Many a Slip-Why Doctors are Not Sharing in the Healthcare Boom

According to Dr. Sandeep Jauhar, author of the book, “Doctored: The Disillusionment of an American Physician,” 30-40% of all physicians say that they would not choose their profession as a career if they had to do it all over again and an even higher percentage would not recommend medicine as a career for their children.

With an estimated $3 trillion being spent on Healthcare in 2015 and an almost endless requirement for primary care physicians as a result of changing nationwide demographics and the ACA, what are the primary reasons for the huge disconnect between physician job satisfaction and the demand and respect physicians command in today’s economy?

The answer can be traced back to a 4th Century Greek poet, Palladas, who famously noted that “Multa cadunt inter calicem supremaque labra” or as the 19th century British William Thackeray paraphrased in his novel “the history of Pendennis” in 1850: “there’s many a slip betwixt a cup and a lip.”

Putting the expression in even simpler terms; Doctors see patients and every insurer, vendor, regulator and everyone in between, wants a part of the money the doctor has rightfully earned for seeing the patient.

Let me give you three recent examples:

1).When talking to a medical practice’s contracted insurers last year about reimbursements for patients who come to a doctor’s office after signing up through the healthcare exchange, the insurance plan’s contract administrator stated that the insurer was planning to reimburse at a rate greater then the physician’s contracted rate for these patients. “We want to make our contracted physicians happy” she stated. But only a few months later, the practice learned that the insurer was only paying 70% of their regular contracted rates for these patients!!! The insurance premiums had not decreased, more patients were becoming customers, yet the insurers were paying their providers less for performing the same services. Not just a little less, but a lot less. How many physicians even know which of their patients are coming through the exchange and what the actual reimbursements are for these patients?

2). Meaningful use incentives for physicians are no longer applicable for practices attesting for the first time in 2015. Additionally, if a practice has not successfully attested for Meaningful Use, Medicare is now penalizing physicians. Though attestation requirements have not changed between the years 2014 and 2015, CMS is requiring that practices use a more updated version of their EMR to attest. At least one EMR vendor, understanding that their clients must update their EMR’s to attest for 2015, is prioritizing practices that purchase Meaningful Use software over clients that simply need the software to attest. The bill for updating in this particular case was over $130,000.

3). Insurers are sending out letters to providers through third party contractors stating that the providers must provide the contractor proof that a patient visit has occurred. I originally saw such a letter and did not think anything of it, since I get a lot of mail and I did not recognize the name of the contractor. I received the letter a second time, and this time, I took the time to pay attention to what the letter stated. The contractor needed the proof of the patient visit or the insurer would deduct the reimbursements for these patient visits from a future reimbursement.

From large medical supply companies not honoring agreed upon written price quotes to medical waste companies not honoring signed contract prices, no vendor or insurer is too big to try and nickel and dime the poor providers from their rightfully earned money.

I come from a difficult and notoriously cut throat industry, apparel manufacturing. Comparatively, in contrast to the healthcare industry, in the apparel industry there seems to be “honor among thieves.”

Practices need to upgrade their IT infrastructure, they need to attest for Meaningful Use, they need to understand PQRS, they need to go through their patient aging and insurance EOB’s, vendor invoices and reimbursement rates. They need to understand and imlement new ICD-10 requirements, plus keep up with the ever-changing healthcare landscape.

However, the economic realities of adding infrastructure costs for the change implementation required for practices is a huge roadblock, especially in times of decreasing reimbursements.

An immediate cost effective solution would be to outsource specific practice initiatives on a project management basis based on pressing needs, immediate return on investment and short term budgets.

The benefits of project management outsourcing are numerous:

  • Focused commitment on a specific problem with a pre-determined budget, timeline and projected return on investment
  • No additional employee related costs such as insurance, taxes, etc., training or cultural fit dilemmas
  • No long term commitments
  • Flexibility to alter pace of initiative depending on practice requirements
  • Peace of mind knowing that “nagging” practice issues are being addressed professionally and knowledgeably

Physicians must take the first step in the effort to keep their practice economically viable. Burying their heads in the sand, hoping that healthcare reverts back to the golden age(whenever that was!) is not the first step, unless the direction the physician wants to take is to continue on the road toward an impending financial calamity.

Why Doctors Are Not Sharing in the Healthcare Boom


Many a Slip-Why Doctors are Not Sharing in the Healthcare Boom was last modified: February 4th, 2015 by sbhatia, Medical Practice and EHR Compliance Consultant

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