NEJM Perspectives Examine Physicians’ Shift to Larger-Group Practices, Medicare Physician Payment System

• "The Independent Physician -- Going, Going ...," New England Journal of Medicine: In the perspective, Stephen Isaacs and Paul Jellinek, partners in Isaacs/Jellinek, a firm that advises health foundations; and Walker Ray, vice president of the Physicians' Foundation, discuss the lack of information about physicians' "ongoing migration from independent solo or small-group practices to larger-group practices where they are often employees." According to the authors, "This trend and its consequences for the care of patients and the practice of medicine have scarcely been explored." They conclude that the "gaps in our understanding are troubling because many of the forces that have been driving the decline of independent practice are likely to persist, and perhaps even intensify, in the coming years" (Isaacs et al., NEJM, 2/12).
  
  
• "Reforming Medicare's Physician Payment System," NEJM: In the perspective, Gail Wilensky -- a senior fellow at Project HOPE, a former administrator of the agency that is now CMS and a former chair of the Medicare Payment Advisory Commission -- examines efforts to patch the Medicare physician payment system. Wilensky writes that she believes "the key to reforming physician payment is to develop a more aggregative payment strategy," which in the near term means developing payments "that cover all the services that a single physician provides to a patient for the treatment of one or more chronic diseases." She continues that bundled payments also "should be developed for high-cost, high-volume [diagnosis-related groups]" to reimburse all physician services associated with the DRG "and perhaps hospital payment, as well." To solve the long-term issue, CMS "should move ahead with a two-part request for proposals -- one part for the design, one part for the implementation strategy -- that would result in a more fulsome redesign of an aggregated physician payment system" (Wilensky, NEJM, 2/12).