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What is Going to Kill Physician Productivity in 2012

December 29, 2011
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If you follow the trends in NCQA (National Committee for Quality Assurance), PCMH (Patient Centered Medical Home) and MU (Meaningful Use) you quickly realize that the way physicians practice medicine will change forever. The amount of oversight provided by all these initiatives, combined with ACO (Accountable Care Organizations) represents a big gorilla inside each exam room.  

Never before has there been such a radical intrusion in the way patients are treated, tracked, prescribed, data mined, and handed over during the continuum of care. Physicians will be ranked publicly against their peers, they will have to keep patient data neatly organized electronically so that they can provide reports to the government. They well be held accountable for the management of their patient’s chronic conditions; on how easy it is for them to schedule an appointment when they want it, and how quickly they provide electronic copies of records to their patients. Not to mention the countless other measures that will be tied directly to compensation and reimbursement.

From a Healthcare Informatics standpoint this opens up employment opportunities, vendor initiatives, and new software possibilities. I guess at the next HIMSS conference there will be other acronyms besides HIE. From a patient standpoint this means that my doctor is spending more time with me, I have already noticed this during my last visit. I can also get an appointment when I want and by my physician, not five days later by someone filling in.  My doc did look a little uncomfortable when I told him that his Meaningful Use score was going to improve since he was updating my medication list. I guess patients are not supposed to know why they are doing all this new stuff all of a sudden.

Do I think that all of this will result in better quality of care? You bet I do! However, what this means for small physician practices is that they will not survive the onslaught of technology and accountability. The tipping point may very well be the implementation of ICD-10. Small physician practices and private offices will not be able to afford the technology. Their margins are so slim that they will not be able to keep open appointments for walk-ins, or take the productivity hit for all the additional steps required for electronic documentation and new codes. When rates change post-ICD-10, they will see that the insurance reimbursement will be closely tied to the complexity of the diagnosis code rather than the standard E/M office visit complexity.

So next time you see your healthcare provider, don’t be surprised if they are wearing a brand new badge. They will either be acquired by someone, join an ACO or be an undefined part of a new Clinical Integrated Network.  Goodbye Marcus Welby, wherever you are.



Can you please cite a reference for the comment of "they will see insurance reimbursement will be closely tied to the complexity of the diagnosis code rather than the standard E/M office visit complexity." Thanks.

As a practicing family doc for 28 years I find many of your comments right on target. The patient -physician relationship has increasingly been pryed open by payors and government. All of the reportable data will now be transparent to our Big Brothers. Since many medical issues are patient life-style choices (not physician inepitude or mistakes) I believe patients are in for a rude awakening when their Big Brothers discover the reason for the real costs. I'm not at all clear that the quality has improved since the day of Marcus Welby. What is clear is that the costs have gone up, but I can tell you that so have patient expectations, maybe even more than the costs. Reimbursiments to primary physicians have annually decreased and so we now have fewer of them. Those of us who remain have no more windows to escape out of as the doors continue to be slammed shut in front of us to provide care for our patients. So as you acurately predictated, I will be wearing a new badge soon and answering to a new boss, not you the patient , but one of uor Big Brothers.

You'll pay cash to the doctor for your visit or go to a minute clinic for your ACO nurse visit.

There will be two systems: the old system with tired, overworked docs or the new again older system of cash for treatment (like it's done in most countries).

Good luck with your nurse visit.

Your points are all valid. But the physicians in large medical groups using the 900-pound gorilla of EHRs will tell you the biggest killer of physician productivity is the physician-EHR interface. It simply takes way too many mind numbing clicks to complete the charting for each clinic patient. The user interface to manage messaging and lab results is awkward and clunky and unable to handle the throughput required in clinical practice leading to over 1/3 of family practioners working a reduced schedule to keep up with their electronic in-box. The dominant EHR vendors aren’t interested fixing these problems in the middle of a gold rush.