— Patients will become increasingly “provider-agnostic,” analyst predicts
In the future, patients will lean less toward having “personal physicians” and more toward visits — whether video or in-person — with whatever physician is accessible and practices the relevant specialty, a Wall Street analyst predicted.
As younger patients begin to age, “unless you’re polychronic or you have a long-term disease state you’re in contact with a specific provider on, I think people are going to increasingly become ‘provider agnostic,'” George Hill, managing director for Deutsche Bank Securities in New York City, said Tuesday at the annual “Wall Street Comes to Washington” conference sponsored by the USC-Brookings Schaeffer Initiative for Health Policy. “The idea of ‘my doctor’ is going to diminish.”
Instead, “you’re going to need the doctor who serves you on your terms when you’re ready, because that is the type of consumer experience that people who have grown up the last 10-15 years are used to having with technology,” he continued. “They want to be served in their manner, on their terms, in a way that suits them, as opposed to walking into a primary care office and potentially waiting in the lobby for an hour to an hour and a half to spend $250 for the 6.5 minutes they got with their overworked primary care provider.”
Panelists also discussed the changes in provision of care that are being accelerated because of COVID-19. “Telemedicine is front and center,” said Ricky Goldwasser, managing director at Morgan Stanley, who also noted that the Centers for Medicare & Medicaid Services recently relaxed some of its rules and will now allow nurse practitioners to write prescriptions. “I think we’re going to see a real change and a leap forward in some of the trends that we were looking for that were otherwise going to take 5 years to a decade. Once this is out of the box, you can’t fold it back in. I think you’re going to see more localized care, more nurse practitioners taking responsibility, and I’d say the concept of ‘health hubs’ might take a leap forward because of that.”
Hill agreed, especially about telemedicine. “This really has been telemedicine’s time to shine,” especially with COVID-19 coronavirus, where providers don’t want to risk catching the disease or spreading it among their patients, he said. “The genie is out of the bottle; we’re not going back to the way things were. Telemedicine will be a big part of the ‘new normal’ — it improves access, improves outcomes, reduces costs, and now it minimizes provider risk.”
The trend toward more employed physicians was another topic of interest.”The jury is still out on what exactly is being achieved through the acquisition of all these physician practices,” said Matthew Borsch, managing director at BMO Capital Markets. “Is it part of forming cost-efficient accountable care organizations (ACOs), or is it more oriented around controlling the market or controlling volumes? I guess the answer is a little bit of both, but I think what we’ve seen heretofore, a little more the latter than the former.”
“What stops this trend from continuing ad infinitum?” he asked. “Historically, when hospitals have gone through a number of years where they’ve done heavy acquisition of physician practices, the results have not been economically sustainable. That may not be the case this time, but that certainly was the case in the late 1990s.”
“The last stats I saw of doctors graduating from medical school — almost 90% of them are going into employed practice these days, up from a number that looked like 50% a little over a decade ago,” said Hill, cautioning that his numbers may not be completely correct. “Primary care has become much less attractive of a business economically — standing up your own practice is hard work.”
“If the idea is that you’re going to come out of medical school $300,000 in debt looking to take a primary care job making $125,000 or $150,000 a year, standing up your own practice is probably not the best economic idea; the thing to do is probably go work for a large health system nearby,” he said. “I think the employed model, it’s the decision that makes sense from the provider’s perspective.”
It’s unclear, however, which type of employment model works best economically — whether it’s hospital-owned practices, private-equity-owned practices, or insurer-owned practices, said Hill. However, “I do think that despite the amount of attention that ACOs have gotten — and contracts with ACOs — the shift of medical budget responsibility … is still in pretty early days, so to the extent that that is the best place to get to, the insurer-owned practices are certainly accomplishing that more rapidly, at least from what we’ve seen thus far,” he said.
The analysts were skeptical that much would change in the area of drug prices. What happens next in that area “is not going to be until after the November elections,” said Borsch. “To some extent, it will depend on what results of the elections are. There’s some historical skepticism that we’ll see a whole lot of change because the pharmaceutical lobby is very strong at protecting the current system, which isn’t to say the current system doesn’t have some strong positive features in encouraging innovation. But in terms of sweeping changes or big reform, I just don’t think you’re going to see it in at least the next few years.”
On the other hand, they were cautiously optimistic about concierge care. “There’s a company that just came public that is focusing on concierge care,” Hill pointed out. “I think right now, concierge care is a niche offering in the primary care space. I think it works for a lot of people, but a lot of the market doesn’t know a lot about concierge primary care or what it is … I think concierge medicine has a role in the healthcare system, but it will be a long time before we’re talking about concierge medicine displacing primary care.”