What can doctors do to improve their business prospects in 2006? Place your bets on three activities: political and business activism; creative grouping; and physician entrepreneurs using "disruptive technologies" to improve productivity.
Norbeck and his colleagues' efforts show organized medicine can win business and political battles. Most of the
$16 million in initial grants went to primary-care organizations.
My other advice on political activism is this: Repeatedly inform your political representatives that Medicare cuts will create a political crisis among seniors, 65% of whom vote. Already 30% to 40% of doctors say they will not accept new Medicare patients if a 4% rate cut goes through this year. Medical student enrollment is dropping; fewer physicians are entering primary care; and a 50,000-doctor shortfall is predicted by 2010, a deficit expected to reach 200,000 by 2020. Politicians will soon be hearing from seniors who can't find a doctor.
Should doctors team with hospitals or go it alone? Together is preferable, apart if necessary. It depends on physician relationships with hospital chief executive officers. It may depend on Stark laws, state certificate-of-need laws, or inspector general's office regulations. Right now the feds are considering safe harbor exemptions for joint hospital-doctor EMR ventures. Generally hospitals have the brand-name recognition and other resources, including capital, to make a joint venture better than a solo deal. Also keep this in mind: Most hospital executives have concluded that partnerships with physicians are required for long-term survival. Success will depend on a critical mass and mix of hospital and doctor skills that appeal to consumers.
James Weintrub, a plastic surgeon in Providence, R.I., with the help of a software expert, Greg Brownell, has converted the
400-page CTP code book and the 900-page ICD-9 book into one electronic volume. For $99 per year, you and your coding people can subscribe to this book by going to the Web site dpnx.com.
Why is this "disruptive"? Well, one, you can toss those bulky code books. Two, you can save time looking up those codes. Three, you can find out how codes really work. Four, you can speed health plan pre-authorization requiring codes. Five, you can control and capture charges for those procedures you perform out of your office.
What about EMRs? Don't they qualify as disruptive technologies? Many are promoting EMRs as a holy grail. Everybody knows, except for practicing doctors, that EMR implementation is the thing to do. It's being pushed by government, health plans, pundits, economists, and more than 100 EMR vendors, all of whom benefit one way or another by EMR implementation.
Certainly EMRs are disruptive. But they are not simple. They change workflow, initially lower productivity, suck up lots of money-as much as $44,000 per physician the first year-and encounter resistance from many physicians within any given group. But the handwriting is on the wall. By 2010, EMRs will probably be necessary for practice marketing and survival. n
Richard L. Reece, M.D., is a pathologist, author and speaker based in Old Saybrook, Conn. He is also editor of Physicians Practice Options, a national monthly newsletter.
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