Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Hospitals taking over private practices

Manoj Jain, MD, MPH
Physician
March 8, 2011
Share
Tweet
Share

A decade and a half ago, when I moved to Memphis, I proudly hung a sign outside an office I shared with another doctor. It had my name followed by an MD. I had started my own small business as a solo practitioner in medicine.

Over the years, the practice has grown. I now have several employees and my own office, with the names of several other doctors alongside mine on the sign.

But across Memphis and the nation, health care delivery systems are shifting, and doctors are radically changing how they practice medicine. In a matter of a few years, small and large medical practices are crumbling, lumping, merging, or rebuilding — depending on one’s perspective.

According to the Medical Group Management Association, in 2005 more than 65 percent of medical practices were physician-owned. Within three years that figure had dropped to 50 percent, and by now I suspect it is much lower.

So why all these changes, and ultimately what will it mean for patients?

For one, providing health care is becoming increasingly complex. Keeping up with innumerable regulations from private insurers and the government, transitioning to electronic medical records (EMR) and caring for a growing population of chronically ill patients make it nearly impossible for a full-time practicing doctor to manage patients and a practice. For example, last year, I invested $15,000 in an EMR only to scrap it because it did not connect efficiently with hospital computer records.

There is another more significant reason for the demise of physician-owned practices. Two years ago, a cardiologist educated me over a coffee at Starbucks about the way Medicare was changing its payments. For the technical component of an echocardiogram, a hospital-outpatient department receives $450, while a physician-owned cardiology office gets $180. “It doesn’t make sense. We are going to go out of business.” According to rumors, that’s what was happening with many large private practices that had invested heavily in technology and diagnostic equipment. With the cuts, the practices were not sustainable.

So why did Medicare cut payment to doctors for office procedures? Many studies have found that if doctors have medical equipment in their offices, they tend to overuse it. One study showed that doctors who have an MRI machine in their office tend to order three times more MRI scans per 1,000 office visits compared to other physicians. For a cardiologist it was 2.6 times more cardiac echoes, according to a 2009 Medicare Payment Advisory Commission’s report. Overuse of imaging studies is a major factor contributing to skyrocketing health care costs.

So I asked a few doctors why did Medicare not cut payments to the hospitals. Some say, “That is coming soon,” while others say, “The hospital lobby was stronger than the doctor lobby.”

Whatever the case, the new health care landscape gives hospitals greater control over local health care resources. But as one hospital CEO told me, “I really don’t want to take over doctor practices. Managing doctors is like herding cats. But there is no choice.”

True — doctors are independent, autocratic and often have trouble working together. “I didn’t go through medical school, residency and fellowship training to be told what to do by an administrator,” one doctor told me. But a more efficient system requires more hospital and doctor collaboration.

What many people might not realize is that these Medicare payment changes predate the health reform law that was passed last March. The new law does encourage the bundling of care where doctors and hospitals must join together in pilot projects to bring efficiency, but the law does not mandate these changes.

A simple but important lesson from all this is: One of the best ways to change health care is to change the way one pays for health care. Businesses and insurance companies are watching and preparing to do just this.

ADVERTISEMENT

So, with my small practice and business, like many other doctors, I am at a crossroads — to join hospitals or to tough it out. Nothing is certain in today’s health care conundrum.

Manoj Jain is an infectious disease physician and contributor to the Washington Post.  He can be reached at his self-titled site, Dr. Manoj Jain.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Mental illness in men, and how physicians can prevent suicide in males

March 8, 2011 Kevin 1
…
Next

5 ways I use my iPad at pediatric point of care

March 8, 2011 Kevin 11
…

Tagged as: Hospital-Based Medicine, Primary Care, Public Health & Policy, Specialist

Post navigation

< Previous Post
Mental illness in men, and how physicians can prevent suicide in males
Next Post >
5 ways I use my iPad at pediatric point of care

ADVERTISEMENT

More by Manoj Jain, MD, MPH

  • 3 steps to a better health care system

    Manoj Jain, MD, MPH
  • How this physician transitions to becoming an empty nester

    Manoj Jain, MD, MPH
  • Health care in American is on life support, and the future is uncharted

    Manoj Jain, MD, MPH

More in Physician

  • Implementing value-based telehealth pain management and substance misuse therapy service

    Olumuyiwa Bamgbade, MD
  • How an insider advocate can save a loved one

    Chrissie Ott, MD
  • A powerful story of addiction, strength, and redemption

    Ryan McCarthy, MD
  • Why reforming medical boards is critical to saving patient care

    Kayvan Haddadan, MD
  • Why heart and brain must work together for love

    Felicia Cummings, MD
  • How pain clinics contribute to societal safety

    Olumuyiwa Bamgbade, MD
  • Most Popular

  • Past Week

    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • From Civil War tales to iPhones: a family history in contrast

      Richard A. Lawhern, PhD | Conditions
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • From Civil War tales to iPhones: a family history in contrast

      Richard A. Lawhern, PhD | Conditions
    • Reframing self-care as required maintenance for physicians [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden dangers of over-the-counter weight-loss supplements

      STRIPED, Harvard T.H. Chan School of Public Health | Conditions
    • Implementing value-based telehealth pain management and substance misuse therapy service

      Olumuyiwa Bamgbade, MD | Physician
    • How an insider advocate can save a loved one

      Chrissie Ott, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 25 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why physician strikes are a form of hospice

      Patrick Hudson, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech
    • From Civil War tales to iPhones: a family history in contrast

      Richard A. Lawhern, PhD | Conditions
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • From Civil War tales to iPhones: a family history in contrast

      Richard A. Lawhern, PhD | Conditions
    • Reframing self-care as required maintenance for physicians [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden dangers of over-the-counter weight-loss supplements

      STRIPED, Harvard T.H. Chan School of Public Health | Conditions
    • Implementing value-based telehealth pain management and substance misuse therapy service

      Olumuyiwa Bamgbade, MD | Physician
    • How an insider advocate can save a loved one

      Chrissie Ott, MD | Physician
    • Why medical notes have become billing scripts instead of patient stories

      Sriman Swarup, MD, MBA | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Hospitals taking over private practices
25 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...