When I think about doctors, I quickly realize that there’s no easy way for them to keep up with healthcare innovation. I’m a blogger that’s devoted to Healthcare IT and even I can’t keep up with everything that’s happening. I’m always learning about new companies that I’d never heard of before. How can a doctor that’s seeing 10-15 patients a day suppose to keep up?
This really hit home when I saw this graphic shared on Twitter (yes, it’s a bit old, but in this case it’s lucky that Healthcare doesn’t move that fast):
Add this to the fact that there are probably ~1300 vendors exhibiting at the HIMSS Annual Conference next week and it’s no wonders that a lot of doctors just throw up their hands. It’s overwhelming to say the least. Plus, it’s not like there are going to be that many practicing doctors at HIMSS anyway.
How then do doctors keep up with all the innovation that’s happening? Unfortunately, they don’t. Certainly blogs like this one help. Certainly there’s a lot of word of mouth that happens between doctors. However, it’s a challenge without a simple solution. Plus, let’s face the facts. Many aren’t that interested in the next innovation. They’re happy just doing what they’ve been doing for years. That’s what makes doing a tech startup company in healthcare so challenging.
What do you do to keep up with innovation? I’d love to hear in the comments.
We’ve seen a dramatic shift in healthcare over the past 3-5 years. More and more small group and independent practices have been selling to much larger health systems. Plus, we’ve seen a consolidation of health systems as well. The move to larger and larger health organizations has happened and I’ve heard many predict that we’ll never go back.
While I know there are pressures that indicate this might be the case, I also wonder if the independent doctors and small group practices that remain are the real industry disruptors. Are they the tough ones that survived through the challenging healthcare environment?
With this thought in mind, I looked up the definition of “survival of the fittest”:
the continued existence of organisms that are best adapted to their environment, with the extinction of others, as a concept in the Darwinian theory of evolution.
Sounds a bit like the independent practice to me. Those independent practices that still exist have had to adapt to the changing healthcare world. The ones that remain are likely the most “fit”. We’ve also seen a lot of other independent practices go “extinct.”
Does this give us hope? On the one hand, I can see how those independent practices that remain are strong and can adapt well. I hope that they do it so well that they disrupt the whole healthcare system in a good way. I think that the health system is generally better with more independent practices. There are a certain ownership and patient kinship that happens with independent practices that is often missing in larger health systems that treat doctors like machines that need to produce certain numbers. It’s unfortunate for healthcare that this is being lost.
The thing that scares me most about this trend is that most of the independent doctors seem to be older doctors. Most of the younger doctors I know are just fine going to the large health systems. They don’t want to take on the risk of starting their own practice. If the younger generation isn’t willing to fight the independent practice fight, then independent practices will die.
How many doctors at large health systems have created real disruptive innovation? Not very many. That’s a scary thought that should all have us worried about the future of the independent doctor. Once it’s gone. It will be hard to see how it could come back.
If you don’t think this is a big deal. Think back to the last time you called your cable provider. There’s a reason they’re ranked the lowest in customer service. They have very little competition to force their hand. The loss of independent practices will mean very little competition for the big healthcare organizations. That’s a bad thing for all of us.
What do you think about independent practices? Are the ones that remain the strong ones? Will the independent practices survive in healthcare? I look forward to reading your thoughts on social media and in the comments.
This represents some really fascinating data and illustrates a major trend around consumer demand in healthcare. More and more patients are comfortable with some form of electronic healthcare. Over time I’m sure that this acceptance is going to grow into pure demand for these type of modern healthcare options. Are you prepared for this change?
Right now, most doctors don’t need to offer the services described above. Patients don’t generally choose their doctor using the above criteria, but over time I think that will likely change. As patients get the first glimpse of how much easier a telemedicine visit was as compared to an office visit, they’re going to want more. It’s the natural process of how these things evolve.
My fear is that many small practices are asleep at the wheel in this regard. This will likely lead to problems since their big health system competitors are going to roll this out in a broad way that could make it hard for small practices to compete if they don’t get on it early. Plus, large health system competitors will be able to do things like offer 24 hour services that a small practice just can’t reasonably offer.
At the end of the day, every small practice needs to ask themselves, what am I doing to create an amazing patient experience for those in my care. Small practices that do this will be successful and retain patients. Those that continue practicing business as usual will likely run into difficulties as consumer driven healthcare starts to take over.
I recently had a chance to sit down and chat with Tom Giannulli, MD, Chief Medical Officer of Kareo and Michael Sherling, MD, MBA, Chief Medical Officer and Co-founder of Modernizing Medicine, to talk about the impact of the MACRA legislation on small practices. Both of these CMOs at EHR vendors rode the meaningful use wave and now they’re preparing to ride the new MACRA wave as well. So, they were the perfect people to talk about the impact of MACRA on small practices and how a small practice should prepare themselves for the new MACRA legislation. If you’re a small practice that’s wondering about MACRA (or doesn’t even know what it is), then take the time to watch the video below to see what it means for small practices.
After our formal interviews, we always like to hold what we call the “after party.” We never know how it’s going to go. Sometimes people join in and offer their insights and ask questions and sometimes they don’t. In this case, we continued our conversation about the MACRA and small practices, but we also talked about the impact that legislation like MACRA has on an EHR vendors development lifecycle. You can learn more about MACRA in the video below:
This post was a great way to wrap up the week and also for us to announce a new blog post series we’re starting on Monday called MACRA Monday. Long time readers may remember the Meaningful Use Monday series of blog posts we did every Monday for a few years. This will be similar as we dive into the MACRA legislation and help small medical practices understand the details of what’s coming in MACRA. Watch for that on Monday!
This week as I slowly recover from the #HIMSSHaze that sets in after spending a week with 41,000 of your closest friends and 1300+ vendors, I’m taking a second to think about how the small physician practice fits into the future of healthcare IT that was presented at HIMSS 2016.
As the graphic at the bottom of this post shows, just over 40% of attendees at HIMSS are providers. Of course, provider is a pretty broad term and that has to also be paired with the other number on that chart that 30.5% of attendees are part of the C-Suite. Even scarier is that only 2.2% of HIMSS registrations identified themselves as clinicians.
Those who read this blog regularly likely remember that I already wrote about physicians and patients missing at HIMSS. These numbers seem to prove this out. It’s unfortunate, because that means that the physician voice is largely going to be missing in many of the conversations that happen at a show like HIMSS.
With this in mind, it’s not surprising that I think the future for the small practice is on shaky ground. Many of the solutions presented at HIMSS are going to be hard for a small practice to afford. At some point these health IT solutions will be so good that they’ll become the standard of care. Once that happens, where does that leave the small practice provider who can’t afford these high tech solutions?
Considering many small practices aren’t joining in these conversations, I think it’s going to leave many small practices up a creek without a paddle. No doubt there’s a large portion of the physician population that are betting that retirement will come before this becomes a reality. Others probably think that the worst that could happen is that they’ll have to work for a large organization.
Despite this rather negative outlook on the future of small practices, there is some hope. When you look at the work that Farzad Mostashari is doing at Aledade to make accountable care and valuable based reimbursement available to the small practices you can see a future where small practices can survive even in this changing reimbursement landscape.
I think there are two models that I see emerging to allow small practices to keep some autonomy and survive in this changing healthcare world. First, small practices have to join together with other small practices to be able to create a large enough entity to be able to share in the costs associated with this future technology and to be able to compete with much larger hospital systems. Second, we need organizations like Aledade that help small practices survive by spreading their resources across a diverse group of small practices.
There is strength in numbers. So, whether the small practices form together themselves or whether health IT vendors essentially create a network of small practices, either option requires small practices to combine their efforts in order to survive. It reminds me of this clip from the film Finding Nemo. Small practices need to start “Swimming Together!”
Here’s a look at the registration numbers for HIMSS 2016:
We’re excited to be hosting this week’s #KareoChat on Thursday, 6/25 at 9 AM PT (Noon ET) where we’ll be diving into the details around Value Based Care and ACOs. We’ll be hosting the chat from @ehrandhit and chiming in on occasion from @techguy and @healthcarescene as well.
The topic of value based care and ACOs is extremely important to small practice physicians since understanding and participating in it will be key to their survival. At least that’s my take. I look forward to hearing other people’s thoughts on these changes on Thursday’s Twitter chat. Here are the questions we’ll be discussing over the hour:
What’s the latest trends in value based reimbursement that we should know or watch? #KareoChat
Why or why aren’t you participating in an ACO? #KareoChat
Describe the pros and cons you see with the change to value based reimbursement. #KareoChat
What are you doing to prepare your practice for value based reimbursement and ACOs? #KareoChat
Which technologies and applications will we need in a value based reimbursement and ACO world? #KareoChat
What’s the role of small practices in a value based reimbursement world? Can they survive? #KareoChat
For those of you not familiar with a Twitter chat, you can follow the discussion on Twitter by watching the hashtag #KareoChat. You can also take part in the Twitter chat by including the #KareoChat hashtag in any tweets you send.
I look forward to “seeing” and learning from many of you on Twitter on Thursday. Feel free to start the conversation in the comments below as well.
Full Disclosure: Kareo is a sponsor of EMR and EHR.
Michelle has posted an interesting CMS analysis of the price of EHR penalties for physicians:
CMS reports that the majority of physicians who will be penalized this year for not having met MU requirements will lose less than $1,000 of their Medicare reimbursement; 34% of the penalties will be $250 or less, while 31% will exceed $2,000.
The adjustments will impact approximately 257,000 eligible providers. While no one likes losing money, the CMS penalty “stick” is pretty small compared to the overall cost of implementing an EHR.
Unfortunately her link to the CMS report seemed to be the wrong link. I’d love to dig into the 31% of doctors who will exceed $2000 in penalties. $2000 still isn’t very compelling to most doctors I know, but if it scales from there we could see how many doctors are really going to suffer from the EHR penalties.
What’s also not clear to me is if this includes the PQRS penalties as well. All of the penalties start to add up. I also heard one doctor talk about the feared 22% Medicare cut that’s been delayed for a decade or so (I lose track of the number of years). I’ll be surprised if those cuts aren’t delayed again, but it’s interesting that many doctors fear these cuts even if they’re likely to be delayed. Perception is still very important.
Back to the meaningful use penalties, $1000 penalty is not something most doctors will bat an eye at. Even those who have an EHR are opting out of meaningful use stage 2. The math doesn’t work out for small practices. $1000 of penalties certainly won’t balance the equation either. I expect a very small number of small practices to do meaningful use stage 2. Hospitals on the other hand are a different story.
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.