He also called it a fallacy that inte- grated health care delivery models must center around a hospital to succeed. Nor must a physician be an employee to par- ticipate. “We can already do these things in
Texas, and the idea that you can put phy- sicians on a salary and that will cure all of the ills in the world is overly simplis- tic,” Dr. Lockhart said. Instead of reducing costs, eliminating the state ban on the corporate practice of medicine could have what he called a “paradoxical effect” and actually increase costs. That’s because hospital-based ser- vices, such as labs and imaging — which an employee would be required to use — come at a considerably higher rate than those a private practice physician might find at an independent facility. “What makes these models work — whether it’s an ACO or a health care col- laborative, I don’t care what you call it — is providing an integrated delivery sys- tem with effective physician governance, where policies are designed so we physi- cians can discharge our primary role as patient advocate,” Dr. Lockhart said. Physicians also caution that health
care delivery is a local issue, and any policy must give physicians and others the latitude to organize and integrate in a way that meets their communities’ needs. “ACOs are one option, but not the right thing. Nor is the patient-centered medi- cal home the right thing, although these ideas are a step in the right direction generally,” said Plano family physician, Christopher Crow, MD, chair of TMA’s Council on Socioeconomics. About half of primary care practices
in Texas comprise small physician groups that often lack the financial or admin- istrative wherewithal to form the large, coordinated systems needed to manage large patient populations, he says. On the flip side, it can be inefficient for pur- chasers, such as health plans, to contract with a myriad of small practices using something other than a fee-for-service payment model. Dr. Crow’s primary care practice, Vil- lage Health Partners, was one of the first in Texas to launch a National Center for Quality Assurance-certified medical
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November 2012 TEXAS MEDICINE 27
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