Designing the future: physician poll rates the trends.

ABSTRACT

A recent interactive electronic poll of 160 physicians attending an educational conference at ACPE's Future Forum reveals some opinions physicians have about the transition of medicine into the 21st Century. Emerging issues include capitation, quality, law, and how to manage integrated delivery systems. Overall, respondents are concerned about remaining solvent in a capitated managed care environment. Electronic polls are the signposts on the information highway. As physicians negotiate the twists and turns of medicine's advancement into a managed care marketplace, there are few opportunities to question where medicine is going. Ideally, the profession would design its own future. In an educational session at ACPE's February "Future Forum" conference in La Jolla, Calif., some 160 physicians rated their opinions on the transition of medicine to the 21st Century. The "realtime" poll allowed physicians to respond electronically to questions flashed on an overhead projector.

For the sake of the poll, the physicians were divided into subpanels based on their organizational structure: hospitals/health systems made up almost 50 percent of the audience, with medical organizations making up slightly over one-third, and HMO/"other" making up the rest of the respondents.

The poll's results provide a window of insight into the strategies and opinions of ACPE members:

* The level of organizational integration for managed care is "low" or "increasing" for more than 50 percent of respondents. * Most physician group practices and hospitals have little - less than 15 percent - or no capitation in their revenues yet. * Developing an integrated delivery system (IDS) is the most difficult strategy that physician executives are managing today. * Maintaining profitability is a real concern, especially for hospitals, health systems, and HMOs. * Organizing physicians is the toughest challenge in dealing with managing care.

Level of Managed Care is Rising Faster

than Organizations Are Responding

America is moving quickly to embrace managed care, but provider organizations are still playing catch-up. On a national basis, two-thirds of physician executives rated their markets at Stage Three or lower, which reflects less than 25 percent of managed care enrollees. Only 14.3 percent of medical executives work in Stage Five markets where HMOs have signed up more than 40 percent of the population.

Overall, the rush to integrate is speeding up. All providers are restructuring for managed care. Physicians are at the center of this vortex. The number one challenge in a managed care future is creating an integrated delivery system (cited by some 27 percent). Putting the physician piece together is the toughest obstacle to overcome, report some 38.2 percent of physician executives. Right behind that is physician-hospital communications. Other key concerns are pricing services, developing information networks, reducing costs, and negotiating contracts.

The most important management issue is how to integrate physicians into an AIDS, which was indicated by 26 percent of the responding physician executives. The second most valuable skill is physician-management communications, followed by the ability to create a shared vision between physicians and management. Physician executives in medical groups rated "shared vision" as the most critical skill, while HMO medical directors ranked "communication" as their most important management tool. Developing the right strategic concept filled out the four most-cited management skills required for tomorrow's integrated systems.

Additional emerging issues that will effect physician executives are:

* Capitation. More than 50 percent of physician executives report that their organizations are doing business under capitation agreements, but for most it is less than 15 percent of revenues. As HMO enrollment rises, maintaining profitability is the second-ranked concern among the challenges of a managed care environment. * Quality concerns. Quality will be a critical success factor in the managed care world. However, while developing treatment protocols is making progress, it is not highly ranked as an issue of concern. It is still early for quality to be a major criteria for managed care selection. Creating information systems and developing indicators of quality are substantial issues for IDS organizers. But the biggest obstacle is gaining physician support for such mechanisms. Only four percent of physician executives report that their organizations have difficulty responding to data requests from purchasers. * Legal issues. Legal hurdles to IDS development are significant. The top three issues on participants' minds include antitrust (23.6 percent); managed care contracting (22.8 percent); and hospital-physician relations (22.8 percent). Legal barriers arising from physician compensation are less troublesome.

What is your organization's level of integration?

                  Total         Medical       Hospital/      HMO/
                               Organization  Health System  other
Low             13.8% (Total)    5.7%          22.2%        11.1%
Increasing      38.8% (Total)   45.7%          33.3%        33.3%
Moderate        15.5% (Total)   14.3%          17.8%        16.7%
Significant     19.8% (Total)   17.1%          17.8%        22.2%
High            12.1% (Total)   17.1%           8.9%        16.7%

What is the level of capitation in your facility or practice?

                Total          Medical        Hospital/       HMO/
                              Organization   Health System   other
None          35.8% (Total)     46.9%           34.1%        41.2%
1% - 15%      42.5% (Total)     34.4%           51.2%        29.4%
16% - 30%      8.5% (Total)      3.1%            9.8%          -
31% - 50%     13.2% (Total)     15.6%            4.9%        29.4%

Which elements of managed care do you find most challenging?

                    Total       Medical       Hospital/       HMO/
                               Organization  Health System   other
Reducing hospital
use/costs        14.6% (Total)    8.1%         14.9%         26.3%
Organizing
Physicians       38.2% (Total)   40.5%         44.7%         21.1%
Negotiating
Contracts        14.6% (Total)   16.2%         12.8%         15.8%
Pricing
Services         16.3% (Total)   13.5%         19.1%         10.5%
Integrated
Information
Networks         16.3% (Total)   21.6%          8.5%         26.3%