That’s true for more than economic reasons, he said. Younger physicians today, down to those completing their fellowships, have different priorities, Norman said. “They are lifestyle considerations—the practice work is too long, there are too many late hours. It impacts families.” Physicians in that group have found that hospital employment allows them to work with tools that a small practice might not be able to afford. Throw in the retirement plans, group and volume purchasing power, costs of medical malpractice insurance—it becomes an easy call, he said.

For physicians that thrive on seeing patients, he said, a hospital setting removes many of the barriers created by practice ownership. That same dynamic has brought accusations that patients are being run through medical mills, without the attention they might get at a private practice, but Norman believes that a commitment to quality patient care will set large practices and hospitals apart; those that don’t meet that standard are less likely to be successful.

Home Sweet Home?

If family practices are to not just survive, but thrive, they’ll have to embrace new models that produce more efficient, quality care, professionals say. One example of innovation in practice structure is taking place in the Northland, at Clay-Platte Family Care. A fast-growing company in its own right, CPFC is perhaps the best-known local case of an emerging business model in health-care known as the family-centered medical home. Under the direction and influence of clinic administrator Jamie Stevens and Nathan Granger, a physician who also holds an MBA degree, it is the only clinic in Kansas City yet to be recognized with that status by the National Committee on Quality Assurance.

The model draws on collaborative efforts of physicians—general practitioners and specialists, working under one organizational banner—to coordinate preventive care, along with acute care and treatment of chronic conditions. Its hallmarks are said to be better communication among medical professionals and improved responsiveness to patient needs. More physicians working in concert, for example, can provide better access through extended office hours, and communication between patient and physician is improved through the long-term relationships the model fosters.

Norman, at KU Med, doesn’t discount the need for organizational change, but wonders whether it amounts to “old wine in a new bottle.” Others, such as Douglas Henley, chief executive officer for the Leawood-based American Academy of Family Physicians, see it as vitally important change: “It is a vision for the future that is, first and foremost, centered on the patient and not on the physician or the practice,” Henley told the American Health Management Information Association. It is, he said, “health care as it needs to be vs. where it is now.”

By paying physicians differently, the family-centered medical home model attempts to tackle the real driver in the health-care finance debate. Rather than burning out doctors and short-changing patient care with churn-’em-out practices based on fee-for-service, the new model sets a per-patient monthly fee for each doctor, with additional payments for patient visits, in person, on the phone or by e-mail, or even through care provided to groups of patients.

The cost-reductions come from better up-front care; proponents say those preventive steps can yield a six-fold savings on costly follow-up procedures and hospital re-admissions.

Still to Come

If some sense of equilibrium isn’t restored to private and family practices, something will be lost in the spectrum of medical care, said Metro Med’s McCandless.

“It’s really scary when you’re trying to make payroll and people start changing the rules on you,” she said. “That’s very unsettling from a business standpoint, and that kind of uncertainty makes people re-evaluate whether they can be in a practice by themselves.

“We’re seeing an awful lot of flux because of that. I think that will settle down and that we’ll move to a better form of medicine from delivery side. … I think we are going to see some innovative models where doctors main-tain autonomy in their individual practices, but do things where there are shared costs and expertise.”

Innovation, some believe, may be the only thing that can keep private practices going. But even if hospitals mega-practices come to dominate entry into the health-care system, one fundamental principle will still apply, McCandless said.

“I think all of medicine is completely based on relationships, and it doesn’t matter if you’re going in for super-special surgery or taking care of diabetes. What matters is that good communication occurs, how confident you feel in the quality of care, how much partnership there is,” she said.

“And that’s not restricted to any kind of delivery model,” McCandless said. “You may have to work harder in a big institution to be able to ensure that you still can maintain those relationships, so I think that larger practices or hospitals have to be very deliberate in finding ways to build that continuity. It’s much more inefficient not to.”

 

Return to Ingram's September 2011