The Solo Provider Conundrum

With the increasing popularity of Accountable Care Organizations (ACOs), the quest for affordable care may not seem too far. Health IT has helped transform the care structure, enabling physicians to become more responsive to change. Today, almost 55% of physicians have access to electronic medical records (EMRs) helping engage other concerned parties across the care continuum. However, the support for this change is not free of personal concerns.

The healthcare reform focuses on two key elements, quality and affordability of care. While most professionals will resonate with these principles, there is some uneasiness regarding the course laid out by the government. “While the consequences may be unintended, the current healthcare reform clearly favors hospital based physicians over private practices. It is increasingly becoming difficult for solo practitioners to work independently. Reimbursements are low, costs are high and then there is the regulatory pressure.” says a Practice Manager in New Jersey.

The last few years have also shown a trend amongst large healthcare corporations of acquiring smaller independent practices. Competition is rife, and while independent physicians struggle to keep up with business expenditure, hospitals and health corps are moving on to electronic platforms with EMRs and independent health information exchanges (HIEs). “It is creating a technological gap. Solo practitioners are still struggling with EMR adoption while hospitals have started to receive their return on investments.” says one industry expert.

A significant percentile of physicians reports a decrease in overall revenue with the economic depression. Revenue cycles are drawn out with claim complexities further jeopardizing business health for solo providers. “ACOs are being slated as the next generation of healthcare organizations. Practices that fail to embrace the concept and the technology will soon become dinosaurs.” says a Hospital Administrator.

The fee-for-performance does not appease every provider. With the level of competition in the medical services market, solo providers have much to lose already. Most physicians are advocating a blended system including fee for service along with an outcome based reimbursement. George Kamajian, DO from Florida complains that the government policies do not involve the physicians in such (reimbursement) decisions. Kamajian believes that this is in fact the main reason why most patients requiring care are deprived of it, “It all comes down to government guidelines and barriers and restrictions.”


One thought on “The Solo Provider Conundrum

  1. Of the 55% who have ‘access’ to EHR’s, how many actually use them – let alone effectively? Too many EHR’s AS IMPLEMENTED are hard to fit into existing workflow for many doctors, and the only reason some cooperate at all is that they are absolutely required to. Because of workflow and other problems, too many doctors still use paper all day and then fill in the EHR later, and make little or no practical use of it.

    In the US, doctor’s who are employees are not likely to care about their employer being payed for performance vs by services – unless they get a bonus for good performance, or are on salary and have to handle far more patients as performance based reimbursement leads to staff cuts and longer hours. Doctors on their own want to maximize revenue and I can’t seem many of them wanting to give up the current fee for services model unless they see a big fee revenue the new way.

    Remember – we have a capitalism based health care system in the US. It’s all about profits, not patient outcome. And with EHR incentives limited to Medicaid and Medicare, the huge number of practices that take neither are not interested in MU and in care improvement, just maximizing revenue. HIE is still a huge, bad joke in much of the country, and doctor’s have little reason at this time to go to ACO. Imagine, for instance, that you do take Medicaid – in fact, you run a Medicaid ‘Mill’. You want to cram through as many patients as you can as quickly as you can, figuring that given the circumstances of your patients that you will make far more money with a well padded Medicaid claim then you will by a long visit with a hoped for ACO based payment.

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