- Physician specialists may find themselves holding the short end of the stick—and either close their practices or merge them with large providers—when Medicare's value-based approach to reimbursement begins to take hold, according to a survey by the Physician's Foundation.
- Specialists, whose practices have traditionally thrived under fee-for-service rules, said that patients in rural areas may have trouble finding specialists under the new reimbursement protocols. Just 35% of physicians described their practices as independent, down from 62% just seven years ago, the survey reported.
- "Avoid single payer without a private alternative," commented one surveyed physician. "And stop this silly talk about doing away with fee-for-service. It will only increase the movement of physicians becoming clock-watching salarymen."
The survey report even has a section devoted to that exact discussion, and it's clear that younger physicians are less enamored with fee-for-service than their predecessors. Whereas 90% of new physicians are participating in ACOs and providers—as opposed to opening up or working in independent practices—the old guard is still clinging to the independent model.
"While some physicians have elected to participate in new delivery models such as Accountable Care Organizations (ACOs), and while most have adopted electronic medical records, many are dubious about the benefits of these models and systems and do not believe they will achieve cost or quality gains," the survey stated. "Though one-third of physicians participate in state or federal exchanges/marketplaces established by the Affordable Care Act, close to the same number have no plans to do so. Almost half of physicians give the ACA a low to failing grade, while only one quarter give it a positive to excellent grade, though opinions of the ACA and many other topics vary among 'new guard' and 'old guard' physicians."
The times they are a-changing, and like it or not, value-based payments from Medicare are on the way, with fee-for-service steadily being left behind. Physician fears may be reasonable, however, given that HHS designed a rather ambiguous roadmap for the transition. Clarity could do much to address concerns in the specialist ranks.