As the health care reform debate drags on in Congress, change in our health care delivery system is certain, according to Mike Segal, who for the past two decades has worked with physicians to form large practice groups and currently heads the Health Law Practice Group of the Florida law firm Broad and Cassel.
“The manner of delivery and the way providers are compensated most likely will change markedly over the next decade, no matter what Congress does,” he said.
Segal believes these changes will occur primarily because of the government’s focus on gearing physician payments more toward “performance” or “outcomes” versus the existing “fee for service” system.
“This new type of reimbursement methodology could fuel systems that involve clinically integrated health partnerships between doctors and hospitals, also called 'accountable care organizations',” he explained. “State-of-the-art health information technology will add to this shifting momentum as well.”
“The signs are clear that change is imminent and that hospitals and physicians need to be prepared. Medicare already has developed pilot projects to test ‘pay for performance’ programs.”
A recent New Yorker magazine article, “The Cost Conundrum,” compared the per capita health care costs in two Texas cities, McAllen and El Paso. In McAllen, where specialty physicians reign and own hospitals, the testing is high, and medical costs per person are extremely high. In El Paso, where the costs per person are much less, the article states that much less testing occurs, yet the population seems to be as healthy as the citizens of McAllen.
“The Obama administration has been all over this article,” said Segal. “It’s required reading there. Their stated goals are to cut health care costs while improving quality, while also providing universal health care - a daunting task.”
“As pay for performance pressures grow, the need for more integrated networks will increase,” continued Segal. “This is not a new concept. Health care networks based on this model are operating in pockets across the United States.”