Physician-Practice Consolidation---Slowed by Better IT ??
"There is an easy solution to every human problem---neat, plausible and wrong," said H.L. Mencken back in 1917. Little has changed in 93 years. Frequently, the solution becomes represented by a single word. In 1967's "The Graduate," Dustin Hoffman is told the future is "Plastics." Since then, we've had other one-word fads, bubbles in the Internet and Real Estate. Lucky we have a Stimulus.
But not all solutions that are simple are wholly wrong. Writing in the Chicago Tribune---Health, Mr. Bruce Japsen writes: "Doctors seek out cure for inefficiency." Lead sentence: "All the consolidation that took place in the health care industry in 2009 could have a surprising benefit for patients: greater strides towarrd efficiencies in customer service." Thanks to computers and better IT, information technology, patients spend less time repeating their medical histories and waiting for an appointment.
Said Alwyn Cassil of the Center for Studying Health System Change: the tools are expensive and "they don't make sense for smaller practices because they don't have the financial wherewithal to implement them." This affects more than patient convenience. It causes reduction in coordination, accuracy and also the evaluation of physicians themselves.
Ten years ago, 40% of physicians were in a one or two person practice; that has dropped to 33%, and the statistic is falling rapidly. From every corner of health care, hospitals and clinics and large practices are witnessing a flood of physicians seeking to join large organizations---frequently on salary.
The tools allowing Mr. Japsen's prediction to come true will be the EMR, delivered as a SaaS (software as a solution) product, best done on-line, natively web-based, with the addition of a PHR---the HIPAA preferred connection to patient choice, privacy and involvement. But as change just as disruptive as consolidation and IT will come from cost---that is, lower prices paid by physicians.
The server-based, IT-employee monitored, three-month installation package costing $50,000 per doctor will be gone by 2012 and replaced by software and storage by contract. Paid by the month as a utility. And so, the imperative to leave a two-person practice may depend less on IT cost than other factors---practice management, band-width availability, insurance contracts, etc. The fact that the PHR inter-operative platform will talk to EMRs that talk to EHRs that talk to Insurers, may provide greater efficiency in a smaller practice than a group of 500 where other frictional losses are endemic. It will be fascinating to watch. Will small companies (and there are a dozen or more) with minimally-invasive, flexible EMRs (like the mi-EMR) provide better solutions than the huge companies that have annoyed physicians with their hospital-sized software? Or, will the big-guys adapt--in time?
We will see continued consolidation, but one size does not fit all, even in Lycra. And, smart-useable IT, like "Plastics" will be the key to this generation of Graduates.
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