But after this study the government might have to consider it.
"Healthcare integration" is the fashionable term being used to justify the trend of hospitals employing an increasingly larger number of MDs. Have all doctors (or providers as they generically like to refer to us) work for the same master, under the same tent and ‘voila!’ let the magic of care coordination kick in and make costs plummet.
Until they don’t. Reality sure is a bummer.
This study looked at over 2 million patient claims (that’s a lot) and found that costs actually increased as physician employment by hospitals increased.
Employing MDs works well for hospitals as it locks down coveted patient revenue streams from labs, tests, surgeries etc. It creates more vertically integrated regional oligopolies.
But these data suggest that it may not work well for the system as a whole. Are employed MDs incentivized to rack up more tests, procedures and codes because it increases the overall revenue they bring into the hospital, (their employer)? I don’t know.
I know a bunch of MDs who have become hospital employees recently. Their motivations vary but usually come down to better money or more security. Others acknowledge that the regulatory burden from the government has pushed them to become employed. I’ve never heard one say it was because they believed it was better for patients
They often say something like, “it’s the trend,” or “I just want to get paid for what I do.”
What if more loosely integrated doctor- hospital relationships keep costs lower and work better for patients? What if better care coordination could happen through new technology without the need for everyone to work for the same institution.
If so, shouldn’t health policy discourage hospital employment of physicians?
Not surprisingly, a representative from the American Hospital Association criticized the study as “outdated.” Maybe the AHA should take “evidenced based” practice more seriously and respect the “big data” from this study (when was the last time you saw a medical study with over 2 million patient encounters?)
We need to keep examining these issues. If the big promises of cost savings through systems integration (monopolization?) are not panning out then it’s time to question the assumptions upon which they rest.
Moore’s Law will continue to put downward pressure on the cost of information and new technology. Standardization of care via common pathways is possible through good communication among doctors, administration, and by means of shared technology. The shared technology is becoming so cheap and widespread that it is not necessary for doctors to all be employed by the hospital to make standardization processes work (consider that Practice Fusion is a FREE office based EMR- do you need a hospital to support an EMR for you when you can get one for free?).
While hospital employment of physicians is today’s trend, I don’t think it is necessarily the wave of the future (unless doctors are doing it solely for money and security). Cheaper and better technology tends to produce decentralizing effects on systems favoring more loosely integrated networks (and likely cheaper care). There is more than one way.