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.