Tipping point: AMA study finds physician practice owners no longer the majority -AND- California Senate backs longshot single-payer care bill

CAL/AAEM News Service calaaem.news.service1 at gmail.com
Sat Jun 10 11:23:08 PDT 2017



June 1, 2017


Tipping point: AMA study finds physician practice owners no longer the



xayJ9> Fierce Healthcare



by Joanne Finnegan


The year 2016 marked a tipping point for physician practices. Physician
practice owners are no longer the majority, according to a survey by the
American Medical Association.


Less than half of practicing physicians own their own practice, the first
time that has happened, according to an AMA Wire article. The 2016 data was
collected in a national survey of 3,500 U.S. physicians and reported in a
Physician Practice Benchmark Survey (PDF).


It marks the first year in which physician practice ownership is no longer
the majority arrangement, with physicians evenly distributed between owners
and employees-47.1% of doctors own their own practice, with the same
percentage employed and 5.9% independent contractors.


The share of physicians with an ownership stake in a medical practice
dropped 6 percentage points from 53.2% in 2012, when the AMA began its
survey. At the same time, the share of doctors with employed positions
increased about 5%, up from 41.8% in 2012. In most cases doctors are working
for other doctors, as 55.8% of doctors continue to work in practices that
are wholly owned by physicians. 


The trend was fueled by the preference of younger physicians toward employed
positions, with almost two-thirds of doctors under age 40 working as
employees in 2016, the AMA said.


"Patients benefit when physicians practice in settings they find
professionally and personally rewarding, and the AMA strongly supports a
physician's right to practice in the setting of their choice," AMA President
Andrew W. Gurman, M.D., said in an announcement.


Whether physicians are owners, employees, or independent contractors varied
widely across medical specialties. For instance, surgical sub-specialties
had the highest share of owners (59.3%), while emergency medicine had the
lowest share of owners. Pediatrics was the specialty with the highest share
of employed physicians (58.3 %).


Hospital employment, which had been on the increase between 2012 and 2014,
leveled off in 2016, the study found. Hospital ownership of physician
practices had been on the rise, according to an analysis last year. As of
mid-2015, one in four medical practices was hospital-owned.


Although the majority of physicians still work in small practices, the
latest AMA research shows a gradual shift toward larger-sized practices of
50 or more physicians. In 2016, 57.8% of physicians worked in practices with
10 or fewer physicians.




June 1, 2017


California Senate backs longshot single-payer care bill



5oLaR79TueO29YmCWwNP3krngdiHotwU&_hsmi=52665026> Associated Press



By Jonathan J. Cooper


SACRAMENTO, Calif. (AP) - The California Senate voted Thursday to advance a
longshot single-payer health care plan that would replace insurance
companies with government-funded health care for everyone in the state.


The move came even as proponents acknowledged they don't know how to pay its
huge $400 billion price tag.


The measure would have died if it failed to clear the Senate this week.
Democrats said they wanted to keep it alive as the Assembly tries to work
out a massive overhaul of the state health care system.


"With President Trump's promise to abandon the Affordable Care Act as we
know it, it leaves millions without access to care and California is once
again tasked to lead," said Sen. Ricardo Lara, a Democrat from Bell Gardens
who wrote the single-payer bill with Sen. Toni Atkins, a San Diego Democrat.


Universal government-funded health care could give the state extraordinary
bargaining power to negotiate favorable rates with drug makers, hospitals,
doctors and other health care providers while eliminating costs associated
with billing insurance companies, Lara said.


Critics, however, warned that the measure would require massive tax hikes
and lead to long waits for health care.


Two analyses said the state would need to raise $400 billion a year. While
much of it could come from redirecting existing state and federal spending
on health care, the program would still require as much as $100 billion in
new taxes.


"I can't think of a more effective way to cripple the state financially than
to charge ahead with what seems to be a reckless plan," said Sen. Ted
Gaines, a Republican from El Dorado Hills near Sacramento.


In a study commissioned by the California Nurses Association, which is
promoting the bill, researchers at the University of Massachusetts-Amherst
suggested a sales tax and gross receipts tax on corporate revenue to raise
the money.


Because the plan would eliminate out-of-pocket health care costs for
consumers, like copays and deductibles, the study said overall health care
spending would decrease for the middle class while rising for people with
higher incomes.


"This bill idealistically assumes California can deliver on its promise to
40 million people," said Sen. Janet Nguyen, a Fountain Valley Republican.
"Yet ... the state is failing to sustain the current government-funded
system, Medi-Cal, that only serves 14 million people."


Many patients on the state Medicaid program, which covers people with low
incomes, have trouble finding a doctor who accepts their insurance, she


The bill, SB562, still faces significant hurdles. It must clear the more
moderate Assembly and secure the signature of Democratic Gov. Jerry Brown,
who has expressed skepticism about the costs.


The tax increases would require support from two-thirds of the Senate and
Assembly, and voters would potentially have to change a cap on state
spending. It also would need President Donald Trump's administration to
waive federal Medicare and Medicaid rules.




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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