"It's one more example of the changing balance of power from specialist to primary care, whether you see that as market driven or regulated or however you see that happen," Singleton says. "But as government and payers start to favor that gatekeeper—more preventative primary care practice of medicine—we are going to continue to see these primary care providers ascend over specialists, at least on an average basis."
Singleton says the shift is largely due to the migration of primary care physicians away from private practice and toward the employed model.
"We recognize that the majority of this bump is because more of their physicians are employed now so there is greater control," he says. "These health systems have formulated these vast employee networks and it is no secret that an employed physician is going to be much more apt and even directed in some cases to push a lab or a test or a procedure or a referral down the hall and not down the street. They aren't going to send it to an independent imaging group or an independent lab like they used to. In essence that is not really creating new money. That is just pulling that money within the hospital walls."
"As the primary care physician evolves into this quarterback of the medical home model and if they truly do what they are being designed to do, which is to control the entire flux of that patient, in theory they would dictate what tests happen and what procedures are necessary, what specialist are brought in, what preventative care or home health measures are used," Singleton says.