Written and Edited by: Subodh Agrawal, MD & Michelle Howard
Healthcare Problem: The increasing US healthcare cost and decreasing health quality matrix over the last 5 decades has created multiple new problems, such as increasing the lifespan but decreasing the health span which created a large population of elderly requiring health care.
Currently, US healthcare is spending 20% of our healthcare resources on 1% of the population and 50% on 5% of the population. Studies done by Donald M. Berwick, MD, MPP Andrew D. Hackbarth, MPhil have shown that US healthcare has wasted nearly 1 trillion dollars each year on unnecessary overpriced patient expenses and care. Numerous solutions have been presented to solve the nearly 1 trillion dollar healthcare waste, the most helpful being keeping our physicians independent, here’s why...
What is Freedom of Practice: According to the World Medical Associate, physicians must have the professional freedom to care for their patients without interference. The exercise of the physician's professional judgement and discretion in making clinical and ethical decisions in the care and treatment of patients must be preserved and protected.
Dr. RV Dronavalli, a board certified rheumatologist and member of Doctor’s ACO, says he will continue to be an independent physician, and not employed by a hospital...until the day he retires.
Why? Because he refuses to lose his autonomy and right to give his patients the care they deserve at a reasonable price, and, at times not even charging a fee. He can do this because he has kept his independence. Patient care is why physicians go to medical school and what it means to be a physician. Do not let ethics end with him.
A solution that caused a need for more solutions: Hospitals created employed physicians in order to consolidate healthcare and costs.
The United States healthcare was split into two factions: employed and independent physicians. One main cause of the split is that in the last few decades hospital lobbyists were able to convince Congress that, for the safety of hospitals, hospitals needed to get paid three times more than a visit to an independent physician for the same services.
This resulted in the hospitals going on a buying spree of physicians’ practices as they can make more money by shifting the place of service for the same physician and same procedure. This vertical reorganization of services to have primary care, emergency rooms, hospitalist, and specialist all together under one boss, increased the cost without improving any value because it gives hospitals a monopoly over patient care and has created a system of low-quality, high-cost healthcare.
Therefore, creating the employed physician added to the healthcare spending waste issue because, instead of decreasing it, we added to it by charging the patient/insurance company more and decreased the quality of service.
Solution: Stop the rapid disappearance of independent physicians which will stop the downward trend of high-quality, low-cost healthcare and help the high-cost of healthcare by offering incentives to physicians to keep the cost of healthcare low.
From July 2012 to July 2016, according to a study conducted by Physicians Advocate Institute (PAI), the amount of hospital employed physicians increased 63% and hospitals are the cause. It’s no secret that a hospital visit will cost a patient several times as much as a visit to an independent practice, but it is not as well known that this is a main factor in the loss of independent practices.
As stated previously, healthcare price inflation, along with, ironically, the buying out of physicians who could charge less for visits at their own practice, allowed for hospitals to gain enough money to buy up independent physicians with promises of supposed freedom, higher starting salaries, and lack of stress from running their own practice; thus beginning the decline in high quality, low-cost healthcare and an increase in healthcare waste.
Therefore, physicians losing their autonomy, instead of lowering healthcare waste, increased it because higher cost with less effective care causes readmittance rates to go up. This creates a cycle of patients/insurance companies continuously having to shell out money for issues that would have been better taken care of at an independent practice where they can focus more on the individual patient.
The best way to sustain high quality, low cost healthcare is for independent physicians to keep their individualism so patients/insurance companies may be charged less for better quality of service which will, in turn, help keep patients readmittance low as well.
Furthermore, most physicians did not go to medical school because they were looking for an easy route to get rich and be controlled.
Actually, 75% of the medical students, residents, and physicians in a survey conducted by the American Medical Association stated that helping people was their main reason for going to medical school. They spent countless days without sleep, running on caffeine only, so they could emerge into the medical field to be a force in someone’s life on their own terms, not pump out numbers for a corporation. To help people most effectively, they must keep their autonomy. Independence not only gives physicians the power over their practice but enables more effective patient care by allowing the physician to choose their patients’ care, and, for the most part, what they charge their patients, which is typically less than a hospital charge. Being an employed physician may seem like the better, simpler route, but it is not worth sacrificing patient care, losing the heart and soul of what it means to be a physician, and becoming a pawn for the larger healthcare organizations.
The independent physician route may seem daunting as billing and coding for insurance companies gets more and more complicated, malpractice insurance gets more and more intimidating, and the cost of being an independent physician gets more and more expensive, but there are numerous organizations and options available to help physicians keep their autonomy and arm them in their defensive medicine war so they do not feel desperate enough to turn to a bigger entity for help. A few options are independent practice associations (IPAs), clinically integrated networks (CINs), divisional mergers, and Accountable Care Organizations (ACOs). Each option enables physician autonomy and, like autonomy, empowers physicians to do what they worked so hard to achieve... give patients the care they deserve.
In the current environment, the independent physician will prosper, enjoy their profession, and combat the decreasing value in healthcare by joining a physician-led ACO because ACOs can teach how to provide high quality, low cost healthcare. If you are an independent physician and not in ACO, you should look in your area, otherwise there are many physician-led ACOs which service multiple states and Doctors ACO is one one of them.
Doctors ACO is a physician owned organization which is smaller than larger ACOs allowing for better relationships. It is not the only ACO available but it’s size can make it less intimidating than the bigger ACOs and physicians who are members of smaller ACOs may benefit more from the Shared Savings Program.The Shared Savings Program is another reason to join an ACO. It is how the Affordable Care Act offers incentives to ACOs to be a resource to combat, with the aid of Medicare, the rapidly changing face of healthcare that the buying out of physicians is causing. If you review the following charts which show the Medicare ACO Results for 2018, you can see that physician-led ACOs, like Doctors ACO, are in the lead in new beneficiary savings from the Shared Savings Program.
ACO Characteristics and Performance by Type and Size, 2018
Percentage of ACOs Achieving Shared Savings by ACO Size (number of beneficiaries), Stratified by Provider Type
If you still are unsure about ACOs, please research the other options listed and more available because the most important aspect is that physicians stay independent. However, if you are interested in joining Doctors ACO, follow this link. It takes you to a page that will guide you through the process. If not, just remember that when you are ready, help is available. The path to becoming/staying an independent physician does not have to be travelled alone. Use the resources available to you to keep your autonomy and save healthcare from the impossibly expensive path it is going down in the United States.
In the end, no physician attended medical school because they were looking for an unchallenging route. So why settle for that in your career. Keep it up. Take more risks. Continue following the dream you set out to achieve when you started your undergrad. You are almost there! Do not be intimidated into giving up your goals now. The resources to stay/become independent are available, use them, and remember, there are groups of independent physicians everywhere to help.
For questions and concerns please contact Subodh Agrawal, MD
Subodh Agrawal MD, FACC Cardiologist & Patient Advocate
(706) 308-7099 Founder, Health Wealth Safe,
Subodh.Agrawal@doctorsaco.org - Founder, Doctors ACO