The Affordable Care Act, though still new, has already amassed both foreseeable and unforeseeable consequences to the health care industry. As coverage is expanded and reimbursement trends shift, how will physician compensation and their financial relationships with hospitals evolve?
I certainly don't have a crystal ball, but can make a few educated guesses on how the ACA could influence the way hospitals contract with physicians.
- Emergency call payments could decrease. Many hospitals must pay physicians emergency coverage because of poor payer mix and the lack of guaranteed income from patients seen during coverage. With expanded coverage to millions of Americans, payments to make up for indigent care could decrease. However, it is important to remember that previously unsponsored patients will be covered by Medicaid or commercial exchange plans, whose payments don't equal private commercial payers. Furthermore, with the focus on wellness-based health with both providers and payers, emergency rooms could lose volumes.
- On the other hand, with recent changes in physician demographics and reimbursement, they could increase. Over the past 25 years, physicians have been less willing to take uncompensated call coverage to help build their private practices--in particular because many don't want to be in business for themselves. Additionally, ACA reduces Medicare payments and puts increased pressure on physician incomes.
- Administrative roles, in particular physician champions and leadership, will increase in importance and thus perhaps pay. Physicians are key players in ACO's, as well as organizations implementing huge IT projects like EHR. Increasing demands for physicians to play leadership roles in these transitions will most likely mean that medical administrative payments will increase--if not on an individual level, definitely on an aggregate level.
- Non-generalist hospitalist roles will increase in demand and importance. As quality and patient outcomes become even more important, specialized inpatient physicians will continue to proliferate. Currently, we are seeing an increase in both OB hospitalists and surgical hospitalists, but in the future, we could see more orthopedic surgical hospitalists and cardiac hospitalists.
- Physician contracts, both employment and non-employment agreements, will demand creativity. As hospital and ACO relationships with physicians evolve to better suite the landscape, anticipate more diversity in contractual arrangements. Co-management agreements could rise in popularity, and clinical integration will continue to place importance on the relationship between hospitals and physician groups.
- Qui Tam lawsuits will continue to increase, and incentivize hospitals to be very vigilant with physician contract compliance. The OIG receives more whistleblower suits than it can take on; however, given the return on investment for pursuing False Claims Act cases, it should be no surprise that we forecast these cases to increase. Protect yourself from whistleblowers by ensuring that your physician contracts have FMV documentation.
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