Paul W. Flint, MD, professor and chair of otolaryngology-head and neck surgery at OHSU, attended the session and joined the conversation. He noted that, from a physician perspective, there appears to be a great deal of tension between pay for value and pay for volume. Another audience member agreed but noted, “What we’re all doing is trying to figure out how to get a bigger piece of the pie. … We have to rethink this whole thing. … We need to bring the value of what we do as doctors.”
Explore this issue:November 2017
Charles Ford, MD, owns Blue Ridge ENT in Boone, N.C. As the owner of a small practice in the mountains, he constantly thinks about how to keep costs down while providing quality patient care. One approach that makes sense to him is incorporating office-based surgery.
The balance between pay for value and pay for volume is always on his mind as he brings his small practice into the future.
Kevin Watson, MHA, is chief executive at Colorado ENT and Allergy in Colorado Springs, Colo. The practice includes 12 physicians and one nurse practitioner. While Watson described the practice as “good-sized,” he is in the process of growing it.
Colorado ENT and Allergy plans to meet the future by bringing as many procedures into the office as possible. They have also merged with an allergy practice so that they can treat not only otolaryngologic allergies, but also general medical allergies. They have invested in space and equipment but have also focused on making physicians and their schedules as efficient as possible. For example, Watson said that the practice has added ancillaries such as computerized tomography (CT) scans. Their intention is not to increase revenue from the CT scans, per se, but rather to use the CT scans to identify procedures that can be performed on the same day in the office.
We cannot have half the U.S. economy being spent on healthcare. —Ron Howrigon
As the only physician on the panel, Dr. Ford articulated the challenges felt by physicians. Of course, he acknowledged, all practices have weekly, or even daily, internal challenges. These internal challenges are the challenges that physicians expected when opening a private practice, but now these internal challenges are joined by external challenges, many of them previously unanticipated.
Dr. Ford said that while his practice remains independent, hospitals are increasingly purchasing small practices and employing the physicians (See “Drivers of Hospital and Health System Consolidation,” right). This consolidation of healthcare has expanded to hospitals, with the University of North Carolina and the Medical Center recently signing a letter of intent to merge. Dr. Ford resists this trend, explaining, “I will say that being independent is a value to me. … I don’t like being told by a hospital when I have to work.” The two other challenges identified by Dr. Ford are insurance companies and government regulations.
The Next Generation
After laying out these challenges, however, Dr. Ford emphatically stated that he remains optimistic. He explained that the future will largely be in the hands of the physicians who are training as residents today. Dr. Ford noted that the new generation of residents is being socialized differently than residents from decades before. Current residents are taught to be part of a team and, thus, become medical professionals who seek out team care in their careers. He acknowledged that this socialization may be part of what is driving healthcare away from small practices and into hospitals.