opinion

Help for physicians facing an evolving health care system

A message to all physicians from AMA President Jeremy A. Lazarus, MD, on resources available to physicians as they negotiate the transformations in American health care.

By Jeremy A. Lazarus, MD , a Denver psychiatrist and immediate past president of the AMA. Posted March 4, 2013.

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The thing about change, especially if it is a major change, is that it never happens all at once, and there are always sweeping consequences beyond the change itself.

As the transformation in American health care continues, we physicians are all caught up in trying to deal with new rules, new expectations, new costs, and whole new ways of doing things, not the least of which will be more and more team-based care. Add the on-again, off-again situation with Medicare reimbursement, and many physicians are wondering what to do — and how.

As many of you know, I have a private practice myself. My goal is not just to survive the changes in health care, but also to thrive. However, I know I won't be successful without learning a lot more about where health care is going and understanding what my options will be.

For many physicians facing the health care transformation, the choice will be employment by hospitals or by large physician groups — already the overwhelming option of newly minted doctors. For others, practice integration may be the answer — but what sort of integration will work best as we move to team-based care and a patient population that is older and more riddled with chronic disease? Then there is the question of whether to start an accountable care organization, not to mention the basic and ongoing issues of dealing with payers, electronic record keeping, and the like.

It's a difficult time for all of us, with many important decisions to be made.

This is one of the places where the AMA can help. For some time, the AMA has been developing resources to aid physicians in figuring out what future is best for them, both in the public and private sector.

With a key part of our strategic plan focused on promoting sustainable physician practices in this transformative era of delivery and payment reform, we have initiated programs to investigate the changes ahead, understand their potential effect on physicians, and offer information on what we find.

One important aspect of this work is the Physician Innovators Committee, a group of about a dozen physicians across specialties and practice settings who were early adopters of new models of care and payment. The physicians in the Innovators Committee volunteer their time to share what they have learned with their colleagues.

So far, the group has developed two white papers, one on implementing innovative strategies and the other on what early innovators have learned about physician payment reform.

The Innovators Committee has also launched a series of webinars on subjects ranging from finding needed resources to clinical integration to benchmarking practice performance. The next webinar, on April 2, is “Delivery Reform Implemented: Payment Models that Reward Your Practice.” For more on the white papers, or future or past webinars, information is available online (link) .

As a further help for physicians looking toward team-based care, the AMA has begun a collaboration with the RAND Corp. to conduct in-depth studies at about 30 diverse physician practices in six states. We will be asking what works, what does not work, how challenges were met, what kinds of practices and physicians are successful in which kinds of models or systems, and why. This work will be supplemented with quantitative research and analysis of a broad base of physician practices.

We'll leverage findings to create case studies and tools and resources for physicians to use in the changing practice environment, including identifying which models promote satisfaction and sustainability in different practice situations.

With data on the successful models in hand, the AMA will promote those models in both the public and private sector, and advocate to remove regulatory barriers, change how hospitals define success, and level the playing field with health insurers.

In another key area, the AMA is helping shape the development of accountable care organizations. We have set guidelines for approaches like ACOs. This is very important, as governmental payers, employers and health insurance companies are all pushing for more integrated health care delivery systems, where physicians and hospitals are held accountable for the overall cost and quality of care. On this subject I want to refer you to a valuable AMA resource — our free guide, “ACOs, CO-OPs and Other Options: A 'How-To' Manual for Physicians Navigating a Post-Health Reform World” (link) .

Another terrific resource for someone trying to figure out where he or she can best fit in the health care system of the future is our fellow physicians.

Recently, the AMA's House of Delegates approved a new Integrated Physician Practice Section or the IPPS. This new section will enable physicians from multispecialty, physician-led, integrated health care delivery, along with groups actively working toward such systems. As part of its mission, the IPPS will serve as a forum for those venturing into less traditional formats — a place where physicians from existing physician-led, integrated organizations can network and learn from each other, and share their experience with physician leaders moving toward integration.

The IPPS will hold its inaugural meeting this coming June at the AMA House of Delegates Annual Meeting in Chicago.

So depending on who you are, and where you are, the AMA has information and resources available for you on the Web and in person.

This does not mean that your choices will be easy, or that the transformation will be quick. But nobody should have to face the health care revolution alone.

And the AMA has your back. Remember, together we are stronger. u

Jeremy A. Lazarus, MD , a Denver psychiatrist and immediate past president of the AMA.

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