“What you have is the providers, insurance companies and state and local governments getting ready for the big year, which is 2014,” said Cyril Chang, an economics professor and director of the Methodist Le Bonheur Center for Healthcare Economics at the University of Memphis. “That’s when healthcare reform will kick in in a big way.”

Except, perhaps, for the Affordable Care Act’s individual mandate, which requires every American to buy health insurance or face a fine. The U.S. Supreme Court is scheduled to rule on the provision in 2012.

In advance of the law’s onset, however, the three major hospital systems in Memphis have been acquiring physicians’ practices at a rapid pace. Methodist Le Bonheur Healthcare, Baptist Memorial Health Care Corp. and Saint Francis hospitals all have increased the number of doctors they employ by hundreds in the past year, according to a recent study.

In many cases physicians became employees of the larger hospital systems when their private practices were absorbed. This helped them gain steadier incomes and focus more on patients than administrative worries. Hospitals benefited by securing a larger referral base and enabling better collaboration with doctors.

“When the reform measures kick in in 2014, more and more hospitals and doctors will be paid based on the quality and results that they deliver and less and less on the procedures and the visits that they perform,” Chang said.

Signed into law in March 2010, the healthcare act is all about expanding medical coverage while improving health for patients. In the future, if hospital readmissions are proven to be avoidable or unnecessary, Medicare isn’t going to pay for them.

“So readmissions, rather than being money making, will become money-losing,” he said.

The only way to minimize repeat visits is to monitor patients more closely. Often, the only way to do that is to have a much closer relationship between primary care doctors and the hospitals where patients are seen. Plus, larger hospital systems can furnish the resources necessary to comply with more stringent regulations, particularly when it comes to electronic medical records and uniform billing systems.

“The belief is that when hospitals and practices are merged together, they can form a new type of delivery model that can better connect inpatient and primary patient care,” Chang said. 

Scott Morris, MD, founder and executive director of the Church Health Center, says watching this trend unfold is “mind boggling.” 

“I truly don’t know if it’s a good thing or a bad thing,” he said.

However, certain aspects of reform could be “fantastic.” A less adversarial relationship between doctors and hospitals is one of them. Improved patient care is another.

Begun in 1987, the CHC’s mission is to fill the coverage gap by providing services to the uninsured or working poor. A variety of other services are available, too, from healthful cooking classes to a full-scale fitness facility available on a sliding income scale at Church Health Center Wellness.

Many chronic health conditions can be mitigated with weight loss or smoking cessation, or by patients exercising more regularly. In that respect, the CHC has been way ahead of the reform curve.

“The wellness issues are equally important to us,” Morris said.

Now it’s a matter of showing later arrivals to the total-health bandwagon how to apply wellness concepts on a much larger scale.

“To operationalize that is a huge undertaking,” Morris said. “2012 is going to be, how does that now look?”

One of the ways the local medical community is dealing with impending change is through the Memphis Triple Aim Project, of which Morris and Chang are part. The project is being conducted under the Memphis Fast Forward umbrella of Memphis Tomorrow. The idea is to collaborate on ways to improve the city’s overall health status along with existing measures to boost economic development and quality of life.

“I think what’s increasingly going to happen is that physicians and health systems have to work together to improve health instead of focusing on the treatment of continuing medical problems,” said Guy Reed, professor and chair of the Department of Medicine at the University of Tennessee Health Science Center.

A big driver, besides healthcare reform, is Medicare. It recently changed its payment system for imaging services, which in the short-term has spurred a close alignment between doctors and hospital systems.

“Longer term, they’ll have to work together to keep patients healthy and out of the hospital,” Reed said.

But responsibility doesn’t lie strictly with doctors and hospitals.

“Another tidal shift is that patients are increasingly responsible for their own health,” he said.

Many major health insurance plans are starting to incentivize people for healthful behaviors such as maintaining a certain weight, quitting smoking or monitoring more closely conditions such as diabetes or high blood pressure. Almost gone are the days when patients can “get off scot free” for indulging in unhealthy habits that land them in the hospital or using their medical insurance as a crutch. 

“The healthcare landscape is changing to the point where everyone is incentivized for pre-emptive and preventive care,” Guy said.

Whether Obamacare’s individual mandate is struck down by the Supreme Court, there’s no doubt that healthcare reform is being felt locally as well as nationally.

As Morris said, “I hope and pray that God is smiling on us.”

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