My personal problem is that "health maintenance" has been grafted onto traditional medical practice without considering the payment model.
Who pays us for installing and maintaining an EMR? Who pays us for keeping track of the myriad "quality" measures that are promulgated by different and often conflicting agencies? Who pays us for handholding patients to use the "portal" so they can "interact meaningfully" with their personal electronic medical record.
Answer, NO ONE. There is no provision for that in the E&M ("press the lever, take the pellet"), fee-for-service, "traditional" payment model -- which private practice is wedded to.
I can do all those things -- but not for free.
I don't know if it is really a conspiracy to drive independent practice into extinction, but I suspect it probably is. For me, the conspiracy potential is real, but not particularly relevant. For someone 45-55, it's a real problem. For someone in their 30's -- it probably doesn't make any difference. Those folks live in a different universe from me, and they are already employed by some giant corporate entity that pays for all the "health maintenance" through some other revenue stream (not E&M) that I have no access to.
But the whole enterprise is so dreadfully complex, confusing, anti-life, and non-intuitive that it won't continue in its present form. There is a glimmer of hope in AmazingCharts/PriMed -- maybe they can be a sort of Moses to lead us out of the corporate wilderness. EPIC and Cerner can't do it. Those outfits are sclerotic already.
