Presentation is loading. Please wait.

Presentation is loading. Please wait.

Employment of Orthopaedic Surgeons: Understanding the trend Health Care Systems Committee Alexandra (Alexe) Page, M.D.

Similar presentations


Presentation on theme: "Employment of Orthopaedic Surgeons: Understanding the trend Health Care Systems Committee Alexandra (Alexe) Page, M.D."— Presentation transcript:

1 Employment of Orthopaedic Surgeons: Understanding the trend Health Care Systems Committee Alexandra (Alexe) Page, M.D.

2 Disclosures Vice-Chair of the AAOS Health Care System Committee Partner in Southern California Permanente Medical Group I have no other conflicts of interest to disclose Health Care Systems Committee

3 Is Employment the future of Orthopaedics? Health Care Systems Committee MEDICINE?

4 THE DECLINE OF SOLO AND SMALL MEDICAL PRACTICES UNITED STATES HOUSE OF REPRESENTATIVES COMMITTEE ON SMALL BUSINESS SUBCOMMITTEE ON INVESTIGATIONS, OVERSIGHT AND REGULATIONS Testimony of: Mark Smith, President Merritt Hawkins July 19, 2012

5 Employment in Ortho: Understanding the Trend Review the models of employment Explore factors that are driving the trend Present data from a 2010 AAOS Health Care Systems Committee survey on surgeon practice patterns Suggest responses to the employment trend

6 ARS: EMPLOYMENT in the BOC/BOS DO YOU CONSIDER YOURSELF EMPLOYED? YES NO Health Care Systems Committee

7 Employment: More options than a paycheck Staff Model / Foundation model Hospitalist Academic Center Health Care Systems Committee

8 Staff Model Classic employment Salary, salary + incentive Staff Model: – e.g. Geisinger, Mayo, some academic programs Health Care Systems Committee

9 Foundation Model Ban on the corporate practice of medicine (CA, TX) Medical group has exclusive contract with a hospital e.g. Cedars-Sinai, Sutter, Scripps, Rady Childrens, Kaiser Health Care Systems Committee

10 Hospitalist Follows the internal medicine hospitalist model Delphi established an early model – locum tenems – Filled void for hospitals which could not provide ER coverage Health Care Systems Committee

11 ARS: EMPLOYMENT in the BOC/BOS Do you receive a paycheck for ANY component of your professional services? YES NO Health Care Systems Committee

12 Employment: More options than a paycheck Service line co-management, Joint ventures Medical directorship Physician Enterprise Model Affiliated Professional Entity Health Care Systems Committee

13 Factors Driving Physicians to Employment Models Health Care Systems Committee HOSPITALS

14 1990s Physician acquisition defensive strategy against reimbursement change No physician involvement Compensation on past performance New physicians interested in private practice Now Acquisition as tool for care coordination, preparation for reimbursement change Physicians in hospital leadership Compensation incentive- based Emerging physicians more interested in employment models How has employment evolved?

15 UNITED STATES HOUSE OF REPRESENTATIVES SUBCOMMITTEE Testimony Mark Smith, President Merritt Hawkins July 19, 2012 Flat or declining reimbursement Growing regulatory and administrative paperwork Malpractice insurance costs The implementation of information technology The effects of health reform

16 Factors Driving Physicians to Employment Models Healthcare reform: – Move to integrated care systems (e.g. ACOs, PCMH) – Value-based reimbursement – Reporting requirements (PQRS) Health Care Systems Committee

17 Factors Driving NEW Physicians to Employment Models Increasing burden of educational debt Cultural change among graduating physicians Health Care Systems Committee

18 Hospital Factors Driving Employment Models Challenges with ER coverage Potential for improvements in quality/cost control in era of value- based purchasing Hospital desire to control service lines Market domination Health Care Systems Committee

19 Hospital Factors Driving Employment Models Health Care Systems Committee

20 ARS: In your community, how do employment contracts compare to net income in private practice? 1.Above anticipated private practice income 2.About equal 3.Below anticipate private practice income 4.Dont know. Health Care Systems Committee

21 Hospital Factors Driving Employment Models Services provided in hospital-based entity Free- standing physician practice Physician Facility rate Outpatien t PPS rate TOTAL HOSPITAL- BASED RATE Program Payment $55.18$39.42$60.10$99.52 Beneficiary Cost Sharing TOTAL PAYMENT $68.97$48.27$75.13$124.40

22 AAOS Health Care Systems Committee (HCSC) 2010 Study of Hospital-Physician Alignment Health Care Systems Committee

23 AAOS HCSC 2010 Primer: Hospital Employment Health Care Systems Committee

24 2010 HCSC Study on Hospital-Physician Alignment Electronic survey to 3500 random AAOS Fellows January s returned, total 3381 true surveys distributed 772 responded Response rate 23% Health Care Systems Committee

25 2010 HCSC Study on Hospital-Physician Alignment Employment trend recognized when collected in 2010 Provides powerful comparison to data generated by 2012 study commissioned by the BOC SOS committee, presented next Health Care Systems Committee

26 2010 HCSC Study Mean age of population invited: Mean age of respondents: Gender:

27 Response by practice type 2010 HCSC Survey

28 Shift in Practice Type through Career 2010 HCSC Survey Health Care Systes Committee

29 2010 HCSC Survey Results Trend of increase in employed positions from career start to time of survey – Vast majority (79%) still considering private practice for future – 72% had practiced in private setting at some point Health Care Systems Committee

30 Which setting are you considering for the future?

31 ARS: Are you considering an employment setting? Health Care Systems Committee 1.STRONGLY NO 2.NO 3.UNDECIDED 4.YES 5.STRONGLY YES

32 Reasons for considering hospital employment 2010 HCSC Survey

33 I became a hospital employee by.. (n=142)

34 Problems encountered with Shift to Employment Model Factors leading AAOS fellows to leave a hospital employment setting: Loss of control over staff, finances, contract negotiations, etc. (37%) Change in terms after initial contract term (33%) Lower compensation (28%) Loss of autonomy (28%) Health Care Systems Committee

35 What Does this Mean? 2010 data indicate transition from private practice to employment was increasing Numbers were still low Health Care Systems Committee

36 What Does this Mean? Current trends: Transition to employed setting and Employment directly from training Health Care Systems Committee

37 Is this the future of Orthopaedics? Possible shift to the dominant model as health care reform rolls out I anticipate & hope there will always remain a role for private practice Health Care Systems Committee

38 Concerns with Rising Employment August, 2011: Rising Hospital Employment of Physicians: Better quality, higher costs? Health Care Systems Committee

39 Is this the future of Orthopaedics? Hospitals may find acquiring physician practices & ASCs less appealing: – MedPac recommendations to decrease E&M reimbursement – OIG 2013 plan to review payment disparity between ASC and HOPD rates Health Care Systems Committee

40 MedPac Recommendation The Congress should direct the Secretary of Health and Human Services to reduce payment rates for evaluation and management office visits provided in hospital outpatient departments so that total payment rates for these visits are the same whether the service is provided in an outpatient department or a physician office. COMMISSIONER VOTES: YES 14 NO 2 NOT VOTING 1 ABSENT 0

41 Office Inspector General 2013 Plan HospitalsAcquisitions of Ambulatory Surgical Centers: Impact on Medicare Spending We will determine the extent to which hospitals acquire ASCs and convert them to hospital outpatient departments... also determine the effect of such acquisitions on Medicare payments and beneficiary cost sharing.

42 How do we respond to the trend? Changing definition of what it means to be an orthopaedic surgeon, or even a physician Health Care Systems Committee

43 Employment Challenges: Culture Issue for all hospital-physician alignment models Changes in culture for both physicians and hospital Generational culture changes Health Care Systems Committee

44 Where do we go? AAOS, STATE SOCIETIES Understand and embrace the employed surgeon sector as part of the AAOS Address the particular practice needs and leadership training for the employed surgeon Health Care Systems Committee

45 Where do we go? AAOS, STATE SOCIETIES Recognize lifestyle expectations of the next generation may require changing the structure of small practices to attract new partners Health Care Systems Committee

46 Where do we go? STATE SOCIETIES Recognize & communicate: Legislation on patient issues affects all practice patterns, directly or indirectly Health Care Systems Committee

47

48 Where do we go? Education of residents: Different practice options Understanding pros/cons Personal factors which can influence compatibility with practice types Relevance of advocacy to all practice types Health Care Systems Committee

49 Is Employment the future of Orthopaedics? Employment will likely increase but not eliminate private practice Health reform will change all practices. Just dont miss the boat... Health Care Systems Committee

50


Download ppt "Employment of Orthopaedic Surgeons: Understanding the trend Health Care Systems Committee Alexandra (Alexe) Page, M.D."

Similar presentations


Ads by Google