Specialists: Fill ‘er up with premium

Not since the rise of managed care in the 1990s has there been such a surge in the acquisition of physician practices by hospitals and health systems. Buffeted by healthcare reform, declining reimbursements, demographic trends, the high cost of capital and other market forces, almost 40 percent of physicians surveyed by the American Hospital Association are considering selling their practices. Unfortunately, many of the last decade’s practice acquisitions resulted in substantial financial losses for hospitals and systems, quickly followed by widespread divesture.  


Today, hospitals are seeking to employ physicians strategically based on their ability to fill specific gaps. In other words, they are recruiting more specialists instead of the primary care physicians that were targeted during the 1990s. New compensation models tied to productivity and quality care have replaced the unrealistic guaranteed incomes of the past. Theoretically, this should have better aligned hospital and physician interests, but in the race to affiliate lucrative specialty practices some hospitals are sabotaging their projected revenue by insisting on the adoption of their enterprise ambulatory EMR.


These hospitals are finding out the hard way that force-feeding high-productivity specialty practices a traditional EMR will significantly compromise productivity. A government-funded study conducted by MGMA determined that implementing these point-and-click, template-driven EMRs decrease physician productivity up to 15 percent for a year or more. The workflow disruption is so frustrating that 90 percent of high-volume specialty practices, such as orthopedics, cardiology and ophthalmology, ultimately refuse to continue using the EMR.  


With a focus on data collection and note creation, rather than usability and efficiency, these enterprise EMRs are designed to meet the needs of primary care physicians. The ambulatory successes touted by enterprise EMR vendors reflect primary care implementations, not specialty practice successes. Lumping specialties into the broad “ambulatory practice,” category shortchanges both quality of care and the bottom line. Would you expect the police to catch criminals driving a golf cart? No. Then why expect specialty practices to thrive with slower, less efficient EMRs?


If a hospital refuses to provide an EMR designed for specialists’ high performance needs, the fallout can be widespread.  In addition to creating a direct hit to the practice’s bottom line, the one-size-fits-all approach could result in fewer hospital referrals, imaging studies, surgeries and other procedures. 


We’re beginning to see considerable pushback from these practices. If a hospital requires the use of an ambulatory EMR designed for primary care, more of these specialty groups are saying, “Thanks, but no thanks” to a proposed acquisition. They’re not willing to compromise patient care, reduce their caseloads or suffer financial consequences. 

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