Outlook is negative for nonprofit hospital sector, Moody’s says

https://www.beckershospitalreview.com/finance/outlook-is-negative-for-nonprofit-hospital-sector-moody-s-says.html

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Moody’s Investors Service has issued a negative outlook on the nonprofit healthcare and hospital sector for 2019. The outlook reflects Moody’s expectation that operating cash flow in the sector will be flat or decline and bad debt will rise next year.

Moody’s said operating cash flow will either remain flat or decline by up to 1 percent in 2019. Performance will largely depend on how well hospitals manage expense growth, according to the credit rating agency.

Moody’s expects cost-cutting measures and lower increases in drug prices to cause expense growth to slow next year. However, the credit rating agency said expenses will still outpace revenues due to several factors, including the ongoing need for temporary nurses and continued recruitment of employed physicians.

Hospital bad debt is expected to grow 8 to 9 percent next year as health plans place greater financial burden on patients. An aging population will increase hospital reliance on Medicare, which will also constrain revenue growth, Moody’s said.

 

Doctors Leaving Atrium Buck The National Trend Of Groups Joining Hospitals

http://www.wfae.org/post/doctors-leaving-atrium-buck-national-trend-groups-joining-hospitals#stream/0

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Hospital systems have been on a buying binge the last few years, gobbling up doctors’ practices. By one estimate, nearly a third of medical practices nationwide are now part of a large hospital network.

But one large group of physicians is going in another direction – it’s breaking away from Atrium Health and opening an independent practice next month.
A whiteboard at the temporary Tryon Medical Partners office counts down the number of days till the practice opens. It’s made up of 88 primary care and specialty doctors who are leaving Atrium Health, formerly Carolinas HealthCare System. One of them is Dr. Dale Owen.

“Just because everybody else may be selling that doesn’t mean that we are not at the peak and it’s going to start the other direction,” he said. “Because I really think that’s what’s happening. Because we cannot keep doing the same thing. We can’t just keep buying up groups and then doctors not have any say and then expect a different outcome from the very same process each time.”

Owen is a cardiologist and CEO of the practice, called Tryon Medical Partners. The mood is different now than it was five months ago. Owen and the rest of the doctors sued Atrium so they could leave and start this practice. The hospital relented.

The doctors’ lawsuit said Atrium was making changes like cutting the number of registered nurses assisting doctors, and moving nurses from individual doctors’ offices and to a central a call center.

In preparation for the opening next month, rows of nurses are in a South Park office building taking calls from patients.

They answer questions from patients and schedule appointments. The practice will stagger the opening of eight locations in the Charlotte metro area throughout the next several months, roughly mirroring the locations of the Atrium affiliated Mecklenburg Medical Group’s offices.

What the doctors are doing is unusual. The national trend for the past several years has been practices joining hospital systems. As of 2016, about a third of doctors’ practices were owned by a hospital – a more than 100 percent increase in just four years, according to a study for the Physicians Advocacy Institute and Avalere Health. Hospitals bought 5,000 practices between July 2015 and 2016 alone.

Lisa Bielamowicz is a doctor and president of Gist Healthcare, a Washington D.C. based consulting company. She said hospitals are buying up these practices to grow their networks and keep patients in the system. Physicians sought stability and help with increasing administrative tasks due to increasing regulatory changes.

“So far there hasn’t been a ton of flux away from employment relationships. If you have health system employ hundreds of physicians, of course, there is going to be a handful chose to leave for a variety of reasons,” she said. “But it’s very rare that a group of dozens or more of physicians will leave en masse from a health system. Now that said given where the market is going and all of the change that’s occurring now it’s something that we would expect to see more of down the road.”

Because, Bielamowicz said, some doctors have found being an employee of a large health system isn’t all it’s cracked up to be.

“Most doctors are trained to be independent thinkers and don’t think of themselves as being employees of any organization even if someone is giving them a paycheck and a W2 every year,” she said. “The idea of a parent or employer organization putting limits around how they operate their office or how they would practice, the types of care that they deliver is something very difficult for a lot of physicians to adjust to.”

A few doctors from the original practice decided to stay with Atrium. The health system has said it’s hired nearly 50 providers who have already started or will start by October. As the opening date nears, Owen said his adrenaline is high and he’s excited to practice on his own terms.

“There have been lots of people who said it was going to be too hard to be independent and you can imagine that the hospitals might think that and other independent organizations because they were already independent. Plus, when you are the first do it at this kind of scale and on the backs of primary care. Everybody is going to be watching it.”

Owen and the doctors will start seeing patients the first week in September.

 

 

Employing Docs is Not a Financial Drag, CEOs Insist

http://www.healthleadersmedia.com/leadership/employing-docs-not-financial-drag-ceos-insist?spMailingID=8915501&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=921252342&spReportId=OTIxMjUyMzQyS0#

Physician Compensation

A recent Moody’s report contends that hiring physicians comes with a financial penalty. That may be true, but simple accounting misses the point entirely, some CEOs say.

The Tangled Hospital-Physician Relationship

The Tangled Hospital-Physician Relationship

Blog_healthcare management

Make a Wholesale Shift to Value

http://healthleadersmedia.com/content.cfm?topic=LED&content_id=321503

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Many health systems create divisions charged with value-based care, but if they are to succeed, the other parts of the organization must also see transformation as part of the overall mission.

Employed Physicians Add Revenue, Trim Profits

http://healthleadersmedia.com/content.cfm?topic=PHY&content_id=323647##

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Although hospitals with employed physicians gain revenue, expenses rise simultaneously. Hiring doctors is “a strategic move by hospitals for a variety of reasons, but it does come with a financial penalty,” says one analyst.