In an article in the July 29 New York Times, reporter Alex Berenson outlines an argument developing among a number of economists, including physicians. The major driver of rising health care costs are physician incomes. In the
More importantly, it is argued, is how physicians are paid. Paying piecemeal and paying for doing things to patients leaves out someone taking on the role of coordinating all this and on helping patients do their part.
Personally, I thought capitation made a lot of sense. To do it right–and earn a decent living–requires physicians to revamp how they approach caring for patients. Prevention is king. Reminding patients when follow-up appointments are needed. Use staff–not physicians, and often not even nurses–for care coordination, education and so on.
Many practices ran into trouble under capitation because they did not understand their costs. Too many tried to play insurance company and took on the risk and responsibility for managing care far beyond what they could control and monitor.
Physician incomes are already flat and declining in real dollars. The push back on health care costs is intensifying –all the talk about not paying for services to “fix” errors or holding tightly to “evidence based” services are two examples.
Where does this leave you? Become efficient in your back office and support staff. Spend your time focusing on your patients. On a personal level, prepare for income to remain flat and possibly decline; if it doesn’t do so, so much the better. Finally, find a good financial advisor to help you develop and execute a long-term plan for personal finances.