Financial Incentives, Advocacy Drives Outpatient Practice Unification
Researchers explore the unification of outpatient practices and the structural racism in large health systems that has caused patient disparities.
The unification of outpatient practice and the patients they serve is best achieved through financial incentives and perceptions of equity, according to a study published in JAMA Health Forum.1 While experts believe it is the proper approach to unification, they still believe more needs to be addressed regarding finances, facility space, reimbursement policies, and patient and staff satisfaction.
“There is a strong and increasing focus on redressing structural racism within health care systems,” wrote the authors. “Despite the abolition of legal segregation decades ago, structural racism remains evident in de facto health care segregation. Segregation often results from redlining practices affecting neighborhood racial, ethnic, and socioeconomic composition and health and quality of care.”
In their investigation of racism in a large health system, researchers explored the barriers, facilitators, and effects of unifying outpatient practices—essentially reducing racism. With persistent systemic racial issues in many areas of society, health care is not exempt. From disparities in medication access2 to nearly half of health care workers reporting instances of discrimination3, researchers are collecting data to both identify and address systemic issues within health care.
Researchers explored the barriers, facilitators, and effects of unifying outpatient practices. | image credit: Artinun / stock.adobe.com
According to the authors of the study, the unification of outpatient practice is defined as multiple care sites coming together as one, offering services to all patients no matter their race, ethnicity, or whether or not they have insurance; insurance type also tends to become an issue leading to segregation in health systems.
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“It is further exacerbated when patients covered by Medicaid are treated at different health care sites and/or by practitioners than patients covered by commercial insurance,” continued the authors.1 “Because patients of racial and ethnic minority groups are overrepresented in the Medicaid system, segregation by insurance can lead to de facto health care segregation. Moreover, because Medicaid reimbursement rates are usually lower than commercial rates, these policies may reduce health care access and quality for patients of minority groups within a health system.”
Researchers sought a more defined grasp of systemic racism in health systems and how unification can break down barriers for underrepresented populations. Their goal was to define and identify the challenges, facilitators, and effects of unifying outpatient practices in a large urban health system. From February to October 2023, researchers interviewed clinical, administrative, and health system leaders throughout unified ambulatory practices throughout New York City’s 5 boroughs.
Among over 7200 physicians across 8 hospital campuses, 23 participants (52% women, 9% Black) were included in the final study. They were asked about “care delivery and financing, the current status of unification of the practice, and the barriers, facilitators, challenges, and benefits associated with unification.” The 23 participants consisted of 5 administrative leaders, 12 clinical leaders, and 6 health system leaders.1
“Our findings suggest that complete practice unification requires consideration of 3 critical factors with the potential to both encourage and discourage unification in different situations: financial, spatial, and attitudinal,” they wrote.
With their multipronged investigation, researchers identified pros and cons that support practice unification based on interviews with health system leaders and professionals. Unification that was financially driven seemed to be the most common theme upon the collection of interview data. While participants’ biggest challenge in practice unification was financial concerns, the biggest benefit they noted was financial gain.
“Three factors helped drive clinic unification: financial incentives, changes in space or practice structure, and advocacy (by leaders, trainees, or medical students). Because Medicaid reimbursements are consistently and substantially lower than those of commercial insurance, efforts to ensure financial stability were critical components of unification discussions,” they continued.1
While it’s no surprise that money helps health systems provide care, researchers also found that the benefits of advocacy and perceptions of equity contributed to practice unification. When leaders of a health system come together as advocates for unification and ensure equity within health care, overall perceptions of that health system and the services it provides will be held in higher regard.
Despite many providers consistently working to make health care more equitable, the professionals that make the industry operate also need to be properly reimbursed and included in future decision-making.
“This qualitative study found that clinic unification is possible when efforts are supported by hospital leadership and national and state reimbursement policies. However, these policies are vulnerable to political and regulatory challenges, putting future unification efforts at ongoing risk. Pending concerted efforts to fortify equity in Medicaid reimbursement, clinical and administrative leaders can work to harness existing reimbursement opportunities to support clinic unification and bravely lead us to more equitable and unified practices,” concluded the authors.1
READ MORE: Health System Resource Center
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