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I am in an area with a heavy concentration of managed care, (80% of my practice). I have given this some thought over the past 20 years and I am more excited about the future than I have ever been with the possible exception of when I got accepted to medical school. I got involved in doing a few lectures on the EMR for our state Osteopathic medical society and from that I was asked to speak to the Freshman class at Western University of Health Sciences in Pomona, Ca.
In the process of all this I came to see the database generated by the EMR as a tool for the practice of medicine. I believe that the use of the database as tool for the practice of medicine allows sweeping changes in how we practice, and the possession of the database means we have a tool for the negotiation of payment based on our OUTCOMES. (See my earlier thread about the "Outcome Oriented Medical Record".)
I may be full of hot air, but I don't think so. I think ultimately we must go to a single payer system or at least a single policy system, (you can't be excluded for pre-existing conditions) and it is inconceivable to me that all physicians will be paid the same. I believe that there are some who simply should NO LONGER be practicing. If you accept that premise, then you must agree that some are also better than average. If we are, and we can prove it, I think we can get paid for it.
The first step remains to be substantially better than average.
