The Wall Street Journal had a thought-provoking opinion piece by Scott Gottlieb, MD, on Friday entitled “The Doctor Won’t See You Now. He’s Clocked Out.” Gottlieb asserts that the ACO model ObamaCare encourages is basically handing hospitals a monopoly in many markets, and encouraging them to buy up practices to take advantage of higher, ‘facility’ reimbursement rates from Medicare. And he adds that, once employed, physicians are less motivated to take ownership of the full spectrum of patient care (e.g., because they hand their patients off to another hospital physician at the end of their shift). The overall picture is higher costs and less productive physicians.
As someone who’s studied economics, I find it hard to argue with Gottlieb’s analysis of the effect of market power: hospitals will inevitably use their monopoly (or quasi-monopolistic) positions in many markets to drive higher prices. I wonder, though, if that won’t — at some point — create opportunities for more entrepreneurial doctors. To the extent that hospitals and other larger systems raise rates, that should make working with smaller, more nimble, and less expensive independent practices more attractive to payers. And, that may ultimately enable more entrepreneurial physicians to find a path to keeping their practices open and profitable, and even developing new models (as occurred with, for example, ASCs in the past).