Warning: I'm going to be annoying again.
Reading multiple posts, it seems clear that a basic issue is that many physicians have built unsustainable business models for themselves, and are hoping that technology is going to bail them out. I do not think that is going to happen, nor will wishing make it so.
Here is a sort of brutal example. Let's say that you decide you need to make $200,000 a year to pay a mortgage, repay loans, and have a reasonable life style. Assume you are willing to work the more or less standard 2,000 hrs/year. Let's assume you have a 40% overhead. That means you need to collect $140/hr all day long.
Let's also assume adult primary care medicine, where each mid-level visit is something like hypertension, type II diabetes, a little hyperlipidemia. That's what I envision as a level 3 exam. No padding the numbers here, using the EHR to document meaningless drivel, or the like; just ethically a middle of the road patient with a middle of the road problem set. I can do about three of those an hour, leaving time for phone calls, potty breaks, tending fires, documenting, etc. That means I need to collect $50 per visit, assuming a full schedule.
Now, if insurance company W comes along and offers to pay me $30 for a level three exam, the answer is easy: either learn to say "no" or accept the fact that you are going to 1) start "fudging" what you did; 2) start doing unnecessary stuff; 3) stop spending the amount of time that you really need to do your best work, or 4) accept that your business is going to go tango uniform.
These strike me as being really simple, unassailable facts. Meaningful use is not going to save you. Jon Bertman is not going to save you. Obamacare is not going to save you. As my father told me, you can't get by with the philosophy that "I lose a little on each patient, but then again I have so many patients."
In medically overserved areas, there will always be plenty of physicians who will opt for options 1), 2), and or 3), or work in groups where they can be loss leaders for the procedure oriented specialties. If so, you have IMHO one of four choices: Sell your soul and join them, accept a life of genteel poverty and frustration, change specialties/careers, or move to an area where your services are valued and needed.
If, after 20 years of education and training $18K or $25K or $40K is going to make or break it for you, then let me suggest the handwriting is already on the wall. Remember, if you are going to realistically retire, you can hope to live on 4% of what you put aside. That means you need to have saved $2,500,000 by the time you quit if you want to retire on $100,000/yr. That puts Meaningful Use money squarely in the area of chump change.
The younger you are, the more hope you have of survival if you dump wishful thinking. As I said, I know I am annoying. I just prefer not to see my buddies go down.
