[Spooky23]

Did you get any sense of how they ran their businesses?

My doctor was part of a medium sized practice that was swallowed up by a big regional system. Since that acquisition, they make the .gov that I work for look efficient and streamlined. They literally added 5-6 non-billable staff to an office that was staffed by 2. Per my doctor, that’s typical in most offices!

[aaavl2821]

Most of them focused on two metrics: 1) increasing inpatient admissions (ie volume) and 2) increasing surgical volumes (biggest profit driver in HC services). To increase inpatient volume and surgeries they often buy outpatient clinics so they can control that patient flow. So they often view primary care as a loss leader that is directing patients to the profit center of surgeries. If those nonbillable staff are optimizing billing, or generating / managing patient flow, they are accruing profits to the health system even if they are losing money for the individual clinic

Negotiating good rates with payers is a top priority and a lot of strategy derives from that (which is another reason why they bought your doc: if they control all patient flow in and out of hospital, they have more leverage with payers)

how does your doc like working for a big health system?

[Spooky23]

It seems like they can direct book specialist referrals, so I guess that’s where the money is.

My doc hates it — they built a good practice and did a lot of innovative stuff. Now it sounds like 10/10 on the awful bureaucracy scale.

The only happy doctor I know is an eye doctor who pays the fine to Medicare instead of putting in an EMR. He keeps the staff minimal and avoids overhead like IT. According to him, all of his colleagues with the big systems are miserable, working 80 hour weeks and probably 50% have alcohol or other substance problems.

[aaavl2821]

Is the doc you're speaking of a primary care doc or specialist? I've been working with some PCPs to try to find new models that allow them to remain independent without sacrificing too much financially. It's a tough needle to thread but I think happier, more independent primary care physicians are a good way to start righting the healthcare ship