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And Then There's That Chinese Proverb

October 27, 2010
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It is indeed the curse of interesting times, for physicians

MGMA president and CEO William Jessee, M.D., referenced the old Chinese proverb in his remarks at the press briefing here in New Orleans on Monday. It's that proverb that says, "May you be cursed to live in interesting times." Dr. Jessee certainly is right that these are very "interesting" times for physicians. Buffeted by actual and anticipated reimbursement cuts for Medicare, expected to achieve meaningful use under HITECH, and facing both potentially excellent and destabilizing effects from the implementation of federal healthcare reform, doctors are feeling "tempest-toss'd" as never before.

All that has been clearly on display this year at the MGMA annual conference. While there are numerous opportunities emerging in the field, including the chance to help create the new reality of accountable care organizations and bundled payments (not to mention the raft of newly insured patients expected to knock on their doors over the next few years), physician group leaders are deeply concerned over the instability of Medicare reimbursement, the unknowns around the new payment models, and, based on recent MGMA membership surveys, a tremendous hesitancy on the part of many member physician organizations to leap head-first into EMR adoption in the currently unsettled environment.

Given the potentially dramatic cuts in physician reimbursement coming out of developments around the sustainable growth rate (SGR) under Medicare that could hit doctors at year's end, perhaps it shouldn't be surprising that medical groups are hesitating significantly around EMR implementation right now. Indeed, MGMA's recent survey finding that 45.3 percent of medical groups "will likely" delay EMR implementation if the full SGR cuts go into place in January, should be seen as alarming on numerous levels.

But can one blame doctors in this situation? If they see up to a combined 30 percent pay cut under Medicare, it could be devastating for many. Naturally,that reimbursement change would undermine the goals of physician EMR adoption under HITECH. Indeed, Dr. Jessee spoke to Dr. David Blumenthal about that very issue in a conversation on Monday, Jessee told me in our exclusive interview.

Alas, as so often happens in the policy world, there are inevitably cognitive dissonances that arise between two different policy imperatives, in this case, the need to rein in Medicare costs, and the need to promote automation in patient care. But it would be devastating for HITECH if very large numbers of physicians gave up on EMR adoption because of Medicare cuts. Thus, the SGR/meaningful use "cross-tab" has emerged as one of the Rubik's cube-like issues most discussed at this year's MGMA conference, and for good reason.

One thing that hospital and health system CIOs in particular will need to remain highly conscious of is of that particular stressor in the physician world, as it holds tremendous implications for physician end-user automation and EMR adoption, interoperability, health information exchange, and a host of other areas. It will be fascinating to see how all this turns out, and what the most challenging issues are at MGMA one year from now, when medical group leaders reconvene next October in Las Vegas.




Thanks for your very excellent and informative comments! I agree completely about physician employment the devil is always in the details, as they say, and that is particularly true in this case. Simply converting physicians' pay arrangements in itself does not transform some important dynamics. There is a host of elements that must be included in order to rework actual incentives towards providing true care management across the continuum and working collaboratively with other providers, etc.

Fascinating, too, that people are discussing overlap and complementarity between ACO development and MU attainment. That is of course inherently true, but it will be interesting to see how the strategy development plays out in individual patient care organizations and systems, because right now, most of those around the table strategizing on ACOs are different sets of people from those strategizing on MU...!

Wonderful insights, thank you as always, Joe!


Mark, Great topic and coverage. Thank you. Last week, I participated in The Advisory Board's Playbook for Accountable Care Organizations conference. The salient point relative to your post was their treatment of physician employment by HCOs. The bottom line is that increasing physician employment by HCOs is neither a panacea nor a clear first choice, even when it's possible.  That's true both under ACO and Patient-Centered Medical Home, was well as under the current payment structures.  That's a generality but I know that I heard it correctly; their research detailed the clinical and financial issues.  The notable exception may be the "Clinics" and systems like the VA and Kaiser.

Another of several major take-aways was that there is overlap and complementarity between ACO's and Meaningful Use attainment. It's extremely unwise to dismiss strategic thinking about ACOs, just because, for example, your not yet at HIMSS Stage 7 with your EHR implementation, or, because you believe FFS payments are going to be with us for some time. It's simply not that simple.