Neurosurgeons (and many other specialists) have traditionally built their practices through cultivating referring doctors and patient referrals. Such systems were based ultimately on patient satisfaction and quality care delivery. But this system is experiencing meteoric transformation. The drive toward integrated health systems can leave specialist feeling like they are embroiled in the childhood game of musical chairs, where all the players find themselves jockeying for a dwindling number of available seats.
Across the country, health systems are quickly aligning, forming defined collaborations and integrated systems to care for patients in an effort to reign in costs. Included are hospitals, physicians, insurers, employers and government agencies. The economic pressure of the 2012 Affordable Care Act are driving formation of Accountable Care Organizations (ACO’s) (working largely in a capitated manner) and other comprehensive provider entities. The result, patients/members receive their care only from entities within their selected system.
What does this mean for physicians? Right now, individual physicians are being compelled to make critical choices. Most feel they can’t survive as independent or small group practices and are electing to join hospital employment or align with large health care systems.
In these integrated health systems, primary care physicians are highly motivated economically to send patients to specialists in their own network. An independent neurologist or neurosurgeon not contracted as an approved specialty care provider risks severing a long time referring relationship.
For the majority of physicians still in independent practice, it is a key time to make the right contractual alignments to provide specialty services to ACO’s and integrated health systems, and/or becoming part of approved specialist panels as designated by commercial payers. It is anticipated that health systems will select their neuroscience specialists and once the demand is met to provide services to their patients, the panels will close to new physicians. These are critical decisions and the negotiations involved are not those most neurosurgeons have experience navigating. BenzilZusman are poised to provide the expertise to secure your position during these changing times.
Physicians should think now about how to secure their seat if the music stops to assure access to patients and referral sources in their communities.