Is meaningful use driving physicians towards employment?

There are many factors that have contributed to physicians seeking employment in the past, including the brief attempt at health system consolidation in the 1990’s, the push towards managed care, and ultimately physician fear of getting boxed out of patient referrals.

The difference now is the advent of the electronic health record (EHR) along with reporting requirements for meaningful use, and the threat of pay cuts if outcomes measures are not achieved.

The EHR is a double-edged sword. It provides near-seamless communication between providers within a health system, allows for more accurate physician ordering, and serves to document the basis for an insurance claim, as a few advantages. To the physician, it takes more time to get through a visit, detracts from the patient relationship, and demands roles that previously were delegated to assistants (such as scheduling tests and communicating the results).

Since EHR’s were encouraged (or mandated) in 2009 as part of the HITECH Act (Health Information Technology for Economic and Clinical Health), we’re now approaching 70% of office based physicians and 95% of hospitals that are health Information Technology compliant. In order to receive EHR stimulus money, physicians need to demonstrate various aspects of “meaningful use,” or risk escalating penalties from Medicare. There are 3 Stages, initially structured through PQRS (physician quality reporting system), now re-formulated to MIPS (merit-based incentive payment systems), with 271 potential quality measures. We’re presently in the midst of Stage 3 with the obligation to demonstrate improved patient outcomes. The ability to report data that relies in part on the patient’s ability to partner in their own care leaves even greater uncertainty.

If these rules seem cumbersome and confusing, imagine the added burden to a single or even multi-physician group that already are dealing with adopting the EHR. Increased time spent on the computer, coupled with the needs to report MIPS data and the potential consequences of not fulfilling meaningful use are now part of the drive towards physician employment. Primary physicians are particularly vulnerable to this trend, having lived with relatively low non-procedure oriented reimbursement, tighter regulation and increased practice overhead. As recent as 2012, the AMA survey demonstrated that 59% of pediatricians, 58% of family practice and 50% of internal medicine physicians were employed.

While the number is much lower for the surgical subspecialties, it’s only a matter of time before they feel increasing pressures to align. Preferred provider insurance networks, and health system employment models that incentivize or require specialty referrals within the system will ultimately drive specialists into employment as well. Although there are benefits and pitfalls to this new order, at least physicians can start to focus on the patient again.

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This column is part of a series devoted to clarifying and enhancing the physician-health system relationship. Dr. Ken Altman is Chief of Otolaryngology at Baylor St. Luke’s Medical Center in Houston, TX.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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