Doctors shifting gears

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It could be the prescription for future health care: doctors working for hospitals instead of in private, independent practices.

No longer able to meet the rising costs of malpractice insurance, deal with paperwork and juggle patients on their own, many physicians are going to work for hospitals.

“It’s significant,” said Dr. Steve Berkshire, health care administration professor at Central Michigan University. “And it will be the way things go in large cities during the next five years. Even doctors that are listed as private practitioners will be associated with hospitals — actually be hospital employees.”

While patients won’t notice much difference — they’ll still see their primary care doctors — the benefits can be huge for physicians’ practices and their bottom lines. But hospitals don’t directly make money from employing doctors.

“Hospitals get the benefit from the patients,” Berkshire said. “If you have a high volume doctor, or one that is involved in specific practices, then the hospital gets those patients for surgery and overnight stays. That’s where they make money.  … If you work directly for a hospital, that’s where the patient is going to go.”

Leaving private practice is a matter of survival, said Dr. Manoj Pawar, chief medical officer at Memorial Health System.

“For primary care in particular, the reimbursement rates are really low,” he said. “We’re paying for the wrong things: we pay for sickness, not for health. All the things physicians do to keep people out of the hospital — that goes unnoticed, and the reimbursement rates are very low.”

Fee schedules are based on the perceived worth of a service, he said, so reimbursement rates for preventive care are much lower than rates for invasive medicine.

“The way we’re doing things has to change,” he said. “We have to keep primary care physicians, or it could be devastating.”

Memorial is creating a support system for doctors who want to be employed by the hospital.

“It is a national trend, and it is a trend in Denver,” he said. “When I worked there, we did some recruitment, but most physicians were coming to us. They want to focus on providing quality care, focusing on patient care — not doing work that frankly, can be done by someone else.”

Doctors want to practice medicine.

“Physicians can focus on care, not getting bogged down in survival mode — paying bills, dealing with insurance companies,” he said. “They can work with patients.”