Working Harder or WorkingSmarter?

"The healthcare system has put physicians in a bad place... the options they have for escaping it aren't good; in our fee-for-service system,
they mainly consist of performing more services, even though they may not be needed.
We need to move away from fee for service and reward doctors for more efficient, higher-quality care."
Paul Ginsburg, Center for Studying Health System Change

The latest edition of "Medical Economics" contains an exclusive survey about physicians compensation and work hours http://www.memag.com/memag/Physician+Surveys%3A+Compensation/Exclusive-Survey-Earnings-Group-practices-pay-bett/ArticleStandard/Article/detail/471128?contextCategoryId=8485
The key findings of the survey are not surprising:

* Most primary care physicians work harder to break even.
* Physician compensation in 2006 once again reflects economic forces that are eroding the cottage-industry model of medicine. If you want to earn more, join a group practice.
* While family physicians, internists, pediatricians, ob/gyns, and general practitioners as a whole earned a median of $165,000 last year, the soloists among them trailed the pack at $152,000, with doctors in two-partner practices second from last. Their peers in groups of 50 or more posted the highest earnings—$175,000.
* The percentage of internists, FPs, and pediatricians in solo practices and two-doctor groups slipped just a notch—from 37.5 percent in 1996-1997 to 35.6 percent in 2004-2005, according to the nonpartisan Center for Studying Health System Change (HSC). Those in groups of three to five also fell as a percentage, going from 10.3 percent to 7.3 percent during the same period.
* Medical and surgical specialists stand to earn far more by consolidating, and as a result, they're deserting solo and two-doctor practices at five to six times the rate in primary care.
* Suburban and rural doctors took home more than their urban and inner-city counterparts. The white coats of suburbia benefit from having the highest percentage of privately insured patients.

What can we learn from these facts:

1. The medical economic climate will remain cloudy in the foreseeable future and doctors need to adapt to the changing market place.
2. Declining reimbursement will force many doctors to work harder to keep their practices open, but working harder will cost MORE money (more staff hours, more overhead, more office utilization etc.)
3. Working SMARTER may include the following:
* Joining a group practice
* Rebalance the payer mix
* Renegotiate contracts and if necessary discontinue existing contractual relationships
* Hire midlevel providers (PA, NP
* Implement cutting -edge technologies (EHR, Electronic Prescribing etc.) to reduce the overhead, increase patient satisfaction, reduce waiting time, maximize billing options
o Comment: Many EHR systems provide quality reporting functions allowing you to demonstrate efficient, high-quality care to potential payers (employer groups, insurance companies). This puts the doctor in the position to negotiate higher reimbursement rates based on demonstrable quality care. I have had a meeting with an executive of a large employer group who offered to pay significantly MORE $$$ per visit if chronic disease management measures can be implemented that will reduce ER visits and hospitalizations. But doctors need to have tools in place to demonstrate that they can track patients adherence and disease management performance criteria. That is an untapped potential income source for doctors who are willing to take the leap into the 21st century medical practice.

The future for medicine is not that bleak if we learn to adapt to a changing market place.

Yours
Bernd