Concierge Medicine Can Ease Escalating EHR Requirements

As I talk to more and more physicians about what is happening in their offices, I hear that concerns regarding EHR requirements are having a significant emotional as well as physical impact on providers. As with most government programs developed at a distance from the front lines, the intent is good, but there’s little understanding in the halls of government about what it is really like in a doctor’s office.

In the end, it is as much about time as it is about information management. The cost of information is not zero. When anyone tells me that the EHR saves money, my opinion, as a businessperson, is that they are dreaming. More importantly, it is impacting the nature of the encounter with patients.

First, it was managed care with its referral authorizations and testing pre-certifications, now physicians face the continuing burden of documentation under the guise of meaningful use. Healthcare theorists continue to layer obligation upon obligation on practicing physicians without proof that the endpoint will be either higher quality of care delivered or reduced cost.

The Affordable Care Act targeted EHR development, funding upwards of $44,000 per eligible practitioner. Regulators devised meaningful use criteria to qualify for these funds. EHR software vendors have worked hard to keep up with these evolving criteria which grow like weeds. The costs of these software products have become prohibitive for most small practices let alone the solo practitioner. Originally, legislation was devised to incentivize physicians towards this end.  Newer statutes, particularly changes to state law, are aimed at making meaningful use criteria a requirement of licensure.

What most physicians who haven’t as yet endured this change don’t realize is that there is a significant burden to maintaining this increasing data acquisition and documentation. Sure, one can hire an extra medical assistant or purchase electronic systems for direct patient data entry but, anyway that it is done, it will cost significantly more and take physicians more time per encounter without a concordant increase in compensation. How is a physician to survive this change?

The only way to economically survive this healthcare transformation is to either become a part of something much bigger, like a hospital system or a large medical group, where these costs can be diffused across a broad spectrum or facilitate longer encounters which are appropriately compensated. The latter necessitates a smaller panel of patients who compensate physicians for their dedicated time. Sure sounds like concierge care is the perfect alternative for physicians who wish to maintain autonomy and are prepared to participate in the meaningful use revolution.

Concierge care is not about dismissing the value of the exchange of medical information, but rather encouraging it. Having more time enables a physician to communicate better with other providers. That communication, whether it is verbal or electronic, has benefit to the patient. While it may take years to develop an effective information exchange system and implement it, concierge care today enables physicians to act as advocates and advisors today using existing communication methods to help manage the needs of patients.

Should a practice move to an EHR? Most of you already have, but with mixed results. Even if you are a concierge physician you should do so; but the private revenue stream, from a full or hybrid model, allows you to offset additional costs associated with technology. Plus, the more leisurely time allocated to office visits (up to an hour vs. 10 minutes to 15 minutes) gives you the time to still speak one-on-one to a patient - and not just stare at a computer screen. You can have a dialogue, input, refer to the EHR, and better accomplish your tasks and goals.

Electronic information is a reality and EHR is not debatable. We can hope as more physicians point out the current systems shortcomings and the excessive time it is taking away from patients, that some adjustments and improvements will be made. Meanwhile, physicians need to look at options that will enable them to continue to care for patients, and meet government and state requirements.

So I’ve heard literally hundreds of horror stories about EHR. What is your story?