Surviving Regulatory Irritation

With nearly 125,000 pages worth of Medicare regulations governing the U.S. health care system, physicians are confronted with overwhelming regulatory burdens that continue to erode their practice of medicine.

Perhaps it’s not surprising following the success of baseball’s Oakland A’s and Moneyball, that the sport has become obsessed with collecting data. But one look at the dizzying array of baseball statistics that are kept today — sabermetrics such as wins above replacement player, isolated power, runs created per 27 outs, and ground ball to fly ball ratio — and you have to wonder if it’s gone too far.

Ripley Hollister, MD, board member of The Physician’s Foundation, and a family medicine specialist operating a private practice — Hollister Healthcare Team — in Colorado Springs, says the same thing is happening in health care. With nearly 125,000 pages worth of Medicare regulations governing the U.S. health care system, physicians are confronted with overwhelming regulatory burdens that continue to erode their practice of medicine.

“The problem is that the gathering of all this information and data oftentimes ends up being sort of this clinical noise that really has nothing to do with my ability or the process of caring for the patient,” Hollister says. “If you say there’s a given amount of time that a physician and a patient have to ensure that the patient is getting better, and if you take a good portion of that time and place it into data gathering that might be meaningless, then what you end up with is less time to positively impact that patient.”

And a negative impact on a medical practice’s bottom line.

It’s personal

Hollister says the myriad of regulatory irritants is affecting his practice of medicine, and that he’s not alone. He points to a March 2013 report by The Physician’s Foundation, “The Unintended Consequences of Regulation,” as an indication of some disturbing trends. For example, five years ago, 70% of physicians were independent compared to just 30% today.

The problems, Hollister explains, are personal. He points to the ICD-10 codes, which could increase workloads by as much as 15%.

“I spend a good portion of my time with the patient figuring out what their diagnosis is, and coming up with a treatment plan, and then I have to go out and find some number, and it’s not terribly helpful to me to have that number because I know what I’m treating,” he says.

The impact federal initiatives and regulations have had on his medical practice? According to Hollister there’s a huge amount of insecurity and uncertainty.

“I don’t know what’s going to happen in 2014,” he explains. “My patients don’t know, and my employees don’t know. So if you asked me what I’ll be doing a year from now, I can tell you what I want to be doing, but I can’t for sure tell you what I will be doing.”

Survival tactics

The Physicians Foundation recently published a report, “Survival of the Fittest,” containing specific steps physicians can take to help them remain in practice. These tactics include contracting out billing and collections; collecting copayments and deductibles at the time of service; reducing and cross-training administrative staff; computerizing the practice; employing midlevel providers; and adding new revenue-generating services.

Hollister has already begun employing many of those recommendations.

“My staff has been contracted by two full time equivalents over the last year,” he explains. “We are adapting to that, trying to be more efficient.”

The practice has also added an automated phone answering system, and is currently working on its next initiative: online scheduling. A patient portal is another information technology process where patients can get their lab results without additional phone calls. Secure messaging, where practice staff can communicate in a HIPAA compliant way, can also be very helpful.

“And then there’s this whole concept in primary care that’s evolving, a sort of risk sharing,” Hollister explains. “We’re going to give you a certain amount of dollars to do your primary care thing, and to do it well. I actually think that’s a pretty good idea. It doesn’t matter how many times you see a patient, or how you see the patient (electronically, face-to-face, group visits around certain medical issues), it all ends up being primary care. And the end goal is that the person does better.”

In addition, the report suggests that joining independent practice associations, or merging with other independent practices, can provide greater negotiating leverage with hospitals and payers, as well as with vendors. It may, however, include some loss of autonomy and control over the practice.

“I think physicians are open to providing good care in innovative ways,” Hollister says. “And if we can do those things to reduce the cost, and still get compensated so we can maintain our practice, I think we’re very open to that.”