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Prematurely Calling the End of Small Practices

Posted on October 16, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I continue to hear people predicting the death of small practices. In fact, I’ve met many vendor executives that have essentially started treating small practices as an extinct species. While there are certainly a lot of pressures and challenges associated with running a small practice today, we’re far from the end of small practices.

The biggest challenge to small practices is these major hospital systems that are buying up small practices left and right. We’ve seen this happen all over the country and they’ve become extremely dominant in some parts of the country. No doubt this is a threat to many of the small practices out there and is worth watching.

While many hospital systems are buying up practices, I over heard Dr. Halee Fischer-Wright, President and CEO of MGMA, make a really interesting counter point to this trend. The media and the acquiring hospital systems love to talk about small practices being acquired. However, we don’t give the same coverage to all of the doctors who leave a hospital system or those practices which get divested from a hospital system because they’re not working out as expected.

What does this mean? It means we hear about all of the small practices being acquired, but we don’t really hear about the small practices that leave the hospital system. This means we likely have a false impression of how many small practices actually still exist. I still know of many in my local area and I’m sure you do too. They just don’t get the same coverage as the large systems.

I do think that this current health care environment is harder for small practices than it was previously. The shift to value based care will continue that pressure. However, I heard over and over at MGMA about small practices coming together with vendors to be able to receive the benefits of value based reimbursement while still maintaining their independence.

Certainly this is no longer your father and your grandfather’s healthcare system. However, I still think the small practice is alive and will be for a long time to come.

Remote Patient Monitoring and Small Practices

Posted on February 18, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’ve started to see the proliferation of wireless health devices that can track a wide variety of health data and more of these devices are becoming common place in the home. Here’s a great tweet that contains an image of some of the popular devices:

While many of these devices are being purchased by the patients and used in the home, there are a number of other programs where healthcare organizations (usually hospitals) are purchasing the devices for the patients who then use the device at home. These programs are designed for hospitals to remotely monitor a patient and identify potential health issues early in order to avoid a hospital readmission.

For those who work in hospitals, you know how important (financially and otherwise) it is for hospitals to reduce their readmissions. While this is great for hospitals, how does this apply to small practices and general and family practice doctors in particular. There’s no extra payment for a small practice doctor to help reduce the readmission of their patient to the hospital. At least I haven’t seen a hospital pay a doctor for their help in this service yet.

What then would motivate a small practice doctor to leverage these types of remote patient monitoring tools?

Sadly, I don’t think there is much motivation for the standard small practice office to use them. It’s easy to see where a concierge doctor might be interested in these technologies. As a concierge doctor or direct primary care doctor, it’s in their best interest to keep their patient population as healthy as possible. As this form of care becomes more popular, I think these types of technology will become incredibly important to their business model.

The other trend in play is the shift to value based reimbursement and ACOs. Will these types of remote patient monitoring technologies become important in this new reimbursement world? I think the jury is still out on this one, but you could see how they could work together.

I’ve recently had a number of doctors hammering me on Twitter and in the comments of blog posts about how technology is not the solution to the problems and that technology is just getting in the way of the personal face to face connection that doctors have been able to make in the office visit of the past. Their concern is real and those implementing the technology need to take this into account. The technology can get in the way if it’s implemented poorly.

However, these people who smack the technology down are usually speaking from a very narrow perspective. EHR and other technology can and does disrupt many office visits. We all know the common refrain that the doctor was looking at the computer not at me. This is a challenge that can be addressed.

While the above is true, how impersonal is a rushed 10-15 minute office visit with a doctor? How impersonal is it for the doctor to prescribe a medication to you and never know if you actually filed it? How impersonal is it for a doctor to prescribed a treatment and never follow up with you to know if the treatment worked? How impersonal is it for the doctor to never talk or interact with you and your health unless you proactively go to that doctor because you’re sick?

Technology is going to be the way that we bridge that gap and these remote patient monitoring technologies are one piece of that puzzle. I believe these technologies and others make healthcare so much more personal than it is today. It changes a short office visit to treat a chief complaint into actually caring for the patient.

This is what most doctors I know would rather be doing anyway. They don’t want to churn patients anymore than the patient wants to be churned, but that’s how they get paid. Hopefully the tide is changing and we’ll see more and more focus on paying providers for using technology that provides this type of personal care.

Small Practices Don’t Really Have Someone To Trust When Adopting EMRs

Posted on March 4, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

If I were running a medical practice — and knew I had to roll an EMR soon — I’d be banging my head against a wall.  While there’s plenty of talk about the reasons for EMR adoption (in some cases, 44,000 reasons) what consistent, reliable, accessible sources of information can physicians find on the subject?

You may think, “doubtless there’s plenty of colleagues to talk with, not to mention news stories and how-to sites out there, for physicians wanting an EMR,”  but it’s really not that simple:

*  Sure, physicians trust their peers, but with so few having gone whole-heartedly into the EMR game, there’s not a ton of peer support available — and that holds adoption down. You gotta love the whole chicken-and-egg dilemma here.

* Medical practice journals toss off the occasional article on the subject, but they’re often just highlighting a study on how many their peers are also looking into buying in (big help!)

*  Consultants of unknown bias pump out advice on how to choose an EMR, but it’s scattershot and often goes too technical or gets long-winded

*  Bibles of the medical news industry may pop out a case study or two on EMR adoption, but they’re usually focused on big players like the Cleveland Clinic, not the two- to five-physician practices that really need feedback.

* Sure, there’s the Regional Extension Centers, but I’m having trouble visualizing how an already intimidated doctor would bring him or herself to spend enough time with them to benefit.

* Of course, vendors are happy to tell nice stories about EMR use by small practices, but everyone takes those with a grain of salt, with good reason.

In other words, for a problem of such importance, there’s far too little appropriate guidance out there.

In truth, some medical societies probably are reaching out, not to mention hospitals, health plans and government, with reasonably useful suggestions.  But it’s still like a violent info thunderstorm out there.  Unless physicians find an ongoing source of reassuring guidance, which seems relatively unbiased and thorough, many are likely to hang back.

It comes down to this.  Incentives or no, no small business in or outside of medicine makes such a significant purchase without feeling comfortable — and if I was a low-tech doctor, I wouldn’t know how to get there. This can’t be good.