What Does the Physician Practice of the Future Look Like?

Ever wondered what the future holds for your practice, your career?

A new report released by the Institute for Alternative Futures, a nonprofit think tank, aims to answer that very question.

Dubbed “Primary Care 2025: A Scenario Exploration,” the report illustrates four very different scenarios that could be coming down the pipeline for primary-care physicians and their practices.

Scenario 1: Many Needs, Many Models 

This scenario predicts a mixed bag of primary-care settings in 2025 as a result of three varying payment models.

It predicts that 40 percent of primary-care physicians will operate under global payments. These physicians will be part of integrated systems, such as ACOs and other managed care organizations.

Thirty percent of physicians will be reimbursed based on volume of services and incentives. Many of these physicians will operate in patient centered medical homes.

Another thirty percent of physicians will continue operating primarily under the fee-for-service model. Some of them will practice in “concierge” practices in which patients pay a higher fee. Small and solo practices will exist, but they will be struggling to survive.

Scenario 2: Lost Decade, Lost Health

This scenario predicts a widening gap in primary-care services provided to patients based on a patient’s economic status.

This scenario will occur if a global debt crisis pushes the world economy back into recession. Healthcare will be hit especially hard and most of the Affordable Care Act will not be implemented, according to the report.

Primary-care will take place in three settings: concierge practices in affluent communities; low-cost fee-for-service retail clinics in poorer communities; and integrated healthcare systems - in which physicians will be reimbursed through global payments or through a mix of productivity measures and incentives - in urban and middle-class communities.

Primary-care physicians will struggle with declining reimbursements and the physician shortage will worsen. Some will still practice in small and solo practices but not enough to meet patient demand.

Scenario 3: Primary Care That Works for All

This scenario predicts a more optimistic future. In the years leading up to 2025, primary care will be “reshaped” by a series of delivery system measures that focus on value and equity, according to the report. Federal and commercial payer reimbursements will both shift from volume to value.

More primary-care physicians will practice in patient-centered medical homes and gradually, these homes will become community-centered health homes. In this model of care, physicians will also work to support health throughout their communities and primary-care teams will grow to include additional staff members, like social workers and community organizers.

About 10 percent of the population will receive fee-for-service concierge care.

Scenario 4: I Am My Own Medical Home

This scenario is largely based on technological innovation.
Technology will develop to further enable patients to take control of their own health. Smartphone apps, for instance, will monitor patient health, and health “avatars,” (online characters that interact with patients), will become sources of information and guidance for patients.
As a result, 30 percent of patients will no longer have long-term relationships with primary-care physicians.

Physicians may actually find themselves competing for patients and most will be part of integrated health systems such as ACOs.

Share your thoughts with us. What do you think of the report’s predictions? Which scenario is most likely to come about? Any of them? A mixture of each them?