New health law deals blow to single physician practices

We won’t know with any certainty for years whether the Affordable Care Act will ultimately result in a healthier US population, but the new health law is speeding the demise of an American small-business institution; the one-doctor medical practice, according to an article published in the Union-Tribune San Diego.

Problems for the single physician practice began in the late 1990s. Government cost controls steadily eroded revenues while simultaneously boosting costs, by stacking on requirements for paperwork and accounting. Some physicians increased patient visits to maintain income, but others just accepted the decreasing reimbursements, and consequently, falling incomes.

The article reports that the new federal health care policy has delivered a major blow to productivity with the ferderal HIT meaningful use program. Mirroring the problems that crippled online insurance exchanges for months, physicians are dealing with the phase-in of the meaningful use program, to install and maintain electronic health records for their patients.

Compounding the cost for an EHR investment, Medicare reimbursement fee schedules have stayed far below inflation, ranging from zero to 1.8%.

The article recounts one doctor’s tale of low, almost ridiculous reimbursements that have arrived years after having been filed. And now with meaningful use mandates, practices like this one need to make significant financial investments in electronic health systems to avoid financial penalties.

Nearly 70 percent of physicians say digitizing patient records has not been worth the cost, according to a survey by Medical Economics magazine. This negative cost-benefit view comes even after $27 billion in subsidies to health care providers for the systems. A big problem is interoperability. Since that wasn’t included in the federal mandate, the communication gains among the hospitals, clinics and physicians’ offices just aren’t happening.

Though interoperability among EHRs is a major focus at the Office of the National Coordinator for Health Information Technology (ONC), it is still not mandated and continues to be a barrier to the flow of health information between healthcare providers. In addition to the significant financial investment needed for EHRs, physicians are finding the EHRs difficult to use and oftentimes, the EHR system robs the physician of time he or she could be spending treating patients.

In a recent study, Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy, published by the Rand Corporation, one of the key findings of physician dissatisfaction was regarding EHRs. Aspects of current EHRs that were particularly common sources of dissatisfaction included poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information, and degradation of clinical documentation.

According to the article, for many doctors, these monumental changes to the practice of healthcare represent the final straw. Surveys suggest that older physicians are retiring in high numbers. Younger ones are closing practices and taking jobs with integrated health systems.