Commentary: ACO affiliation to lower doc productivity, increase costs

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The Affordable Care Act is pushing more physicians out of private practice and into hospital employment in a bid to better regulate doctors, a resident fellow at the conservative American Enterprise Institute contends in a commentary published in today's Wall Street Journal.

Although the move is intended to lower healthcare costs by funneling patients to hospitals and hospital-owned practices through hospital-owned accountable care organizations, costs instead will rise, writes Scott Gottlieb, M.D. That's because physician productivity plummets by more than 25 percent when doctors work for hospitals, he writes, citing research by the Medical Group Management Association.

He also cites a recent study by the Medical Group Management Association showing a 75 percent increase in active doctors employed by hospitals since 2000. By next year, Gottlieb says, 50 percent of U.S. physicians will work for a hospital or a hospital-owned health system.

"Once they work for hospitals, physicians change their behavior in two principal ways. Often they see fewer patients and perform fewer timely procedures. Continuity of care also declines, since a physician's responsibilities end when his shift is over," Gottlieb writes.

He argues that hospitals aren't buying doctors' practices so they can reform healthcare delivery, but to gain market share and develop monopolies. When working for a hospital, Gottlieb says, a physician changes his or her behavior--seeing fewer patients, performing fewer procedures.

Becker's Hospital Review recently interviewed Randal Dabbs, M.D., about ways to "engage, retain and recruit physicians." He stressed the importance of having a medical director other physicians can look to as a leader, rather than just a CEO without a clinical background. He cited experience gained through his own Knoxville, Tenn.-based physician management firm TeamHealth.

Constant communication among all levels of staff, compliments and coaching are all important ways to make physicians feel heard and appreciated, Dabbs said. Additionally, he recommended training in risk management, which he said builds confidence in physicians who fear being sued.

In a recent Harvard Business Review blog post, LIz Wiseman highlights ways to help employees become more productive. She describes two types of managers: 'diminishers' and 'multipliers. Multiplers know how to motivate staff to be more productive by following up on milestones, avoiding micromanagement, using encouragement and rotating roles, she writes.

To learn more:
- read the commentary in the Wall Street Journal
- read the interview in Becker's Hospital Review

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