Health reform and the hospitalist
By Richard Rohr, MD, MMM, FACP, FHM
Some sort of health reform is likely to be enacted by Congress before the year is out, and we can be sure that it will change hospital medicine in some manner, but details are still hazy.
We will see some expansion of coverage to the currently uninsured, which would help hospital medicine groups, but I am not sure that universal coverage will be achieved this year. Don’t look for a single payer system–this country is too pluralistic to accept that. Private insurers will continue to play an important role, and you’ll probably keep all or most of your present billing numbers.
“Quality” is going to be the watchword. Atul Gawande has galvanized the debate with his New Yorker piece about wasteful utilization in McAllen, TX. Higher quality is associated with lower production costs in manufacturing, and there is at least some evidence that this will work in healthcare. The Physician Quality Reporting Initiative will probably have some serious money attached to it (if you can actually collect). There will be a big push on hospital readmissions, and there will be much pressure on hospitalists to ensure that they communicate discharge plans to primary physicians and patients.
Healthcare integration will be a major theme. The Obama health wonks are much taken by organizations like Kaiser and Mayo Clinic that deliver quality care at low cost. If you are working in a hospital smaller than 300 beds, expect a merger into a larger system within the next five years. If you are in a hospital with less than 100 beds, yours will either close or become a 25-bed critical access hospital. Hospitals and physician practices will be coming into closer alignment than ever before. Given the long-standing mistrust on both sides, I expect that a lot of medical practices will coalesce into multispecialty groups that can undertake joint ventures with hospitals, rather than merge into them.
In addition, don’t look for a raise anytime soon. Payments to doctors and hospitals will be maintained at their present levels or possibly trimmed a bit to pay for expansion of care. Money will flow, instead, to those people who can organize systems of care that deliver good treatment at attractive prices.
About the Author: Richard Rohr MD, MMM, FACP, started one of the first hospitalist programs in Connecticut in 1996 and is a charter member of the Society of Hospital Medicine. He is a graduate of Columbia University, New York Medical College, and received the Master of Medical Management degree from Tulane University. Dr. Rohr is certified in internal medicine and pulmonary disease. He began his career practicing pulmonary and internal medicine for two staff-model HMOs in MA and CT, and then directed a long-term care facility specializing in medically complex patients before joining Milford Hospital to establish the hospitalist program. Dr. Rohr spent a year as vice president for medical affairs at a small hospital in upstate New York before assuming his current position directing hospitalist programs for the Guthrie Healthcare System in Sayre, PA.
