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AAOS Warns That Reduction in Number of Solo Practices Could Negatively Affect Patients and Economy

During the hearing, titled “Health Care Realignment and Regulation: The Demise of Small and Solo Practices?,” Dr. McIntyre told the subcommittee how increasing administrative and regulatory burdens from the American Recovery and Reinvestment Act (ARRA) and the Patient Protection and Affordable Care Act (PPACA), coupled with decreasing reimbursements, has forced his New York-based private practice to join a hospital group. “The combination of decreased reimbursement, increased reporting requirements, the need for huge outlays for technology improvements, and uncertainty about future earning potential are driving private practice physicians to seek employed positions,” Dr. McIntyre said during his testimony. “Doctors cannot take care of patients and, at the same time, meet all of the demands placed upon them, especially in an environment of shrinking revenues and increasing costs.” According to the AAOS, Medicare reimbursements for common orthopedic procedures, such as torn meniscus surgery, have decreased up to 28% during the last decade, and reimbursements from private insurers have fallen in a similar fashion. At the same time, practice costs, especially medical liability insurance costs, have risen exponentially. Dr. McIntyre told the subcommittee that his medical liability insurance rates have risen by 300% from 1994 to 2010. This has resulted in a 300% increase in hospital employment of orthopedic surgeons between 2004 and 2010, the AAOS says. Should this trend continue, Dr. McIntyre suggested that growing physician–hospital employment could lead to a shortage of employed positions, which could threaten patient access to care. The situation could also result in decreased physician autonomy, reduced physician awareness of the cost of care, barriers to innovation, and the loss of jobs and tax revenue. “If private practice disappears,” Dr. McIntyre warned, “patient access to care, local employment, and tax revenue will all suffer. We need to strengthen private practice as well as the other models of healthcare delivery to ensure patient access to quality care.” Visit the AAOS's Web site for more information.

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