Will Physicians and Hospitals Ever Get Along? Prospects for Defragmentation in a Post Health Care Reform World
Elizabeth Weeks’ earlier post considers how payment systems serve as a source of fragmentation, discussing the excellent example of how under Medicare reimbursement rules physicians and other outpatient providers have little incentive to coordinate care with and consider the costs faced by hospitals. Indeed, the misalignment between hospitals and physicians runs across many of the book chapters. This is not surprising as the modern hospital is the epitome of fragmentation problems. For example, Einer Elhauge (Introduction) notes how hospital-based services evidence team production problems. David Hyman (Chapter 2) observes that under the current reimbursement rules “providing integrated care doesn’t pay better than fragmented care – and in some instances, it pays worse.” Kristin Madison (chapter 5) discusses regulatory contributors to hospital-physician fragmentation, such as the corporate practice of medicine prohibition and health care fraud and abuse laws that may, counterproductively, impede even beneficial integration efforts. James Blumstein (Chapter 7) and Alain Enthoven (Chapter 4) call for greater regulatory flexibility to support integrated delivery systems. Also, Frank Pasquale (Chapter 11) thoughtfully discusses the hospital-physician battles over physician-led specialty hospitals. A common theme is that at many medical centers physicians and hospital management work disconnected from each other or have relationships strained and full of discord.
The interesting question moving forward is whether health care reform will respond to these concerns and collapse the hospital-physician divide, a goal that has eluded reform attempts in the past? I’m hoping for the best but remain somewhat dubious.