Is the push for electronic medical record use driving providers out of small private practices and into the “arms” of hospitals and health systems?
Although a recent New York Times article suggests this might be the case, it doesn’t appear to be the biggest push.
According to a recent Medical Group Management Association survey more doctors are joining hospitals and health systems than going into private practice. In a recent poll of practices with three or more physicians, the percentage of medical practices owned by doctors dropped from 70 percent in 2002 to below 50 percent in 2008.
The percentage of medical practices owned by hospitals rose from about 20 percent to 50 percent within the same period.
Eric Weiss, president and senior principal consultant at The Worcester Group, Inc., a business intelligence systems consulting practice, believes that if small practitioners have not begun the EMR adoption process by 2012 they will be driven from the market, because they won’t be able to do business with either Medicare or most private insurers.
During the first couple years of adoption doctors will have a “really steep learning curve that will negatively impact both patient throughput and quality of care, says Weiss. “Hopefully patient outcomes will continually improve, which will benefit all of us. But right now that is just a vision that places a lot of responsibility on the small practitioner and offers no immediate rewards,” he continued.
Although physicians will need to adopt EMRs to cope with the shift to quality-based reimbursement and P4P/medical homes, healthcare blogger, author Ken Terry, doesn’t see the pressure to do so resulting in physicians giving up their practices now.
“Medical errors and EMRs are the simple, obvious and wrong reasons for the disappearance of private practice,” says Lucy E. Hornstein, MD, author of Declarations of a Dinosaur: 10 Laws I've Learned as a Family Doctor.
As “unsexy” as it is seems, says Hornstein, “ Private practice is disappearing as the job itself becomes more difficult – increasing demands for non-medical paperwork, meaningless oversight by non-medical personnel, and the ever-increasing litigiousness of the American public – and as an up-and-coming generation of doctors value lifestyle issues above a demanding career.”
Terry says two factors contributing to doctors joining hospitals are:
1) Hospitals are hiring, because they believe they'll need to control doctors to maximize their reimbursement and their competitive advantage in the market; and
2) Many physicians are interested in going to work for hospitals because they're seeing business drop off while reimbursement is falling behind the growth in expenses.
