Hospitalist employment opportunities are currently expanding at a rapid pace in the United States in part due to healthcare reform and in part, due to a desire to evade current hardships of independent practice, such as unstable revenue and extended hours.
The government reform encourages hospitals and physicians to unify through “accountable care organizations” in order to gain additional compensation for better patient care (“Number of Physicians Employed by Hospitalists Snowballing,” Medscape Medical News). An additional incentive the new healthcare policy offers for physician and hospital alliance comes in the form of bundled payments, which may be distributed to both parties for inpatient care.
According to Medscape, “The rise in hospital-employed physicians parallels an increase in the percentage of institutions that use hospitalists, which was at almost 60% in 2010 compared with half that in 2003, according to the just-published 2012 edition of AHA Hospital Statistics.” The American Hospital Association additionally reports that 37.9% of hospitalists working in hospitals were employees in 2010. This is true both of the east coast as well as the west coast.
While healthcare reform is providing extensive opportunities for hospitalist employment, the need for significant cuts in Medicare has resulted in the broad and virtually unrestricted authority of the Independent Payment Advisory Board (IPAB) to restrict provider spending, reports The Hospitalist in an article posted this month. The article explains that IPAB was created under the Affordable Care Act (ACA) in an effort to ensure Medicare provider spending does not exceed the pre-determined caps, a goal Congress has been unable to meet thus far.
Any proposal submitted by IPAB will immediately become law, a huge distinction from the Medicare Payment Advisory Commission (MedPAC), which traditionally counsels Congress on Medicare payments but has minimal to no authority to enforce their suggestions. The only possible checks on IPAB’s considerable autonomy are either Congress drafts an alternative proposal that results in equal cuts in spending, or Congress marshals a three-fifths majority to rule out the proposal. The executive and judiciary branches have no control over IPAB whatsoever; however, members of the board are selected by the President and then must be approved by the Senate.
The Hospitalist article goes on to address the board’s potential effect on the hospitalist profession as a whole and asks the opinion of Judith Feder, a supporter of IPAB and former dean of Georgetown Public Policy Institute. According to Feder, hospitalists will most likely be less affected than other providers, “because the Board’s cost-reduction proposals would likely focus on services where overpayment is the most acute – like imaging and high-cost specialty procedures,” (“IPAB is Medicare’s New Hammer for Spending Accountability,” The Hospitalist). Nevertheless, healthcare specialties have legitimate cause for anxiety when the board assembles this year with $15 million in funding from ACA to start.