Traditional healthcare providers are using both cooperative and
competitive strategies in response to entrepreneurial physicians.
Hospital cooperative VHA recently counseled its members to "build
barriers" to restrict physician entrepreneurs who compete with
them. These barriers can take many forms which include, threats of
revoking the admitting privileges of physician investors, lobbying
for tighter state control of permits for construction of new
medical facilities, convincing insurers that competitive pressures
will require higher reimbursement rates to offset volume declines,
support of bills that tax facilities providing little charity care
to provide additional funds for providers of charity care in the
community, and initiating large numbers of lawsuits against those
who desire to construct new facilities, are just a few examples of
"barrier building"(Anonymous,2004).
Cooperative strategies are emerging especially with regard to
hospital / physician joint-ventures. Typically these joint ventures
involve procedures that generate a technical fee, or facility use
fee from both public and private payers. Ambulatory surgery
centers, endoscopy suites and imaging centers are common examples
of services where hospitals joint venture with physicians.
Hospitals participating in these joint ventures realize that
hospital revenues will be reduced, but tend to participate based on
the rationale that "half is better than none"-assuming that
physicians could move ahead alone or with other partners if the
hospital is unwilling to participate (Lifton & Bryant,
2006).
The emergence of the physician entrepreneur should not really
call the question of friend or foe, as has been the case in most of
the academic, professional, and healthcare industry literature.
Research demonstrates that physician owned facilities tend to be
well run facilities with short lengths of stay and good patient
outcomes. Having pressured physicians to reduce patient lengths of
stay, integrate more technology in the practice of medicine, accept
capitation of payments, while facing increasing costs associated
with operating their practices; should it be surprising when
physicians seek ways to protect and increase their incomes? The
economy in the United States is based on the philosophy that open
competition and free market forces result in the delivery of higher
quality / higher value products and services to consumers.
New physician entrepreneurs are challenging the established health
care delivery system in this country. There are basically two
alternatives available which are; enlist the aid of entrepreneurial
physicians in designing a more effective and efficient heath care
system, or seek to protect the current system that is currently in
crisis. Regardless of the alternative chosen, the new
entrepreneurial physicians will pay a pivotal role in shaping the
health care delivery of the future in this country. The likelihood
of significant improvement in the current health care delivery
system may well depend on our view of the new entrepreneurial
physicians as friends or foes.
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