I thought more highly of business folks until I started working for them. I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc. Once the vision was elucidated, everyone worked together like a team to make it happen. Then I became employed by a large corporation as a family physician to provide medical care. And it’s been one eye opening experience after another ever since. To me, it’s quite simple. The vision of a medical practice should be to provide good medical care while being cost conscious, and maintaining strong patient satisfaction. That’s how all the money gets generated, right? The patient pays his/her premium, part of which gets funneled to our large corporation, who is then tasked to provide care for that patient. How is care provided to that patient? By having a doctor see, talk to, examine and treat that said patient. OK. So we all know that it’s not quite that simple. Enter primary care 2014, the world of risk adjustment factor (RAF) scores (which entail the corporation getting paid more for sicker patients), electronic health records (EHR), and quality metric incentive payments (the corporation gets more money from insurance companies by meeting certain goals in screening, like colonoscopies, mammograms, etc.). Now health care has become more complicated. But it’s still all based on that interaction we physicians have with our patients. We can’t meet quality metric goals if we don’t see the patients, we can’t determine if they are sicker and therefore require more funds to care for if we don’t see them, and we can’t use EHR if we don’t see the patient. There’s just a bunch of road blocks and distractions added in. So, the vision to me that this big corporation should have is to support to its utmost the physician patient relationship. That relationship should be the spoke around which the rest of the company revolves. The doctor should see the patient, knowing that there’s a band of brothers holding up and supporting all aspects of that interaction, whether it be making sure the EHR and computers work, collecting data about what quality metrics have been reached and what haven’t, reaching out to patients about getting their screenings done and making it easy to do, figuring out how to code for visits correctly so we doctors get credit for what we do, and providing patient education, just to name a few ways to be helpful. I don’t feel supported. IT is not there when I have the inevitable computer fiasco. We put in tickets for computer issues that then go into a black hole of inertia. The program that tabulates my quality metrics is probably 20 percent inaccurate, and I’m the one expected to correct the data, or suffer the financial consequences. My office manager has literally hundreds of billing and coding problems to deal with, and last I checked she had absolutely zero coding skills. Oh, yeah, and I’m being told I’m not seeing enough patients in the day. My plea to you big corporations that are now owning medical practices: Support the doctors! The only thing a doctor should be worried about is the medical care of his/her patients. He/she shouldn’t have to worry about the computer or software, coding/billing, ongoing patient education, or data entry. If we have to do all that, why do we have you guys? We all need to either get on the same page, with a united vision and clear roles. Each of us on this health care team need to be held accountable for our individual responsibilities. We need to take heed to that famous saying from Lost: “We’ll live together, or die alone.” Because that’s where we’ll be. Source
