EHRs Push Private Practice Docs Out of Business

Sixty-one percent of independent physicians are seeking employment, and the majority of those doctors say that the government requirement for them to adopt and show meaningful use of an electronic health record (EHR) is one reason, a new Accenture report finds.

The paper, entitled "Clinical Transformation: New Business Models for a New Era in Healthcare," notes that the percentage of private practice physicians in the workforce dropped from 57% in 2000 to 39% in 2012. By the end of next year, Accenture forecasts, only 36% of physicians will be self-employed.

The biggest reason for doctors to seek employment, the Accenture survey shows, is the cost of doing business as an independent practitioner. Eighty-seven percent of respondents who were looking for a job cited that challenge, and 61% checked off "the prevalence of managed care." Government EHR requirements and maintaining/managing staff each were mentioned by 53% of doctors.

[To find out which medical apps doctors and patients are turning to, see 9 Mobile Health Apps Worth A Closer Look. ]

Many private practice physicians are daunted not only by the cost, but also by the complexity of EHRs, said Kaveh Safavi, MD, managing director of Accenture Health North America, in an interview with InformationWeek Healthcare. "A lot of it is the expertise -- everything from the selection of an EHR to the maintenance, the technology infrastructure and the compliance," he said. "So it's not simply dollars and cents, it's also a complexity issue. And this is a mission critical function for physicians, so they can't just get it kind of right."

Accenture's findings raise some interesting questions about how many doctors in small practices have attested or will attest to Meaningful Use. It's also an open question whether many of those physicians will be able to keep up as the government incentive program raises the bar on compliance in the next few years.

More than 110,000 eligible professionals have attested in the Medicare and Medicaid EHR incentive programs, but it's not clear how many of those are in large organizations. The Office of the National Coordinator of Health IT last June touted the fact that its regional extension centers had enrolled 143,000 physicians, mostly in small primary care practices, and had helped about half of them go live on EHRs.

Of the physicians who plan to remain independent, a third are moving to "subscription-based" practices, including concierge practices and other "direct-pay" subscription models, according to Accenture. Such practices either don't take insurance or charge insured patients a fee if they want a higher level of service.

To be successful, these practices must find a niche that distinguishes them in the marketplace, Safavi noted. "The physicians who want to remain independent have to be particularly good at something." This might not involve information technology, he said, "but technology is a critical enabler. You have to know your customer, you have to engage your customer, and you have to meet them on their terms."

For example, he said, concierge and other subscription-based practices might make it easier for patients to access their doctors, either on the telephone or in some kind of video conference. (Some iPhones, for example, have video chat features.)

"Instead of a phone call, it might be a virtual visit," he said. "Those are the kinds of things where technology enables a physician to meet patients on their terms, and it can also create a greater level of engagement."

The Accenture report also points out that direct-pay practices should "allow patients to access services in ways that work for their lifestyle. For example, allowing patients to access medical information or book appointments via their smartphone." This is one way for an independent practice to differentiate itself whether it's direct pay or not, Safavi pointed out.

Eventually, he said, U.S. physicians might emulate their counterparts in Singapore and adopt an Open Table kind of application that allows patients to book appointments with doctors based on the doctors' availability. A patient with a chronic condition might prefer to see a certain primary care doctor or specialist, he acknowledged, but this approach could work well for minor acute conditions.

Technology can enable doctors to overturn the conventional approach to practice in many other ways, he observed. "There's a whole area of technology that involves communication and collaboration, including social media and telehealth technologies, that can have a significant impact on a clinical practice. Those are lagging in healthcare, but they're starting to show up, particularly in practices that are trying to differentiate themselves from others. So those will be the ones I'd watch for," he said.

InformationWeek Healthcare brought together eight top IT execs to discuss BYOD, Meaningful Use, accountable care, and other contentious issues. Also in the new, all-digital CIO Roundtable issue: Why use IT systems to help cut medical costs if physicians ignore the cost of the care they provide? (Free with registration.)