Change in health care delivery system is certain, says Segal

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.”

As an example of such a network, Segal cites the Greater Rochester (NY) IPA, or GRIPA. It includes a network of 790 primary care and specialty care physicians and two affiliate hospitals. It boasts on its website (www.gripa.org) such benefits as “improved safety, improved quality of health care, better access to the latest proven techniques and treatments for patients, and for physicians the ability to spend more time with patients, less time with paperwork, access to complete patient information and the ability to deliver higher quality care.”

Health information technology (HIT), another driving force in health care reform, may also prompt the creation of integrated practice groups.

“The expense of purchasing HIT is particularly hard on small practices, even with Federal stimulus package incentives, which will not in any event be simple to obtain,” said Segal. “The collaboration inherent in a clinically integrated model allows for an easier implementation of HIT to share patient information and create patient and disease protocols.”

No one can predict for sure how health care reform will impact our nation’s delivery system, added Segal, who admits that encouraging physicians to work together is no easy task.

“Collaboration requires an investment of time and effort,” he said. “However, physicians and hospitals need to seriously consider creating networks which will be in line with the upcoming health care reform and be prepared to provide service under pay for performance arrangements.”

“The results will be reduced costs and improved quality, without necessarily reducing profits.”

http://www.broadandcassel.com/