All of you are interested in forming a sub-IPA composed of primary care physicians in the Glendale/Burbank area with the goal of negotiating better pmpm rates with IPAs and payors.
Most of you see the trend of health care payments moving from fee-for-service to managed care capitation (witnessed by California's dual eligibles being moved into managed care by June, 2013, and the predicted movement of Medicare patients into managed care in the next 3-5 years) which will usher in a new era of health care. In this new paradigm, primary care physicians will coordinate the care of a large population of patients utilizing the Patient-Centered Medical Home model. This system of health care delivery should turn our focus to health promotion, prevention and chronic disease management, thus treating the majority of patients in the out-patient setting. Consequently, this model will decrease the number of patients seen by specialists, as well as decrease the number and length of acute hospitalizations.
Under managed care, we will be expected to deliver good medicine (evidenced by quality measure scores and use of evidence-base medicine) and a lower overall cost (capitation).
Those who see and understand this trend, and who have the courage to embrace it and make the decisions needed to thrive in such a system want to form a clinically (with EHR shared data) and financially (with centralized billing and HR) integrated single-specialty medical group that is owned and directed by primary care physicians. This is the only model that will give us the power to control our own destinies in the health care market place for our benefit and the benefit of our community of patients.
In a totally integrated medical group of significant size (over 12), we can accomplish the following:
1) Stable and increasing incomes by negotiating fair capitation rates and developing other lines of service (urgent care, virtual medicine, concierge-type services, etc.)
2) Decrease our expenses by collective bargaining and collective right-sizing of practices.
3) Increase the equity in our group by growing the practices of physicians that are slowing-down or near retirement and strategically acquiring practices of value in our community and in other select areas.
Our only other options are to stay in solo practice and see our practices dwindle, or sell out to the "sharks"-- hospital groups, insurance companies, IPAs, and other entities that wish to exploit us rather than work as equal partners with us. I think many of you have the same thought I have: I went into medicine to become a noble professional to use my skills, knowledge and wisdom to help my patients, and not merely to be an employee to be owned by an entity that cared more about profit than patients and the good people who care for them, us physicians and health care providers.
Right now, these are all good ideas. We invite you to come and work along side of us like-minded primary care physicians to make it a reality.
