Doctors weigh the best pitch
Private equity groups continue to invest in specialties such as radiology, anesthesia, emergency, dermatology and ophthalmology. The more doctors they add, the lower the operating costs.
“Where private equity roll-ups become attractive again is when they can bring in money to fund some of these big expenses related to administration and electronic medical records,” Jennifer Breuer, partner at Feagre Drinker Biddle & Reath, previously known as Modern Healthcare.
On the one hand, it makes sense for a private equity firm to invest and provide additional resources, said Dr. Peter Angood, CEO of the American Association for Physician Leadership.
“On the other hand, the pressures on productivity are damn high,” he said. “If doctors are exhausted, reclaiming some personal time and choice could be more valuable than more money.”
There has been some resistance to the private equity model from state medical associations, Scheffler said. “I suspect that some doctors, rather than getting bought out by a private equity firm, will ask why they couldn’t regroup small practices and replicate the model to make money for themselves,” he said. -he declares.
Meanwhile, for-profit primary care businesses are also growing rapidly, often with the support of private capital, venture capital, and insurers.
VillageMD is one of them that aims to use comprehensive primary care as a team to improve patient outcomes and the overall patient experience while reducing costs. Optum, Humana and other UnitedHealth Group insurers have also invested heavily in coordinated primary care groups.
Paul Martino, co-founder and chief strategy officer of VillageMD, described it as a physician-led, multi-payer business model. When the company employs or partners with doctors, it keeps them in the community they serve with their full panel of patients, he said.
“Unlike our competitors who hang up a shingle and recruit a resident from a new community, we find well-known doctors in their community. Doctors don’t like when someone comes to recruit their patients,” he said. . “The last time I checked, physicians don’t want to be employed by a payer looking only for their members – we’re not asking them to lose a subset of patients.”
VillageMD often welcomes physicians who are reluctant to take risks on their own, Martino said. It often takes physicians who are fed up with hospitals’ emphasis on their specialty groups rather than clinical models, he said.
“We are looking for physician leaders who believe that value-based care is here to stay,” said Martino. “We’re not looking for 63-year-old physicians who want to increase their fee-for-service fees and retire.”
Many for-profit primary care practices use capitation payment models, the Medicare Shared Savings Program, and other risk-based agreements. Atrium, said Rissmiller, can match these incentives and support them with a well-known system that offers a full continuum of care.
Optum, the provider division of UnitedHealth Group, is the market leader with 56,000 employed physicians. It is set to grow to over 10,000 physicians over the next year.
“We continue to evolve and employ physicians who are truly very drawn to our value-based primary care model,” OptumHealth CEO Dr. Wyatt Decker said on a recent results call . “We are removing much of the administrative burden in the practice of our physicians and advanced practitioners.
“Why has the system around us created an environment where the highest paid member of the team typically does data entry two hours a day per hour of patient care? absurd and doctors hate it, ”he continued. “So there is just a huge opportunity for us to get it right.”
Humana has developed its primary care offerings for commercially insured elderly people. It has 171 CenterWell and Conviva facilities and plans to double the number of CenterWell locations from 2020 to 2022.
“It’s good to see that primary care physicians have more choices than just selling their practices to a large, integrated delivery network,” said Buckingham of Humana. “There is a resurgence around the role a primary care physician plays in helping to slow the progression of disease and helping people take control of their own health.”
Buckingham focused on its integrated model which offers seamless transfers as patients move through the system. Doctors also have the opportunity to make more money based on clinical outcomes and patient satisfaction, she said.
“We include social workers, behavioral health specialists, community pharmacists and clinical pharmacists who can all help manage the acute or chronic needs of patients,” Buckingham said. “Our primary care physicians can spend time with a care coach to understand the lifestyle changes required or with social workers to help them address the social determinants of needs.”
When it comes to recruiting doctors and asking them to reduce their patient panel, Buckingham said they are working closely with doctors to make sure their pre-65 patients have a good point. landing.
“There is usually a 60, 90 or 120 day transition period to ensure patients are transferred appropriately,” she said.
As large insurers strengthen their primary care teams, some early-stage insurance companies are moving into home health and virtual care.
The Federal Trade Commission is committed to cracking down on mergers in all industries and increasing competition in one-way markets. Federal regulators are considering vertical consolidation, with a focus on consolidating physicians across health care.
The agency voted in June to prioritize investigations into healthcare, tech and digital platforms over the next decade and allowed the use of subpoenas to gain information.
In January, the FTC asked six health insurers for claims data as they studied the impact of physician consolidation.
Regulators hope that a revamped retrospective merger program can determine whether the agency’s threshold for taking enforcement action in a merger case has been too permissive.
“Medical societies fear that there is a demise in the practice of medicine, especially in small groups,” said Scheffler of Berkeley. “All of the small groups are getting bigger and membership will continue to be a massive trend.”