that there are two kinds of private practices left in America. Those that sold to hospitals and those that are about to be sold.”
[...]
In contrast, the shakeup in health care is towards greater — not lesser — consolidation. This is because the government — not patients — will be increasingly in charge of the money. Under ObamaCare, government is projected to account for a whopping 66% of overall health spending. More centralized control of health spending will inevitably mean more centralized control of health care.
Nor is this centralization of health care some “unintended consequence” of ObamaCare. Rather, it is an explicitly desired goal. In 2010, Obama health advisor Nancy-Ann DeParle wrote in the Annals of Internal Medicine that the health law will “accelerate physician employment by hospitals and aggregation into larger physician groups” and that “physicians will need to embrace rather than resist change.”
Whether physicians resist the change or not is beside the point. The precipitous decline of private practice physicians will allow hospitals to jack up their prices — exactly the opposite effect of what the government intended with Obamacare.
The New York Times reports:
Health economists are nearly unanimous that the United States should move away from fee-for-service payments to doctors, the traditional system where private physicians are paid for each procedure and test, because it drives up the nation’s $2.7 trillion health care bill by rewarding overuse. But experts caution that the change from private practice to salaried jobs may not yield better or cheaper care for patients.
“In many places, the trend will almost certainly lead to more expensive care in the short run,” said Robert Mechanic, an economist who studies health care at Brandeis University’s Heller School for Social Policy and Management.
When hospitals gather the right mix of salaried front-line doctors and specialists under one roof, it can yield cost-efficient and coordinated patient care. The Kaiser system in California and Intermountain Healthcare in Utah are considered models for how this can work.
But many of the new salaried arrangements have evolved from hospitals looking for new revenues, and could have the opposite effect. For example, when doctors’ practices are bought by a hospital, a colonoscopy or stress test performed in the office can suddenly cost far more because a hospital “facility fee” is tacked on. Likewise, Mr. Smith said, many doctors on salary are offered bonuses tied to how much billing they generate, which could encourage physicians to order more X-rays and tests.
I can’t believe that this switch is ultimately in the patient’s interest. A private practice physician is independent and the decisions he makes for your care are based on what’s best for you, not what some green-eye-shade hospital bureaucrat thinks is “efficient” or “cost effective.” Those goals are very nice — as long as the patient’s health is not sacrificed in their name.
In the end, I want a doctor making decisions in consultation with me regarding my health. You can’t be sure if that will hold true when all doctors are working for Big Medicine.
The Government-Industrial Complex Ike warned us of is soooo 1960. Today it’s all about the Gummint-Healthscare Complex. I am never going to the doctor again.
It’s truly horrible. How many doctors that you talk to “get it?” I have a SIL (early retirement pediatrician) who thinks single-payer is the way to go, despite encountering the same problems you described in her practice.
Pediatricians are a group that is most used to .gov control. Most of their patients are Medicaid since most States have expanded it to cover most kids. Their group is also run by very,very liberal people. Why has she retired early??
“Your doctor can have his office anywhere..the only difference you might notice, as a patient, is who sends you the bill. “
Not even close. The big cardiologist group around here got bought by one of the local hospitals. There was then a big war between all the hospitals as to whether those new employees of the purchasing hospital could be on emergency duty and/or perform elective procedures in their hospitals.
The upshot was that the cardiologists ended up being able to use the cath labs ONLY in the purchasing hospital, and all the other hospitals had no cardiologists until they hired some new ones from out of state.
And the patients? Why, we all now have to travel an hour if we get a heart attack and want to be treated by our former doctors OR travel to the nearest hospital and get treated by some stranger instead of dying during an hour’s ambulance ride.
It’s going to work like this everywhere, for all doctors bought by a hospital. It’s not just a matter of offices and billing when your doctor gets bought by a particular hospital. He becomes owned by that hospital has to do what he’s told to do. Period.
“-— My Mom is on Medicare so when she goes to our doctor its $175.00 when I go to the same doctor and pay cash its $40.00 -—”
Yeah, but Medicare probably actually pays the doc only $25.00 of that billed $175.00.
“How does one “go to the hospital” to see a doctor? Walk in the emergency room?”
Or get carried their by an ambulance when you have a heart attack. All hospitals have a large number of doctors on duty or on call for the various emergency specialties, aside from the ER docs themselves. The biggie is on-duty cardiologists to man the hospital cath labs as ambulances bring in a steady stream of cardiac patients day and night.
Hospitals used to do deals with private docs to receive this coverage in exchange for the docs having admitting privileges for elective procedures.
In smaller cities, it’s almost certain you’d see one of your own doctors on duty at the hospital, particularly with a cardiac emergency.
obamacare has destroyed this model. Most private practices can’t survive the obamacare regs, so they sell out to a hospital and become employees of THAT hospital, and are forced to abandon relationships with ALL other hospitals. So, goodbye to seeing your doc at hour local hospital. Thank you, obama, you fuching fascist!
-— Why has she retired early?? -—
She ran her own group practice, but her margins kept shrinking. Her husband makes a lot of money, so she could afford to quit.
My nephew (sister’s kid) is a neurologist who left his practice of 10 years to become an employee. Very sad.
That’s true. The Medicare part didn’t register when I read that.
Yep, Charages mean nothing as far as what the hosp or physician gets paid.
I figured that. So she wants more of the same type of system that forced her to retire??
Your mom is charged 175.00 because reimbursement for that bill from
Medicare is $30.00-$50.00! It is the same for my mom and myself I always
pay cash my visit is 65.00 Medicare is billed 175.00 and 40.00 is payed to
the doc! She saw a throat specialist once the doc told me she was paid
30.00 for a tonsillectomy by Medicare HOW CAN A DOC SURVIVE ON THAT? Such a shame our best and brightest not able to make a GOOD
living after their YEARS OF SCHOOLING AND INTERNSHIPS!
Government DESTROYS all that is good!!!
Our doctor says he has to hire one personjust for the insurance paperwork so thats a fulltime salary that he would not need if he was a fee based practice.
One of the things that drives up the cost of tests and everything else is that the insurance company gets the bill or the govt if its Medicare. If the patient was being billed the cost would be way less.
ER cost is about half if you pay cash. Mr. GG2 went to the ER a couple of years ago. The cost was almost $1200. They asked him how he would pay and he said cash so then it was $675.
The Internal Medicine doctor I had gone to for about 9 years did that in December. He dropped his private practice to go to work for a hospital about 40 miles away. He didn’t even bother to notify his patients that he was leaving.
Luckily, the local clinic had just employed another IM doctor, so the new doctor and another local IM doctor took in the abandoned patients.
We may see many more of these small local clinics closing as the healthcare costs and regulations increase.
If you like your doctor ...
Private physicians, many general practice, internists, and others, are hiring on as ‘hospitalizes”’. Here they give up their private practice and work on the floor of the hospitals to see patients to evaluate a problem which arises while one is hospitalized. General surgeons are hiring on to hospitals, givinging up their practice to take trauma and general surgery call for indigents who come in to the ER with gunshot wounds, bowel obstructions, gallbladder problems….those areas of general surgeon expertise. I have a good friend who is a thoracic-cardiovascular surgeon who hired on as a hospitalist. Gave it all up. These people go to work at 8 a.,m. and gol home at 4p.m. They have no night call. Their liability goes down, and their salaries go down. Government remuneration is on the decline to such a degree that they cannot afford to pay the light bill, the rent, the salaries of employees, etc. Now, they are just like everyone else.;;;;They ;have less money and less liability, and less personal risk, and a life.. My advise is,….do not get sick on weekends, or at night. There is no personal incentive to race in at night to assume medico legal risk, work all night only to have to work throughout the next day. And finally know this,……single payor is coming. Look at the screwup associated with the rollout of the ACA. and all of the following lies exposed…..it has got to be profoundly embarrassing…..but still the cluster**** keep on coming…..Obamas dedication to single payer goes forth. He is committed no matter how much pain and diminution of quality of health care follows. This is when you will see many worst case scenarios….rationing, limitations of medication and medical devices for the plebeians and Obama and the oligarch in Washington will get the gold plated health care……you know……the kind you have 4 years ago.
Around here the hospitals have clinics on practically every corner. Downtown, out in suburban strip-mall land, everywhere. Primary care and specialists. Competing hospital clinics jockeying for the best corner exposure.
The lawyers(govt types) are jealous of medical people. Always have been. The lawyers finally won the war.
The ubiquitous hospital clinics I just mentioned include many urgent care facilities, where you are welcomed up until 8PM. I am just about to head to one now, because it's the weekend.
-— So she wants more of the same type of system that forced her to retire?? -—
My wife tries with her. The most she’s been able to get out of her is that the free-riders will have to pay into the system. Her husband is a professor and a die-hard Democrat, so I’m sure that factors in.
Yeah, it frosts us when we”re getting shafted, while the can afford higher premiums.
I did 29 years in the trenches of general surgery and trauma. I would have liked to have worded another 6 years, but I saw the same thing you did…..I am OUT. I have seen it coming for some time, but, like you, Obamacare made the handwriting clear as crystal. I, we all, bitch about it, but we have done nothing to combat this juggernaut. The shame is, it will come upon most people quiet suddenly. Most people, most of the time, do not need a physician. But when they do,….it will be a maze to run. Only when they have a major medical event in their or their family’s life will they come to understand what they lost. Who is going to develop the drugs or medical devices? Who will pay a billion dollars to develop a drug……that kind of risk will go the way of the dinosaur.
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