Growth in the number of medical homes could make winners of those pathology groups and medical laboratories that learn how to best meet the needs of these providers
Physician executives at TransforMED, a wholly-owned subsidiary of the American Academy of Family Physicians, are blogging with their opinions about which providers will be winners and losers in healthcare. Although most pathologists may not agree with these opinions, there are useful insights to be gleaned from the reasoning behind these opinions.
According to TransforMed’s physician-leaders, healthcare is not about to transform—it already has! The healthcare world is no longer changing, it has changed, and “there will be winners and losers,” stated Terry McGeeney, M.D., MBA, FAAFP, in a blog published on the TransforMed Website.
McGeeney is founding president and former CEO of TransforMED, the American Academy of Family Physicians’ (AAFP) medical home consulting subsidiary.
‘The Healthcare World Has Changed!’
“Over the past several years, the underlying themes of this CEO report have evolved from ‘the healthcare world as we know it will change’ to the ‘healthcare world is changing’ to the message of today: the healthcare world has changed and there will be winners and losers,” blogged McGeeney.
McGeeney hopes that the winners will be patients. But he had plenty to say about why some types of providers are not likely to survive. “The losers will include insurance companies that cannot adapt to the new realities of health insurance marketplaces and new regulations,” he wrote. “There will most likely be less acute hospital beds and possibly fewer hospitals.
Hospitals That Don’t Adapt May Not Survive
“Certainly with the rapid consolidation that is occurring in the hospital arena, hospital systems will be fewer in number but larger,” he continued in his blog. “With the new payment methodologies of Accountable Care and bundled/global payments, hospitals that do not adapt and change their business paradigms may not survive.
McGeeney then described what may happen to physicians. “There will also be losers in the physician space,” he said. “The expectations on primary care today are different than even two years ago. Many physicians recognize this, but many insist on holding on to outdated beliefs and expectations—putting their future in jeopardy.
Insights for Clinical Laboratory Managers
For pathologists and clinical laboratory managers, McGeeney’s observations about the reimbursement changes occurring in primary care settings are directly relevant to expectations that fee-for-service arrangements will soon go the way of the dinosaurs.
“Primary care is moving from ‘pay for volume’ to ‘pay for value,’ observed McGeeney. “Payment models are transitioning to blended payment models from fee-for-service and RVU.
“Physician payment will ultimately involve capitated models heavily laden with incentives around quality and cost,” he predicted, adding that, “The number of independent primary care practices in this country decreases by the day as physicians are joining IPAs, large groups and hospital systems. Some predict that 75% of primary care physicians will be employed by 2015.”
McGeeney’s blog and his words were meant to alert family practice physicians that the change has already happened. He is attempting to capture their attention and motivate them to respond to these changes in a proactive manner.
On that point, he wrote, “The comment I hear repeatedly from physicians is ‘I want to practice the way that I did when I chose primary care.’”
Are Pathologists Ready to Accept McGeeney’s Predictions?
That is certainly a frequently heard comment from pathologists, particularly when the pathologist business leader and the group’s practice administrator attempt to conduct a strategic planning exercise involving all the partners in the pathology practice.
I want to practice the way I did when I chose pathology as my practice specialty” has a familiar ring. It is what prevents many of the nation’s pathology groups from responding more effectively to how healthcare in their community is evolving.
McGeeney had some comments on exactly that scenario. “Healthcare in this country is evolving—with independent primary care practices disappearing, hospitals consolidating, payment methodologies changing and the focus shifting from the providers of care to the consumers of care,” he observed.
“This trend will not reverse and it continues to pick up speed.”
His advice to his professional colleagues gives pathologists and clinical laboratory executives some insight in how they can position their medical laboratories to serve the more innovative primary care docs in their community.
McGeeney wrote “Primary care practices must transition to high-performing, comprehensive primary care practices embracing the principles of a Patient Centered Medical Home. Furthermore, these practices must become part of medical neighborhoods coordinating and managing care with patients and their families, hospitals, specialists and other stakeholders.”
Family Practice Doctors Are Clients of Pathologists, Clinical Labs
These are insights that clinical lab executives and pathologists should take seriously. After all, the American Academy of Family Physicians has almost 100,000 members! Local medical laboratories and community pathology groups already serve large numbers of these family practice physicians as clients.
If the more innovative of these physicians are changing their practice model by adopting medical homes, participating in ACOs, or selling their practices to local hospitals and health systems, then the labs servicing these primary care groups should have their own strategic plans in place to be the laboratory provider of choice.
—By Patricia Kirk