The bureaucracy around healthcare and the ever-increasing administrative burden is not alien to any medical expert. Analogous to that, Physician burnout, patient dissatisfaction is also amidst the exponentially increasing trend in the United States. Notwithstanding its crushing problem here, yet it has not spared physicians in other countries. Of course, the spectrum of contemporary healthcare challenges contrasts somewhat depending socioeconomic and political milieu of the given country. Nevertheless, all share a common denominator; i.e., in almost all cases, independent medical practices are suffering enormously.
Over the last couple of decades healthcare community, more so independent physicians, have looked into finding conducts to maintain efficiency, compliance, quality, and sovereignty. They have desperately done so by acquiring technologies, hiring consultants, and even consolidating with other independent medical practices. All in all, they could not sustain the balance between cost, time, and quality without being overwhelmed and, eventually, “Burnout.” Large Health Systems have been gifted to unilaterally employ the power of the aristocracy, merge technology, strategy, and human power to conquer every aspect of the administrative and regulatory impediment.
For independent Practices to stay on top of the bureaucracy and comply with the top-down government directives, they too should be able to thrive and compete with the large organizations.
One may cynically accept as accurate that the notion of a single physician practice competing with a hospital is farfetched. That is precisely the kind of attitude that has historically forced medical professionals to seek employment instead of maintaining independence and practicing what they do best without interference with clinical judgment.
Many physicians, by trait, aspire to preserve their self-containment, but at the expense of excessive cost loads and administrative weights. Those doctors who endeavor in managed-care systems; are shielded against burdens that independent physicians have to endure. Nevertheless, even those doctors are being driven to the limit by visiting more patients in a restricted time. Overall, this means it is getting more intricate every time to operate an independent medical practice efficiently.
Diagnosing ailment and prescribing a therapy plan by itself is enough of a hurdle for any clinician practicing in any environment. Still, for the independent physician, this challenge is simply one of many.
Physicians Partnering with an extensive System
Some domain experts have hypothesized that physician employment compromise dwells in a grey zone. This means that it combines operating for or within a comprehensive network with diverging degrees of independence with limitless prospects in terms of ruling freedom.
On the other hand, a few support setting boundaries while drafting contracts that elect the right fitting. While such arrangements and scenarios certainly sound intriguing to most physicians, the reality is something different. That is, many doctors have been heaved into and lost legal battles with employers who have claimed legal rights on physician revenue from outside business ventures. Still, attracting the right partner or employer and executing the proper agreement in the face of an ever-changing healthcare realm is another burden by itself.
But, still, Independent Doctors are going away
Despite executing the proper legal agreements, it seems like adequate contract preparation has not prevented independent physicians from tumbling into the employment trap. Such a trend confirms that doctors are giving up most, if not all the rights, to their valuable intellectual properties and competitive promises regardless of how they execute the employment contract terms.
Even the Physician Practice Benchmark Survey of 2016, finished by the American medical association (AMA), indicates that fewer than half of entire physicians who render at least 20 hours of patient care per week practiced independently.
The Physicians Foundation’s biannual survey also presented similar findings. Besides, physicians also reported spending over 21% of their time on non-clinical administrative paperwork, representing 168,000 full-time doctors.
Independent Physicians are not well equipped to compete with large Healthcare Systems
The ever-changing medical practice landscape and its accompanying burden associated with it have established an utter environment for what metaphorically label for “survival of the fittest.” Many services delivered in hospitals can often be reliably and conveniently implemented in ambulatory environs. That is why physicians have become proprietors of entities that are directly competing with hospitals for patients. Although there are increasing prospects that health systems call for hospitals and physicians to collaborate, the enthusiasm and energy for larger organizations and physicians to work together is an underdog in many markets.
Optimistically, federal and local leaders hope to enhance patient safety, and quality appropriates a general interest association between medical staff and hospitals.
Improved patient safety envisions the joint use of new health information technology to enhance quality through physician and hospital collaboration. Instead of cooperating to address excessive healthcare spending, physicians and hospitals have refabricated clash that is pressing costs higher and faster, sometimes as collaborators but evermore as competitors.
Undoubtedly, the hospitals and managed care organizations have captured the patient source, which makes physicians dependent. Additionally, organizations hold the reign on being able to utilize resources for optimal reimbursement and administrative initiatives. Irrespective, government intervention has failed to create peace amongst physicians and hospitals yet has placed many boundaries for an impartial collaborative environment.
Hospitals and large Systems need Physicians
Hospitals and systems need a physician strategy and working model that includes diverse arrangements, incentives, engage the physician community, and so on. Organizations need to absorb their physicians in planning and organizing overhauls. Nevertheless, the Physician professional realm is a winding one, as they cannot be lone employees. Physicians must be keepers of the organization’s objectives and strategies, something which corporate cartels will fight to the teeth before letting it prevail. Instead, large entities will make sure to keep the healthcare community dependent and desperate. The latest has been successfully executed through corporate monopoly, governmental lobbyism, combining human resources and technology, along financial consolidation.
Independence or Employment: What is the Cost?
It has been postulated that when large organizations acquire independent physician practices, costs go up, and quality wane. If the acquisition is charitable, populations endure financial harm; as the taxes that independent practice previously used to pay come off the tax rosters.
With physician’s employment still comes burnout- even more frequently than their independent peers.
Today, the suicide rate among physicians is at its highest. On average, one doctor dies by suicide in the United States every day. The corporatization of medicine is a hunk of the predicament. Irrespective of the physician’s demise, corporations continue to take over medical practices for financial gain. The more physicians that large systems own, the further the market portion they apprehend, the more bargaining power they gain!
A 2019 report from Merritt Hawkins shows hospital systems earn a net worth of $2.4 annually for every doctor they employ. Doctors sign away their liberty to avoid an increasingly burdensome regulatory environment and often regret it afterward. Though various employed doctors will personally advise, as they want to escape employment, stringent non-compete clauses in their contracts restrain them as they are in handcuffs.
It is noteworthy, while physicians’ employment trend proceeds, yet some believe it has slowed down, some even parting employment. Yes, a segment of physicians leaves the employment option utilizing pursuing a Direct Primary care practice model (DPC).
DPC is a lucrative and well-executed strategy only if a long-term plan follows it. Naturally, the corporate world, too, will be looking to gain control of the DPC market. That adds up to another fight for doctors resisting managed care and insurance companies’ dictation. Physicians are at the fore of the new drift in medicine beyond a keen desire to practice medicine without agonizing about meeting an employers’ rations.
Independent Physicians lack larger Engines to compete with Large Systems
The contemporary challenges are threatening independent physicians who verve beyond financial and administrative strains. To be competitive and sovereign, doctors must acquire proper logistics, technology, and hands-on support. The vehicles should cover all aspects of a prevailing healthcare system irrespective of size and association; unlike doctors employed in managed-care settings, physicians in independent practice strife on a day-to-day basis with issues nearly as complicated as human health itself. That includes the shift to value-based reimbursement, HIPAA compliance, the meaningful use of electronic health records, the implementation of the ICD-10. Not to mention- they must take on the costs and time associated with the maintenance of certifications.
However, are Physicians interested in Investing in Technology?
Based on a recent study at Vanderbilt University Medical Center (VUMC), independent practices appear to be less likely to support Electronic Health Record (EHR) technology than clinicians in hospitals or group practices. Everson and others at VUMC based their assumption by correlating rates of testimony and attrition collected among independent physicians to those who joined hospitals or group practices in the meaningful use program between 2011 and 2016. During the survey, roughly 70% of physicians stated that EHR Technology improves medical care quality. Likewise, most young patients retorted that EHR technology enhances the quality of care.
Researchers also found that 49% of independent physicians heatedly confirmed meaningful use at least once during the program. Relatively, 70% of the physicians that integrated with group practices or hospitals attested to meaningful use. Besides, only about 50% of independent physicians that showed the benefit of meaningful use between 2011 and 2013 also testified to it in 2015.
The recent study added that more independent physicians left the meaningful use program as years went by than those who had joined other practice models. It is, thus, clear that independent physicians have more liberty in how their practices are managed. As a result, physicians in group practices or hospitals may prefer not to attest to meaningful use or elect to cut their confidence in EHR technology. The cost-benefit comparison of utilizing EHR and meaningful use showed to be worse for independent physicians.
Independent doctors don’t have the financial incentives to overcome the cost of keeping up with meaningful use in addition to the time weight of utilizing Electronic Health Records. Economic losses are especially steep for independent physicians who can’t distribute the expense over a large organization.
Independent factors such as the aging separate physician population also contribute to the desertion of Meaningful use by physicians. For instance, more physicians retire in more significant numbers than physicians in hospitals or group practices. Or millennials are more inclined to use technology vs. more senior peers.
Everson and his team also posited that independent physicians who confirmed meaningful use were more likely to join hospitals or group practices during the study period than physicians that had not participated in the EHR Incentive Programs. Moreover, clinicians who are not technologically savvy lack the option to join a more generous system to obtain sustenance with new technologies.
Undoubtedly, the meaningful use schedule exacerbates a growing technological split between independent physicians and those seeking employment options.
Other challenges are endangering the bottom line by taking physicians apart from spending quality time with patients. Those encompass the collection of co-pays and deductibles, increasing amounts of paperwork, rising operational costs, the growing sway of payers on treatment decisions, and the need to keep up with rapidly evolving information technology.
In short, Physicians who function in more extensive healthcare networks do not feel certain constraints as acutely as the independent physician does. The more extensive health networks have in-house agents whose time is devoted to grasping those barriers to providing care.
Can join forces help Physicians stay Independent?
Some medical practices are joining forces by shaping into medical groups to stay competitive. For example, Internal medicine and primary care practices that desire to remain independent are contemplating assembly into a variety of practice models along with corporate structures. Doing so they hope will give them a better chance of survival against hospitals and Health management Organizations.
The transformation to value-based healthcare, merger among physician practices, and an emphasis on discovering capableness is rendering it troublesome for smaller practices to succeed alone.
Although the independent physician’s practices have standard goal lines, i.e., to survive and be competitive, there are also variances. For precedent, different medical clinics part with the Accountable Care Organizations (ACOs). The latter are healthcare providers, potentially including doctors, hospitals, public and private health plans, and others, who join forces to provide coordinated care to Medicare patients. But there are multiple types of ACOs, each to choose from its features.
The main drawback of consolidation is its propensity to become excessively bureaucratic and prone to corruption as it grows in size and scope. On the other hand, collaboration enables two or more people to work jointly to accomplish the same objective. Through collaboration, members can freely contribute to the process by practically following their own set of visions and missions with small or no collective authority on others. The discrepancy of collaborative over consolidated efforts is solely originated from emphasizing similarities over differences. The universal ornateness connects people for what they hold in stock, but the same people drop the value of contrasts that makes every soul novel.
The collaboration will harness the diversity of the individuals to efficiently contain the challenges that will, moreover, comprise the unleashing of corporatism.
In an individual's term, diverse talents brought to the table are the most significant unifier of the elements than their similarities. But smaller clinics and independent physicians do not have the luxury of an expert team who focuses on regulatory and compliance problems. The doctors in the following settings must add these duties to their already considerable workloads.
Additionally, the consolidated groups serve as an easier target for the even more substantial organizations, as they inevitably get bought out.
Independent Physicians need leveraging payer support and Partnering with Peers
Pay-for-performance models structures have the propensity to demand steady upfront and ongoing expenditures. It puts practice resources at risk, laboring the already shrunken profit margins of independent physicians and small practices. Thus, Prevailing standards require practice alterations that can cost practices thousands of dollars, if not millions.
From information technology and quality reporting policies to additional staff and preventative care services, small practices that engage with limited budgets and strong earnings always bear the initial outlay needed to join an alternative reimbursement basis. Despite the enlightenment of financial difficulties, physicians in independent practices have been disinclined to embrace pay-for-performance principles.
Today, many independent physicians have access to sophisticated software, hoping that it will help them address many existing challenges. Many expect that software-as-a-service (SaaS) solutions will ease the strain of remaining HIPAA compliance, co-pays collection, maintaining certifications, as well as keeping up with the growing stack of paperwork.
Healthcare system Demands to Fluidity
Healthcare is in a melting physical state, as the traditional solutions will be futile, given the now evolving versatility of the medical tending. The scope of the outmoded population health scheme is extravagantly large to support its uprightness for a sustainable period.
The fundamental solution requires breaking up the health care into smaller dews of societies where all the stressors focus on individual medical practices. It must focus on applying tailored strategies, technologies, policies, and hands-on solutions towards eliminating the political and socioeconomic barriers of quality healthcare for all. The modern system ought to be without risk to personal freedom.
Simplicity is the Cornerstone of Thriving Healthcare Technology
Today's software-as-a-service-based solutions (SAAS) do not address most of the actual pressures that are aiming down on independent practices. Most SAAS products, in fact, only help with ICD-10 implementation, the meaningful use of electronic medical records, and the adoption of “lean business manners. The integration of conflicting physician technologies, escalating administration decrees, and corporate monopoly has resulted in utter physician burnout.
Every task needs simplification. That includes healthcare and the practice of medicine, The simplicity of medical practice is far from close, even though technology has been perfected continuously, thus indicating poor healthcare delivery strategy. In general, the perception of complexity in the face of optimal scientific and technological advancement is a sign of the petty dysfunctional system.
Small Medical Practices Should have Interoperable Systems too
Point of Care Systems Should be coupled and interoperable. Electronic health record adoption must embrace interoperability. Because it will increase practice revenue and improve patient encounters experience for smaller medical practices. Latest means a back-end system comprised of an open Application program interface (APIs) and a system that can easily relate to and share knowledge with other providers, government agencies, and patients.
A more evolved practice-management system will save time and cost for small practices not just as they implement EHRs, but confront the endless other technological concerns that independent practices strive to endure.
Independent Medical Practices should not fall Behind
Independent practices need trained people and technology to work in tandem, which the managed care system has been continually mastering.
For independent medical practices to persist, thrive, and create jobs, the physicians who operate them need to think about better practice management tools, which will never comprise software alone. Combining human expertise with software is what will put independent physicians on an even foothold. Arrangements that achieve this are what independent doctors should be necessitating. When they have this practice management system, they will no longer be in the peril of falling behind.
Independent Physicians need more than just Technology
The solo physicians’ hurdles cannot be appropriately approached solely with technology. Larger health systems don’t even try to address the difficulties in that way. Instead, they place teams of consultants and experts to work on the enigmas using the appropriate technology.
Since small practices are not able to do that, it’s time they begin enjoining more further from their practice administration methods. If they can’t afford to employ teams of experts to address administrative and compliance burdens, they should, at a minimum, have entrance to that expertise. The following is what the practice-management system of the future must be able to do.
New technologies bring doctors, patients, experts, regulators, and other stakeholders together in one marketplace. The end will be the advancement that, once again, will make physicians energized about their professions.
Independent Doctors require the tools to adapt to Policy Changes
Rather than just streamlining operations and helping save time, a robust system must put the independent physician in connection with the human masters who can genuinely solve queries.
This way, the independent physician can do meaningful work: curing the sick.
When Washington finally agrees on healthcare reforms, they will only have settled the country’s policies on reimbursement for healthcare services rendered. The political conflicts will have only done so much to improve the nation’s overall quality of care. It won’t be sufficient!
Fortunately, there are circumstances that technology, technology working together with people that public policies still strive to accomplish.
Real Practice Management asks for new Thinking
When it comes to the new digital systems being used to manage health networks and hospitals, these are also waning to live up to their full potential. Too frequently, healthcare facilities rely on software alone to bring efficiency to their organizations. But healthcare delivery is far too complex to be handled by software alone. There are dozens or hundreds of competing software systems on the market, but also seldom are validated with the actual user’s patients and doctors at the epicenter of the reckoning.
Physicians will need to discover so that their understanding of the fundamental technologies can be improved. The process should start in medical schools to become adept in handling the technology right from the beginning of their practice. The skill of the doctors has to be harmonized and directed in the right path to create the right tool that will help domains such as healthcare. Only then will the physicians use them to achieve positive outcomes and help their patients in the right way. We have to account for the decisions and judgments of the stakeholders of the healthcare community so they can optimally utilize technologies.
Back in the 1990s, when the race to build personal computers and software was heating up, companies like Microsoft and Google pulled to the front by designing intuitive and easy to use for the consumer. We are still waiting for that moment to arrive in healthcare.
Bottom line: Independent Medical Practices must Survive both in Urban and Rural Communities
In rural areas, local medical clinics are slowly vanishing, taking away access to healthcare for people who don’t always have the means to travel. When a doctor in a local clinic shuts the doors because staying in business is too expensive, that physician often moves elsewhere and joins a large network. But the patients that doctors once treated are often left in the cold.
An entirely new practice management system is needed if America intends to provide excellent healthcare outside of urban and rural areas, a system that gives small clinics access to the same expertise and technological advances that larger systems handle.
Originally published at https://www.datadriveninvestor.com on June 3, 2020.