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Doctors Dump Small Practices To Join Large Providers

Intimidated, in part, by the health IT expenses they’re expected to bear, doctors are leaving private practices to seek jobs with large healthcare organizations, according to a new study by Accenture.  The need to purchase EMRs certainly isn’t the only reason doctors are jumping ship, but it is one of the most important reasons, the firm found.

Accenture interviewed 204 doctors in May, drawing from an even mix of primary care docs and specialists across equally-divided sections of the U.S.

The study results projected that only 36 percent of doctors will remain part of an independent practice by 2013, down from 39 percent this year and 57 percent in 2000. (I knew doctors were streaming into integrated health systems but that blew my mind.)

According to the Accenture survey, 53 percent of doctors responding said that EMRs requirements drove them to look for employment with big health organizations.

Doctors are also spending big on updated practice management, billing and scheduling applications. My guess is that in some cases mobile health spending is beginning to rear its head as well, even in smaller practices. After all, while doctors generally bring their own devices to the party, practices may see it as in their interest to own mobile gear and applications as they become more central to care delivery.

On the other hand, health IT may also be the saving grace for some. Doctors who do remain independent are likely to offer telemedicine or online consultations to help keep their profits at an acceptable level, researchers found.

Readers, I doubt any of you are too surprised by Accenture’s findings. I doubt public policy planners are either.

Given these realities, I’ve always wondered why no one has proposed re-structuring Meaningful Use for smaller organizations to account for the disproportionate effect such investments have on the smallest practices, say those with five doctors or less.  Incentives are all well and good, but if we don’t want to see independent practice all but wiped out, perhaps some up-front grants are in order.

November 5, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.

Quest Diagnostics Offers Big Discount On Its EMR-Practice Management System

In the past, I’ve written volumes about hospital attempts to lock in doctors by offering them access to a free or deeply-discounted EMR. I haven’t heard much about this strategy of late — either the approach was dropped or it’s gone underground — but it seems that other players are still giving it a shot.

This time, in what seems to be a fairly logical step, Quest Diagnostics has kicked off a program offering medical practices a steep 85 percent discount off of the retail price of its Care360 EMR and practice management bundle.  The announcement follows up on its 2011 regional giveaway program, which Quest says attracted thousands of physicians.

The deal, which reduces the physicians’ out of pocket cost to less than $100 per month,  also includes training, hosting, maintenance and 24/7 support for Care360. The lab giant says physicians can get Care360 up and running in about 45 days.

I can’t think of a reason why this wouldn’t make great sense for Quest; if my contacts are to be believed, it has no better reputation than its key competitors when it comes to customer service and follow-through on clinical testing.

On the other hand, if I were a doctor I’d think long and hard before agreeing to a deal like this, even though the software is just about free. There’s simply too much at stake to plunge in.

Yes, Care360 is ONC-ATB certified by CCHIT and, intriguingly, has incorporated the Direct Project specs allowing doctors to share information with patients and hospitals. And yes, it seems to have made efforts to support EMR access via mobile devices. This is all good. And of course, the price is right.

On the other hand, I’m not sure I’d want to make this big of a commitment to any particular service provider, be it a reference lab, a radiology provider or the people who stock my vending machines with sodas.

I’d argue that the more important the service is, the less you want to be beholden to the vendor. After all,what if Care360 isn’t your cup of tea?  Do you really want to disrupt your relationship with a critical provider like Quest?

Not only that, it’s risky to lock in an EMR just because it’s cheap. If Care360 takes 45 days to get installed (activated, configured, trained, etc.), it’s not going to be possible to uninstall it in a day or two, and that could mean misery on wheels if the product doesn’t work for you.

Besides, it’s possible to get Web-based, easy to adopt or drop EMRs for only a couple hundred dollars a month more. It wouldn’t make sense to go for an EMR that might not work just to save that little. (If your margin is tight enough that a savings of $200 or $300 a month is critical, you have worse problems than finding the right EMR!)

I guess I’m saying that even if the EMR is nearly free, caveat emptor. You don’t want to get saddled with an albatross system just because the price was right.

February 3, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @annezieger on Twitter.