Home Forums Discussions General Discussion Turmoil in Cardiology field

World is changing with private practices foreseeing dismal future.

The biggest cardiology group in Lansing, MI will be bought by Sparrow Hospital. End of 40 yr old history.

http://www.tciheart.com/handler.cfm?event=practice,main

We have seen a HMO staff model Clinic liquidating in Lansing.

Another hospital - IRMC wants to give Allscripts EMR to physicians to integrate the records.

I hear these are national trends- practices bought by hospitals and hospitals giving EMRs.

Who pays for the support of EMRs given by hospitals?

My PHO just made an agreement with eCW. It would cost affiliated docs more per month maintainance than our annual cost, but they pick up some of the up front costs.

Interestly, their own staff model practice uses Allscripts.

Iowa ePrescribe is being sponsered by the Iowa Clinic and is providing allscripts for e-prescribing. The large cardiology groups in Des Moines are being assimilated also. Change that will make transferring patients, or obtaining consults, more difficult.

Tom

The one constant is change. Embrace the change grasshopper and be light, and flexible so the wind may carry you far..... my apologies to Carridine, BUT:

Many of you remember some years back when hospitals were gobbling up private practices and everyone predicted the demise of solo practice and advised that if you didn't sell your practice to the hospital this week, you would be out of practice by next week and have to go begging.

Many of us looked around and said, "hey, the worst or the laziest Doc's I know already signed up with you, if I join I will have to carry their dead weight." These "win-win" deals were doomed from the start as both expected to profit from the others labor and there was no incentive to hustle in the contracts that were signed. These were big on the West Coast here, but they are all gone now.

The IPA or the hospital now wants to give you the software! (OK, so they really want to help you get the software and YOU pay the ongoing costs, as much as $500.00 per month for eClinical works.) What does the Dr. get? Someone to make the decision for them as to which software to select. They will get what they deserve.

What does the IPA or Hospital get? They get the billing data to begin with, with far greater chances of capturing P4P or bonus money and in many cases they get the database. The data does NOT reside in your office but resides on servers at a remote site. I may not know exactly how to capitalize on the intrinsic value of that data base but I AM CERTAIN IT HAS VALUE AND I AM JEALOUSLY GUARDING IT. Now I am a little ignorant and certainly technically naive, so bear with me on this rant and try to see the possibilities that exist far beyond the horizon of my little examples.

We let just some of the demographic data get away and into the hands of an IPA we used to work with and guess what. The minute my patient turns 65 they get sales data for the medicare HMO that is offered by that group. I don't know that this is not just the result of wide broadcast mailings, but I do know the sales rep that works for them, who we let have too much access to our database. So the demographic data is a great place to look for new Medicare capitated patients. Can you sell those lists? We never tried. I am not sure that it is moral to do so, but my Scottish heritage suggests it is a sin to give it away for free!

Let try to imagine outside the box. What if you are in a large group with several thousand patients taking a Drug for Diabetes and the manufacurer is suddenly confronted with a bad outcome and is scrambling to gather data to refute a link between their product and some disease like Pancreatitis. Would they pay for that data if you could sell it to them in an instant? Would the insurance company sell it if they had it? Would you expect a check from the insurance company for your contribution to this database? HANG ON TO IT! I may not know exactly how to capitalize on this, but it has great intrinsic value and a lot of people out there are offering to take it from you, for free or in some cases after charging you a ton of money.

The bloated systems that are too slow to chart with will ultimately fail as the Doctors who use them will be pushed out of the way, relegated to the slow lane as they struggle to see enough patients each day to make the payments on the system that maintains the database for someone else to own.

Those who chose wisely, keep there eye on the ball, and keep seeing patients, while pursuing quality care will, in the end, be successful.

In a similar vein, this is the main reason I refuse to accept "coupons" or vouchers from Pharmaceutical reps. I do accept samples. As soon as the patient uses one, their names and addresses are accessible to big Pharma and direct-to-patient advertising and mailings can be sent. It is the same reason I never use my real name or address when I apply for a "discount card" at the local groceries. No one has a right to know how many boxes of Captain Crunch I buy a week.


Leslie

You are spot on about the data mining. They are VERY interested in the data both for P4P as well as for use in their analysis.

I too, have issues with my data residing outside the office. Most of us do, one addtional feature about AC that makes it work.

I know Jon was thinking of hosting an online version, and I would be OK with that as long as a copy was available in the office.

I will give them credit. eCW is a decent EMR. It is bloated with a lot of screens and will take the MAs a lot of time to enter data, for it is too much for the MD to enter all. But it does do some nice things. I will stick with AC.

Joseph, the picture you describe is happening in rural hospitals that are critical access. The hospital can charge a professional fee for an employed doc, and a technical fee. Plus they get reimbursed 115% of Medicare. At present the hospitals are willing to pass the extra revenue on to the doc's, but for how long, and how long will this windfall last? Not long. Then there will be a lot of employed doc's making less and they will be owned by someone who couldn't give a hoot about them. I am still privately owned and privately operated, solo. I am also making 50K less than hospital owned docs. The price of autonomy.

I never thought of the direct ads to the patient! Shame on me! I go in our waiting room every week and throw away the kleenex box with Allegra and the brochures for whatever. I don't use coupons usually but now my resistance just went up another big jump.