Will small IMP practices survive the coming healthcare reform?

[Guest guest]

Has anyone seen last week's New England Journal? Apparently they

recently had a piece by Elliot Fisher and Don Berwick recently promoting

the idea that megaclinics such as Mayo or Intermountain are efficient

and microsystems are inefficient. I know Elliot Fisher is a big

proponent of accountable care organizations (described last week in the

New Yorker) that would give control over money for a region to big

integrated health systems.

If that is the future, is is worthwhile to try to build small or

midsized ideal medical practices now?

There's always the Harry Tuttle role of renegade, freelance cash

physician but if enough patients opted for cash docs they might crush

that by denying coverage for tests or consults ordered by docs outside

of the accountable care organization. Too many independent docs

ordering expensive things would be quickly be seen as a problem.

(Extra credit for Brazil references in replies)

R. Pierce MD

Rockport, Maine

www.midcoastmedicine.com