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Innovate or Die

by Allen L. Gee, MD, PhD, FAAN, neurology specialist

“He's an old hippie and he don't know what to do. Should he hang on to the old, or should he grab on to the new?”

While I'm not old enough to be a hippie, I can appreciate the Bellamy Brothers lyrical question. Should I hang on to the dream of having time for patient care or value for my knowledge and skills? Should I leap at pre-authorized (or not), poorly compensated, revenue-driven automated medical processes delivered by variably trained professionals? The question is obviously rhetorical as there is no choice.

The old days of a physician/patient relationship are gone. Physician satisfaction is down. Reading Sermo, the question was “Are you happy as a physician?” The overwhelming answer was “No,” or more specifically, to paraphrase, “I like being a doctor. I don't like practicing medicine.”

The demand is ever-growing for complete, comprehensive, cutting edge and inexpensive health care with limited or no patient accountability. I am in the vortex. I am a solo, private practice cognitive specialist. Reimbursement for cognitive care is falling further and further behind that for procedures.  Consult codes have been eliminated by CMS and I am not eligible for primary care incentive bonuses. As a private practice, I am restricted from mutually beneficial business relationships with medical facilities because of regulatory and legislative barriers too complicated to explain here. The mantra becomes, “Innovate or Die.”

With the challenges of running a private medical practice, many physicians are being consumed by hospitals. I don't believe I need to comment extensively about dysfunctional hospital processes. Does anyone really believe our health care woes will be solved when all physicians are employed by hospitals? I work at a certain hospital that took the position five years ago to go no further with Health Information Technology (HIT) until others made the mistakes and worked out the details. They waited and then bought a five-year-old solution. When questioned about their decision and how it compared to alternatives, they hadn't even done any due diligence. The old was OK with them.

Even with new and progressive creations such as the Regional Extension Centers, we see an ingrained desire to “hang on to the old.” My local REC only recommends HIT that will support their own existence and agenda. Who cares whether HIT will actually help improve the health of the patient or practice?

So it seems we are not only battling inertia, but an industry business model selling software to treat the symptoms while doing nothing to address or improve the mechanistic flaws within the process. But the challenge does not stop with the adoption or implementation of HIT. Even with the delivery of some Software-enabled-Service models, many practices fail to “grab on to the new.”

Perhaps it is time for “Medical Practice Takeover.” Though not soon likely to replace “Tabitha's Salon Takeover” on the Bravo channel, it's clear many medical practices could benefit from similar insightful and blunt assessments of their practices. Not all physicians, medical practices, practice managers, and staff are created equal. Left to their own devices, many cannot, or will not, examine, diagnose and improve upon the systemic illness of their business. Good practices could become great practices and failing practices could succeed through embracing innovation.

Innovate…or die.

The author is an athenahealth client.

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