“We are in a change environment, and to me change creates opportunity,” said Dr. Kosinski. “The opportunity for us is to move from fee-for-service to risk-based care. We have major insurance companies around the country that are sucking 15 to 20 percent of the healthcare dollar because they can ‘manage risk.’ Those of us who know how to take care of our service line, we can handle risk and manage change.”
Another big change, and potential opportunity, is the 30 million people who will be coming into the healthcare system as a result of healthcare reform. “I don’t know how we are going to step up to that,” said Dr. Shapiro. “Looking at anesthesia, there are very few anesthesiologists, so there will be other people administering care.”
Regardless of what the future brings politically, flexibility will be important to remain profitable. “Know what state you are in and be nimble,” said Dr. Prunskis. “Nobody knows what is going to happen, and if you don’t know what is going to happen be nimble.”
Out of this new healthcare environment will arise leaders who are willing to take the time and energy to develop new concepts and partnerships in addition to providing excellent clinical care.
“It’s extremely difficult to allocate time, but I think it’s something you have to do,” said Dr. Shapiro. “I have partners that just want to come in, be doctors and then go home at predictable times. In our practice, they are busy and they are able to generate revenue, but some of the money they gather goes to us who are in leadership. Some doctors don’t understand the value of leadership their associates are providing.”
The panel also touched on the growing trend of employed physicians. While specialist employment threatens the potential recruitment base in any community, primary care physician employment could be more lethal to local ASCs. In some cases, hospitals are employing primary care physicians in preparation for accountable care organizations.
“If hospitals can control the referral pattern, everything else flows down,” said Dr. Shapiro. “When they can limit who has the referrals, they control the market. In my opinion, ACOs aren’t new and they aren’t a new way of delivering care; it’s just a new way to split up the money.”
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