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Obamacare set rules that require large scale-out to be affordable, especially billing and electronic medical records. This is why so many smaller practices, eve

Obamacare set rules that require large scale-out to be affordable, especially billing and electronic medical records. This is why so many smaller practices, even in large cities, had no choice but to be absorbed by local hospitals or merge with competitors; they couldn't afford that cost of regulation on their own. This also means that in areas lacking a certain critical mass of patients, practicing medicine won't make financial sense.

jdc 7y ago
What are the specific requirements? Perhaps there's another way to reduce costs.
- beerandt 7y ago
  Sustaining the infrastructure and support to maintain electronic medical records is probably the biggest. There are so many problems with the current systems that it's hard to know where to start. But related to the context of the article: You can't spread that cost out as a stand alone doctor practicing on rural areas. On top of this is added cost of data entry compared to old paper charts, the cost of training staff to be able to do it efficiently, and the extra time it takes doctors to keep notes and sign-off on electronic charts. Check out some of the recent articles on physician burn-out, especially in emergency medicine, family practice, and general practice. Doctors are deciding it's not worth the hassle, financially or psychologically. Edit: a couple of recent related articles on the topic: https://blogs.scientificamerican.com/observations/electronic-health-records-and-doctor-burnout/ https://blogs.scientificamerican.com/observations/electronic... https://fortune.com/longform/medical-records/amp/ https://fortune.com/longform/medical-records/amp/
  - perl4ever 7y ago
    If computerizing a business makes it more expensive and labor intensive, someone's doing something wrong.
    - beerandt 7y ago
      Agreed... Yet that's what's happening nationwide. The electronic systems aren't simply recording what the doctor does and making a record of it, as charting is supposed to accomplish. The software is dictating (or at least heavily influencing) the behavior and workflow of the doctor. And anytime something is done out of order results in interrupting that workflow, searching through 10 other screens to find the appropriate checkbox, and then trying to return to your train of thought. The focus ends up being on the data entry instead of the patient. This is amplified the less specialized the practice is, hence emergency medicine, family practice, and general practice being the most affected. And rural doctors being affected the most since: 1) they generally are expected to handle whatever gets thrown at them since there are no specialists around and 2) they have the smallest practices (can't share costs with other doctors). Opting out of the system essentially means going cash only, which obviously limits your patients, among other drawbacks. Which leaves burn-out and early retirement or joining a bigger practice in the city. Or concierge medicine, which is one reason why it's becoming more popular.
      - perl4ever 7y ago
        I applied for a few jobs at places that did things like practice management software over the years, e.g. athenahealth but never worked in the industry, so I don't have any insight on what it's like on the inside. But I assume there are systemic reasons. It's easy to say concierge medicine, but I'm not clear on why that should work, if funneling the same amount of money every month through an insurance company doesn't. What is the difference, other than the marketing terminology?
        beerandt 7y ago
        Edited: Easy... They don't take insurance. They're typically cash only, which allows them freedom to do things like charge for house calls. Or they have contracts directly with employers to do checkups and on-demand visits onsite. Employers that are either big enough -or financially successful enough- to be self insured are essentially paying cash for office visits and most covered services anyway. (Many companies that are ~200+ employees self insure, but still pay an insurance company just to manage it all. An in house or concierge doctor on contract might cut out enough paperwork to get rid of the middleman.) I've also seen some setup as prepaid membership operations. But the common denominator is they cut out insurance and medicare/medicaid, which cuts out 90% of the regulations... Including electronic medical records.

jdc 7y ago

What are the specific requirements? Perhaps there's another way to reduce costs.

beerandt 7y ago
Sustaining the infrastructure and support to maintain electronic medical records is probably the biggest. There are so many problems with the current systems that it's hard to know where to start. But related to the context of the article: You can't spread that cost out as a stand alone doctor practicing on rural areas. On top of this is added cost of data entry compared to old paper charts, the cost of training staff to be able to do it efficiently, and the extra time it takes doctors to keep notes and sign-off on electronic charts. Check out some of the recent articles on physician burn-out, especially in emergency medicine, family practice, and general practice. Doctors are deciding it's not worth the hassle, financially or psychologically. Edit: a couple of recent related articles on the topic: https://blogs.scientificamerican.com/observations/electronic-health-records-and-doctor-burnout/ https://blogs.scientificamerican.com/observations/electronic... https://fortune.com/longform/medical-records/amp/ https://fortune.com/longform/medical-records/amp/
- perl4ever 7y ago
  If computerizing a business makes it more expensive and labor intensive, someone's doing something wrong.
  - beerandt 7y ago
    Agreed... Yet that's what's happening nationwide. The electronic systems aren't simply recording what the doctor does and making a record of it, as charting is supposed to accomplish. The software is dictating (or at least heavily influencing) the behavior and workflow of the doctor. And anytime something is done out of order results in interrupting that workflow, searching through 10 other screens to find the appropriate checkbox, and then trying to return to your train of thought. The focus ends up being on the data entry instead of the patient. This is amplified the less specialized the practice is, hence emergency medicine, family practice, and general practice being the most affected. And rural doctors being affected the most since: 1) they generally are expected to handle whatever gets thrown at them since there are no specialists around and 2) they have the smallest practices (can't share costs with other doctors). Opting out of the system essentially means going cash only, which obviously limits your patients, among other drawbacks. Which leaves burn-out and early retirement or joining a bigger practice in the city. Or concierge medicine, which is one reason why it's becoming more popular.
    - perl4ever 7y ago
      I applied for a few jobs at places that did things like practice management software over the years, e.g. athenahealth but never worked in the industry, so I don't have any insight on what it's like on the inside. But I assume there are systemic reasons. It's easy to say concierge medicine, but I'm not clear on why that should work, if funneling the same amount of money every month through an insurance company doesn't. What is the difference, other than the marketing terminology?
      - beerandt 7y ago
        Edited: Easy... They don't take insurance. They're typically cash only, which allows them freedom to do things like charge for house calls. Or they have contracts directly with employers to do checkups and on-demand visits onsite. Employers that are either big enough -or financially successful enough- to be self insured are essentially paying cash for office visits and most covered services anyway. (Many companies that are ~200+ employees self insure, but still pay an insurance company just to manage it all. An in house or concierge doctor on contract might cut out enough paperwork to get rid of the middleman.) I've also seen some setup as prepaid membership operations. But the common denominator is they cut out insurance and medicare/medicaid, which cuts out 90% of the regulations... Including electronic medical records.