Feeding the Fire of Non-Participation
Amid all of the hubbub around ARRA incentives, federally-mandated disincentives for non-EMR adoption, and best-practices-outcomes-based-evidence-based medical standards with which to comply in order to be ‘allowed’ to be a paid player in healthcare provision, did anyone ever stop to consider the huge – and I mean HUGE – motivational log being thrown onto the fire of non-participation?
I mean, come on, I’m committed to provide the best care possible for my patients. Plus, I’m a techno-geek-gadget-guy from way back. I love and encourage the intersection of healthcare provision and technology. But, when you consider the following, even I have to wonder if the conjuncture of the two worlds might best be promoted outside of the current realm of ONCHIT, CCHIT, and a variety of other ‘chit.’
- In order to remain profitable, I participate in around 40 private insurer programs.
- If I generate $4-500,000 yearly, I take home somewhere just into the six figures.
- In order to maintain those numbers, as a primary care pediatrician with a heavy dose of Medicaid patients, I have to see somewhere around 30 patients per day in order to pay my bills and make a decent living. (“Decent living,” by a pediatrician’s standards, as you can see, is not what most specialists would tolerate.)
- If I didn’t have to chart, make phone calls, review labs and other assorted outside medical data, attend hospital meetings, assist my staff, and otherwise run my practice, that would give me 16 minutes face time per patient average in a 40-hour week. (40 hours! Wouldn’t that be nice?)
- I’ll now have to consider 155,000 ICD-10 codes instead of the paltry 17,000 from ICD-9.
- None of this even mentions hospital rounds, emergency C-sections, or 24/7/365 availability.
- I rush through most days and barely know some of my families. (Not to mention my own family.)
- Studies suggest physicians spend at least 1/3 of their time in non-direct patient care work. (I’d suggest that is low-balled.)
- After all of this, in order to “follow my bliss” and pursue technological enhancements of my medical services, I need to detract yet further from my family time, my personal time, or sleep. (Guess which goes first.)
So, follow me here, if I wasn’t a genetic geek, if I didn’t enjoy the thrill of resolving “Blue Screen of Death” issues, if I was like the majority of non-techno-minded primary care docs who lead very similar lives to the list above, how much do you think I would want to add a giant new learning curve into my scheduled chaos? How much do you think I’d want to risk my already meager monies on an electronic health record system that might get reimbursed in a few years?
Now, instead of maintaining 3-4,000 active patients with the life- and work-styles mentioned above, what if I abandoned all of those who can’t pay or who pay poorly and who place excessive non-medically-related demands upon me (both patients and insurers) and switch to an old-timey, doctor-patient-only practice? (Some call the new version, “concierge medicine.”)
I mean, if I didn’t have to answer to insurer and CMS requirements and wasn’t worried about “meaningful use:”
- I would still chart, make phone calls, review labs and other assorted outside medical data, attend hospital meetings, assist my staff, and otherwise run my practice.
- Instead of 30 patients a day, I might see 15 (maybe 5!) – and I would know all of them.
- I could limit my total number of families to a handful of hundreds charging less than $100 per month each.
- Prepayment could include the costs of vaccinations, simple labs, and all office work and procedures, and
- Hell’s bells, I could even do house calls while still more than doubling my take-home pay!
All of this would be allowed without worrying whether or not I have the necessary number of bullet points, if a vision screening or required immunization will get paid or not (or enough), if my receptionist got the co-pay upfront, or if my EMR was being used meaningfully.
Guilt for not helping those less financially endowed? Why? Don’t the families who can pay also have legitimate healthcare needs? Plus, wouldn’t I be actually serving those for whom I work better, with care from a more relaxed, and ergo more focused, medical brain? With the reduced restraints on my time, wouldn’t I have even more ability to help out at the local free clinic or some other philanthropic venture?
Remind me again why I continue to participate with all the restrictions and requirements and rules imposed by sometimes even non-medical people. Jog my memory as to why possible reimbursement of $44-64,000 of my hard-earned moola for the privilege of learning a whole new way to record my work is considered an “incentive.” Tell me once more why participation in a broken medical model, now about to add – oooo, ahhhh! – “Technology,” something often hard to understand and even harder to use, makes sense.
Seriously. Remind me. I think I’m starting to forget as I feel the warm glow from the growing fire of non-participation.
Dr. Gregg Alexander is a grunt-in-the-trenches pediatrician and geek. His personal manifesto home page…er..blog…yeh, that’s it, his blog – and he – can be reached through http://madisonpediatric.com or firstname.lastname@example.org.