How disruption will affect physicians during health reform

To paraphrase Clayton Christensen, author of The Innovator’s Dilemma, when discussing healthcare, disruptive forces set the stage for meaningful innovation and consumer cost reductions.

This is where we now find ourselves. What percentage of our nation’s GDP is reasonable to spend on healthcare – 15%, 20%, 25%? What adaptations are necessary to maintain high quality for those who now receive it and simultaneously provide access to primary care and preventive services to the ~50 million in the US who are presently uninsured? Can we achieve this dual goal, is it a reasonable goal, a moral imperative, a fiscally practical and prudent consideration? Whatever your political leanings or interpretation of the individual mandate present in the ACA, these are important questions to ponder.

Clearly, change by definition tends to be disruptive. And such disruption, in how and how much we are compensated for our work, requires a response. If our “cheese” gets moved, we can simply complain and fail by rejecting the notion of changing (recall the starving mouse in “Who Moved My Cheese?”), or we can adapt, that is we can innovate, to succeed within the new system, the new reality. Can we mitigate otherwise adverse consequences of this disruption, maybe even improve upon our present state?

How are physicians adapting or preparing now?

PHOs appear to be making a comeback, perhaps as a first step toward an ACO. More physicians are gaining employment by hospitals and health systems. We’re somewhat nervously waiting for the Final Rule proposal from CMS re: ACOs to see what the future might hold for healthcare delivery and payment. Some are preparing for EHR Meaningful Use and the attendant bonus; others appear to be eschewing EHRs, willing to forego the bonus and wager that the penalty in future years will either not apply to them (work for a hospital or retire or ?) or on balance will be worth it to avoid experiencing the costs of purchase, implementation and use of electroninc record-keeping. Others, although in the minority, are actively engaging hospitals/healthcare systems in the formation of ACOs.

I imagine that adjustments by physicians are going to be made on a larger scale only after the disruptions are clearer and any new reality that emerges to replace current systems is known.

Michael Shapiro is a nephrologist who blogs at Your Practice – Your Business.

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