by Paul R. DeMuro, JD, CPA, MBA, CHC, FHFMA, FACMPE.
Any form of health care reform likely will result in more individuals having some form of insurance coverage. As many as 46 to 47 million uninsured individuals may have insurance coverage under health care reform. With many areas of the country already without sufficient primary care provider capacity, how will the system react? Will the lines at Emergency Departments at hospitals be longer like in Massachusetts after it enacted its own form of health care reform? Will more primary care physicians, like those in San Francisco, seek to be concierge providers further exacerbating the shortage?
A likely unintended consequence of health care reform is greater difficulty in accessing primary care services. The concept of every individual in the U.S. having a medical home is laudatory, but just how will this happen when there already is a shortage of primary care capacity? Early retirement by physicians and lack of sufficient nursing school teachers does not help the situation.
Compliance officers should be prepared to address many of the unintended consequences that health care reform likely will bring as a result of a probable increasing primary care shortage, including the following:
Physician recruitment efforts will be much more difficult, particularly in the primary care area. Compliance officers will need to pay particular attention to these relationships and contracts to ensure that they are consistent with applicable law and regulations, as there will be an incentive to “push the envelope” to get the recruit. It will be important to make sure fair market value compensation analyses will keep pace.
Contracts for emergency department physicians and allied health professionals staffing and/or employment contracts in this area will have to keep pace with the increasing patient loads in emergency departments. Compensation and/or subsidies to physicians likely will have to rise. A greater use of physician extenders will have to be made. Emergency department redesign may be necessary, but where will all the new professionals come from? Compliance officers will have to keep abreast of these newly evolving relationships and whether they are consistent with applicable law and regulations.
Reprinted with the permission of Paul R. DeMuro,Latham & Watkins LLP, San Francisco and Los Angeles, CA, paul.demuro@lw.com.
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