At the end my previous post, I began to summarize the plight of solo primary care physicians and how they have to chose between a LOSE-LOSE-LOSE situation. I’ll go over them again…
1. Chose or continue to use a non-certified EHR and get Medicare reimbursement penalties – end result: lower net income.
2. Chose a costly certified EHR, and get possible Medicare incentives to offset the cost – end results: lower net income with increasing overhead.
3. Chose to not use an EHR and get Medicare reimbursement penalties – end results: lower net income.
There is one other scenario I didn’t mention and that is for the practice to opt-out of Medicare. If the practice doesn’t already see Medicare patients – this is the no-brainier solution. However, if the practice sees a significant portion of Medicare or Medicaid patients. the practice will see lower net income either way.
All of these horrible choices don’t really “incentivize” solo primary care physicians to jump on to the health IT bandwagon. And those that practice the micropractice way, where EHR’s are absolutely vital to their survival, it forces the micropractice to change their practice to become, well, a non-micropractice (high overhead model) or to resort to other sources of funding (monthly membership fees for example) that would exclude patients who would not be able to afford health care with their primary care provider.
Now, I understand the politics of trying to improve health care systems and that any policy maker is going to set policy that impacts a larger group or population of providers rather than cater to a smaller group. It is true that solo primary care physicians are already in small numbers and diminishing. As a small group, are we going to be able to change healthcare? Probably not. Most primary care physicians are in larger groups by way of survival but most do so without being happy with their job and patients are not necessarily happy with the care that they receive in this “hamster-wheel” medicine model where productivity is the only measure.
It’s gotten this way because in the health care cost pie, primary care physicians have to fight tooth and nail to get every small leftover scrap and in the end, the patients have to suffer. And this dysfunctional, “sick” system has been established from decisions (and every decision since then) made decades ago in the late 1960’s when the US health care system aimed towards higher specialization and focus on treatments and not really about prevention. Firstly, the money isn’t there, nor is it considered “profitable” to support prevention. It’s difficult to “measure” prevention because it’s not a productivity defined idea. It’s difficult to measure success for life habit changes because people are human beings, not widgets or robots. I believe there are ways to measure it (and some other countries do), but to do so, it would require a 180 degree re-think about how we view health care, how it fits with financing health care in a FINITE framework (not INFINITE) and retooling the medical education system where primary care IS the cornerstone to good health, both for the individual and the public.