Dr. Johnson has three partners who have joined forces to form a private office site. In this office, they perform gastrointestinal procedures like endoscopies, colonoscopies among other procedures. Apart from their private office, they have also been employed in three local hospitals. They undertake even more sophisticated procedures in these health institutions. These procedures include biopsies, and minor tumor or lession removal. This group of four is currently involved in several health plans like, Blue cross /Blue shield plan, medicare, medicaid among many others in Unicare insurance. Unicare insurance is a massive commercial plan under the ownership and management of Unicare health system. Unicare health system also owns and manages a highly integrated health delivery system. It is therefore a direct health provider of health care services like owned /employed physicians, outpatient centers and acute hospitals.
In the past few years however, Dr. Johnson and his team have been doing some rethinking. They have been reconsidering critically four options. One of the options is that they should remain independent, The second option to be considered is that can they opt to partner up with large practice groups or be absorbed as employees in them? The third option to be put under consideration is that what of joint venture doctor practice can they have that put into consideration and lastly can they become direct employees in a large health care system?
Pros And Cons of the Four Courses of Action
All these four options have serious repercussions. If they settle on remaining independent or partnership, they will end up with little or no ability at all to accept changes on health plans. The only advantage will be an increament in salaries as a result of economies of scale going down which would have been triggered by partnership or employment.
Problems facing re-embursment systems
If Johnson’s group goes for joint venture doctor practice with Unicare commercial plan, they will have to accept its institutions and forget their involvement in their two other plans.They will get the same base pay as before with higher benefits and more paid time – off. This will be part of this joint venture project added advantage.On the other hand, if they agree to a joint venture with a different health system,things won’t be the same. They will still get a good pay, huge benefits and increased paid time – off, but it will be at the expense of patients. Patients will have to incur a higher co-pay and co-insurance as a result of the nature of contracting arrangement of the joint venture with commercial plans such as Unicare. However, in both joint venture options, patients will be in health care systems that are highly enforcerd when it comes to JCAHO quality. Also, there will be more stringent regulations on the quality of care as opposed to in the independent practice setting.
Impact on Social Welfare
The fourth option, becoming direct employees of a large system, has minimal changes. The wages, benefits and time-off are as before. The only difference will be with the health plan whose quality and productivity base bonuses to the physician will take a new better turn. In the fourth option, the bonus money is feasible that is that is taking all factors into account .These factors can include, technical, legal and scheduling considerations of the likelihood of completing a project in the time frame given. There will also be a restructuring of the outpatient practice to a hospital – based outpatient service provider. This structure leads to higher payments in comparison with outpatient and other large commercial plans. This is because two co-pays will have to be paid. One for the technical component of outpatient procedures done and the other in the professional office visit. The second part of the fourth option is similar to its first part. The only discrepancy is the feature of hospital based outpatient site which only accepts Medicare, medicaid and Unicare commercial plans.
Having covered these four options in detail, the above mentioned group has to consider the pros and cons of each option before settling for any of them. This is in the context of provider/ clinical factors.Pros and cons also have to be considered from the financial ethics angle. For better results, they have to go through the problems facing the current re-embursment systems such as Medicare and Commercial contracts that set the distinction between hospital based versus physician office based payment mechanism. Based on this report, I would advice Dr. Johnson and his team to embrace the option of partnering with large health system since it works for the good of the patients and the physicians.In this way, they would have improved their working strategy and in the long run put into consideration their client that is the patient. The doctors main aim should be to provide a solution to their patients and not to add on to their problems. If they were to adopt the option of direct employment to large health systems, they would have contributed largely to the pain of their patients and that is not good medical ethics.