From commercial payers to physician organizations, six physician leaders joined Becker's to discuss the healthcare power players they are watching.
Question: Who are the healthcare power players you're keeping an eye on and why?
Editor's note: These responses were edited lightly for clarity and length,
Michael Gomez, MD. NICU Medical Director of Pediatrix Medical Group (Long Branch, N.J.): I avoid letting myself be dazzled by anyone as best I can. However, I try to keep my eye on those coming up in medicine who will generate the largest impact five to 10 years from now, rather than those currently "in charge." The life span of a hospital leader, clinical or administrative, is fleeting and fragile. I look to those who show clinical promise and have the wherewithal to demonstrate a higher purpose and direction in medicine, putting in the time to develop it. These individuals typically maintain a positive outlook in their own careers, relish the development of sound clinical systems and promote the growth of individuals who will perform well in them — perhaps a future servant leader. Medicine requires a strong, committed team working together to be successful. I'm most impressed when I see individuals encouraging others to address the most difficult problems in the clinical or administrative parts of medicine.
Clyde Jones, MD. Oncologist in Memphis, Tenn.: I think the major problem was the assumption by Medicare that commodifying medical care by turning it over to corporations would be cheaper. Certainly, in some respects, it gives them more control, but at the cost of paying facility fees instead of compensating the providers of medical care. Medicare has never been willing to pay for cognitive effort, preferring procedure-based care. We're moving away from procedures and into the realm of knowledge-based care. At least in oncology, we're turning cancer into a chronic disease, which will require long-term care and expenditure. Studies in Ireland have shown, however, that treating cancer is much cheaper than repeated hospitalizations. Organizing physicians is historically difficult, and our professional societies have not been strong advocates. The major player is Medicare. At the state level now, and hopefully at the federal level later, better regulation of private insurance could help significantly. If Medicare returns to physician-led outpatient care, they could actually experience cost savings, and private insurance would follow their lead. To think that private equity or hospital corporations are dedicated to the individual patient is naïve.
James Lee Krantz, MD. Family Medicine Physician at Catoctin Medical Group (Frederick, Md.): The main source of erosion of physician autonomy is the entry of businesspeople into medicine, which we physicians facilitated several decades ago. One very doable strategy to empower physicians is to make it more economically feasible to run a private practice. A change that could immediately affect this is to give physicians in private practice the same facility fees that hospital-owned practices routinely receive.
Evan Pollack, MD. Internist in West Chester, Pa.: Unfortunately, this country relies on commercial payers, and as long as that is the case, they will remain the major players. As noted, the payers are now employing the majority of physicians. Reducing that reliance with a government health plan and reducing physician debt would allow physicians to once again own their own practices, make patient care the priority and give back autonomy to physicians.
Sheldon Taub, MD. Gastroenterologist at Jupiter (Fla.) Medical Center: DocNation, a newly organized organization, may be the healthcare power player that can improve physician autonomy.
Grace Terrell, MD. Chief Medical Officer of IKS Health (High Point, N.C.): I always keep an eye on the American Medical Group Association, whose positive influence on healthcare policy through the years has consistently punched above its weight class. The Center for Medicare and Medicaid Innovation continues to drive much healthcare innovation through its various models over the years, even in the private sector. All of us need to continue paying attention to where technology is focusing its healthcare investment. We are riding high on the AI hype cycle right now, but real solutions are being developed both clinically and administratively with machine-learning technologies.