Ed Rabinowitz

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“We cannot communicate with other physicians,” says Ralph Nobo, MD. “Sometimes we cannot communicate with other entities, like labs or radiology services unless we pay a large monthly fee. That presents a challenge when you’re a small practice like I am and you’re trying to survive in these difficult times.”

 and president of the Florida Medical Association, says that despite all the technological advances that are aimed at improving communication, just the opposite has occurred. "Disappointment" is the word he uses to describe physician attitudes towards health information technology (IT) and its related costs.

Nobo is not the only physician facing that challenge, though that’s small consolation when the numbers are crunched. Consider the results of recent surveys.

A survey of physician groups conducted by the 

 found that healthcare technology costs for organizations nationwide exceed $32,500 per physician—an increase of more than 40% since 2009.

 of more than 17,000 US physicians by The Physician’s Foundation revealed 72% feel that electronic health records (EHRs) have detracted from the quality of patient care or had little to no impact, despite EHR’s intention of improving efficiency and allowing more precise billing.

“The greatness that could have occurred has failed,” Nobo says. “So physicians are retiring early in their practices because of all the expenses that we have to incur, and EHRs have definitely not increased any of our productivity or patient care.”

Nobo says the way some physicians are addressing the cost issue is by seeing more patients in a shorter period of time. In other words, the time spent with each patient is being cut short.

“Sometimes when that occurs, quality goes down,” he says.

, shares Nobo’s assessment of the situation in which physicians are finding themselves.

“I think that they are absolutely overwhelmed,” he says. “I think it’s scaring the heck out of them. And I think it’s a major factor that leads physicians to want to be employed by large organizations.”

Fatum says the image that comes to mind is of two doctors he was with recently. They’ve been in private practice for a number of years. And he has this image of them climbing up a mountain. And the IT and keeping up with the regulations that go along with the IT, like the privacy and the security, it feels like they’re wearing a backpack and it’s getting heavier and heavier.

“It’s like they’re saying, ‘Ahhh, can I keep this going?’” Fatum illustrates. “That’s more of their mindset. And I don’t think there’s any group that I know of that’s ever made a decision to sell based on IT alone. But it would be one of the top factors.”

Fatum, who routinely negotiates employment, operating and affiliation agreements on behalf of physicians, says health IT costs are a big consideration when entering into these negotiations. Large physician groups have the advantage of leverage. So, what are smaller practices to do?

“We’ve been involve helping people come together, creating alliances or information exchanges,” he explains. “You don’t have to get together by merger, but you can get together in the form of an IPA [independent physician association]. That can help you do some negotiation around IT contract services.”

Fatum also advises physicians to talk to their colleagues, whether informally or at national association meetings for their specialty.

Nobo acknowledges that EHRs have afforded some benefit. For example, coding is made easier where Medicare patients are concerned. Once the physician has entered all the required information, the EHR can calculate which code or codes need to be used, and that has been a significant benefit.

But the costs of health IT greatly outweigh the benefits.

“I can talk to Quest, and I can talk to Lab Corp, but I have to pay about $200 per month per lab,” Nobo explains. “And if I add a third lab, it’s another $200. That’s $600 just to talk to three labs. It all adds up.”

Articles

“We cannot communicate with other physicians,” says Ralph Nobo, MD and president of the Florida Medical Association. “Sometimes we cannot communicate with other entities, like labs or radiology services unless we pay a large monthly fee. That presents a challenge when you’re a small practice like I am and you’re trying to survive in these difficult times.”

Physicians Disappointed in Cost of Health IT

This piece originally appears in Physicians' Money Digest.

“The importance is increasing on a weekly basis,” says Steven Spalding, MD, chief clinical integration and medical officer for Phoenix Children’s Hospital. And he’s not talking about good nutrition and a healthy lifestyle. Spalding is talking about how every week, more and more medical practices are transitioning from a fee-for-service model to value-based care. That’s a good thing, he says, because the goal of value-based care is to lower healthcare costs while improving quality and outcomes.

Jason Vargas, MD, an Arizona-based pediatrician with the Phoenix Children’s Care Network, says that as payers continue to abandon the fee-for-service model in favor of value-based contracts, providing that level of care is extremely important.  

“And it’s extremely important that we have the infrastructure to provide that care,” Vargas adds.  

That infrastructure Vargas refers to starts with hiring and training the appropriate staff. He says that from the moment a medical practice receptionist answers the phone, customer service needs to be foremost in their mind.   “Kind of like the Disney way, all along the way,” he says. “It’s an advanced level of service. Listening, showing empathy, asking how we can help them in any way.”  

Spalding says healthcare is a service industry, not unlike retail or restaurants. “And for a long time I’m not sure we realized that.” But over the last five to seven years, the increasing transparency around performance and the explosion of social media has brought an understanding of the importance of focusing on the patient experience. Part of that overall experience is the value patients and their families perceive they are receiving by accessing those services.

“I think the transparency offered by social media is going to have a very significant, transformative impact on healthcare, and evaluating care delivery,” he says.

Vargas echoes those thoughts. He says that trust is critical, because with trust comes patient buy-in. Once you achieve patient buy-in, patient compliance with medication regimens will increase, which is ultimately going to increase health, which is ultimately going to decrease costs.

“And that will ultimately improve the bottom line by rewarding those incentivized value-based contracts,” Vargas says.  

Both Vargas and Spalding agree that training can provide medical practice staff with the proper skillset needed to provide value-based care. But the mindset is something that needs to be present from the start. “When we’re interviewing, we’re looking for that personality that wants to help,” Vargas says. “But of course we’re all human, so we definitely need positive reinforcement and leading by example.”  

Spalding says a lot has to do with building accountability into the healthcare facility’s system. He points to organizations that have struggled in this area and says it’s due in part to inconsistent accountability from leadership on down. “You can hire people and teach them the skills, but then it’s a matter of being consistent and making sure they’re accountable,” Spalding says. “If we don’t have people on the care team with strong interpersonal skills where they can bond with that patient, then compliance with therapy or the medical plan is doomed from the start.”  

Spalding believes that beyond hiring and training staff there are many opportunities for medical practices to provide value-based care. For starters he points to insurance companies that, for a long time, “were seen as the enemy.” But today payers have a multitude of resources available to assist practices in providing value-based care.  

“They have rich data sets that talk about utilization outcomes,” he explains. “They have care coordinators and case managers. So, if you look at that as a partnership, you can start to see some real value in what you can do for the patient.”  

Access options are another consideration. From patient portals and scheduling appointments online to telehealth and telemedicine consults, there are many options practices can consider to enhance the patient experience.  

Can taking these steps enhance a practice’s bottom line? Spalding believes the industry is at a transition point in terms of definitively answering that question. He sees growth in value-based contracts coming out of CMS, but most healthcare professionals are still getting paid fee-for-service.  

“If you really want to get into value-based care you have to change your payment model,” he says. “My philosophy would be if you’re going to make the change, make it as fast as you can. Because if you have 66% of your contract in fee-for-service and 34% in value-based care, you’ll drive yourself a little crazy.”  

Spalding also cautions physicians against thinking that value-based care is just another fad. “This is a different time and a different era, and we have different tools available,” he says. “We can now track clinical outcomes in a much more robust nature, and tie those clinical outcomes to the actuaries in the financial office. So, this isn’t going anywhere. And if you sit this one out, you’re going to get left behind.”

Steven Spalding, MD, chief clinical integration and medical officer for Phoenix Children’s Hospital, knows a thing or two about value-based care.

Ed Rabinowitz

Articles

Physicians Disappointed in Cost of Health IT

Value-Based Models: Mindset over Money