Site-neutral payment, consolidation, noncompetes affect family medicine

© MargJohnsonVA - stock.adobe.com

There are a number of interconnected factors in the health care economy that all affect the business of medicine.

Site-neutral payment, business consolidation, noncompete agreements and cybersecurity all have influence over the ways doctors sustain their practices. Or not, because in many ways those factors are working against independent practice for primary care physicians.

Steven P. Furr, MD, FAAFP, is current president of the American Academy of Family Physicians (AAFP). He spoke with Medical Economics about current issues and market trends as of summer 2024. This transcript has been edited for length and clarity.

Medical Economics: What effects would site-neutral payment have for family physicians?

Steven P. Furr, MD, FAAFP: Well, I think that's one of the things that is actually driving physicians to sell their practice, or actually be bought up. We think that that should be a neutral arrangement, that you shouldn't be able to be paid more, just because of where you practice or the site that you're at. So, we have long advocated for site-neutral payments that would make a level playing field, and we hope that will actually help prop up the private practice of medicine.

Medical Economics: You had mentioned a moment ago about physicians selling their practices to join in with hospitals or health systems. Federal regulators have begun to take a stronger look at consolidation in health care, and does AAFP have a position on that?

Steven P. Furr, MD, FAAFP
_{© American Academy of Family Physicians}

Steven P. Furr, MD, FAAFP: Certainly. The biggest thing we're concerned about is the fact that physicians need to be at a practice and that there shouldn't be a restraint of trade. We're really concerned about the fact that physicians might sign a contract, and because they might be part of the large health system, if they decide, after a year or two, they wanted to leave, they would actually have to leave the state and definitely leave the county, to be able to see their patients. So, we're very concerned about that. For us, it's all about the patient-physician relationship. So we want the physicians to be able to be seen, the patient be able to see their physician, no matter where they might practice.

Medical Economics: Can you talk more about noncompete agreements and noncompete clauses and what those mean for family practices?

Steven P. Furr, MD, FAAFP: Of course, this will be probably be tied up (in litigation) for years, but what we have done is we've made sure that we've made our members aware of that, to be very careful when they sign their contracts, to look in those issues of the noncompetes and see how restrictive it might be, and to look at, is there way they can negotiate portions of that, that it might not be so strenuous. I think the important thing that we have done is raise the awareness of that for our members because that is a big issue that they need to look very closely at when they do sign those contracts.

Medical Economics: How are most practices recovering from the Change Healthcare cyberattack from earlier this year?

Steven P. Furr, MD, FAAFP: I think it's another problem that you see with the consolidation of medicine and the problem with the consolidation of our whole economy, with the meltdown in the airlines and the others over the last week. You can see when you've only got a few companies controlling almost everything, and there's a problem with them, where there’s a data breach or just a program goes wrong, that is hard to hard to function with that. So I think all of our physicians have become more aware of how they need to protect their information and put up firewalls and other things to protect their information. It doesn't matter how big or how small you are. I mean, our small local hospital, 32 bed, got broken into by another cyberattack. So as time moves on, they're going to keep moving down the food chain. You're never too big, you're never too small, anybody can be affected. With all these things that are going up, it makes it important that you do have redundant systems, that you're able to back up your systems, that you're able to get online and do other things. There's nobody too big or too small to fail with this.

Editor’s note: On July 19, cybersecurity firm CrowdStrike pushed out a faulty software update that caused a problem in computers using Microsoft Windows. The issue disrupted operations of hospitals, banks, airlines and other businesses, according to news reports. Read more about that here.