Only 31 percent of physicians report having consolidated or considered consolidation with hospitals over the past two years, but approximately 66 percent of all physicians believe they will become more integrated over the next three years, according to the Deloitte's Physician Perspectives Survey.
How likely is this integration among different types of physicians?
• 71 percent of primary care physicians feel they are likely or very likely to integrate;
• 73 percent of surgical specialists feel they are likely or very likely to integrate;
• 61 percent of non-surgical specialists feel they are likely or very likely to integrate;
• 71 percent of other physicians feel they are likely or very likely to integrate.
The 2012 American Academy of Orthopaedic Surgeons census reported that 71 percent of orthopedic surgeons are still in private practice. The number of orthopedic surgeons employed by hospitals increased only 1 percent from 2010 to 2012, to 9 percent overall with another 9 percent of orthopedic surgeons reporting salary from an academic institution.
What this trend toward more consolidation means for the healthcare system is still up for debate. While the Patient Protection and Affordable Care Act encourages more integration to streamline healthcare delivery and cut costs, recent studies show integration could have an adverse effects on healthcare costs.
A recent study from the American College of Physician Executives reported that 32 percent of physician leaders found healthcare costs went up when their practice or group was purchased by a hospital or health system. Another 15.9 percent said costs stayed the same and only 4.9 percent reported a cost decrease.
These findings echoed a Medicare Payment Advisory Commission report showing clinical services cost more when performed as outpatient procedures at a hospital instead of the doctor's office. Yet incentives, such as higher reimbursement for hospitals and hospital outpatient departments, are driving physicians and ambulatory surgery centers to partially or fully integrate with hospitals.
However, MedPAC recently recommend Medicare close the payment gap between ambulatory surgery centers and HOPDs to stave off the upward trend in hospital-employed physicians and inflating Medicare and private insurance costs.
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