The Anti-ACO / Hospital Medical Practice Consolidation

A physician, Charles Beauchamp, recently left the following comment (shown below) on my ACO and Hospital Consolidation post on EMR and EHR. This might be another example of the EHR Physician Revolt. I wonder how many other doctors will go “against the grain” like Dr. Beauchamp.

As a physician who is going “against the grain” (ie “hospital owned” to private practice” rather than in the opposite direction) I have the following model of action to become part of a patient centered rather than exploitative ACO:

1) Establish my rural practice in my house at a very low cost, including asking some of my patients who volunteered to help with construction.

2) Employ myself, a front desk person and a Medical Assistant with backups

3) Establish Telemedicine links to needed specialties (rheumatology, pulmonary, cardiology) AND use physician social networks (eg, Sermo, MedLink Neurology Forum) for informal networking

4) Use LabCorp as a reference lab with negotiated discounts on high yield labs for one of the practice’s centerpieces: preventing stokes, heart attacks, renal insufficiency, onset of diabetes and diabetes complications. Likewise have a systematic literature scan process using EMBASE rather than PubMed for enhancing the testing and intervention effectiveness of the practice’s goals

5) Embed in the practice’s patient education, instruction and self-care facilitation expertise in efficiently discussing and following up on patient-centered discussions

6) Embed in the practice’s counseling activities the ability to counsel patients about which Part-D plan to choose and which health insurance plan to purchase (minus Medicare)

7) Use a general internist centric and concept driven EMR as the practice’s EMR and optimize its functionality for delivering efficacious brief interventions

8) Participate in community groups (eg, Rotarians) and recruit community leaders interested in enhancing the value of care that is being delivered to the community

9) Intersect with the state’s evolving HIE and structure information collection so that disease classification information can be transmitted to an HIE capable of accepting that information. Constantly improve the practice’s ability to collect disease classification information and include that information within the practice’s concept driven EMR.

10) Code reponsively with the help of a viable clinical concept parser, emphasize patient communication, use evidence and experience to follow-up on disease classification information by using efficacious brief interventions and systematically track outcomes while emphasizing 24 x 7 continuity of outpatient internal medicine care.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

6 Comments

  • By thinking about the model he is pursuing, he is way ahead of the curve in building an effective system for himself. I especially like his idea of counseling his M/Care patients about which Plan D – Meds they can buy. While M/Care gives a lot of good information about their coverage and costs, etc., being able to sit down and discuss particulars is win – win for patient and doctor.

    I would like to know:

    1. Is he going to participate in Medicare and Medicaid. It sounds as if he will not?
    2. What are the EHRs that he thinks are worthy of looking at? Has he narrowed the field yet?
    3. What’s the are rural setting that he is going to serve? Would he be the sole practice? What hospital services are available to his patients?

  • This is a very intriguing concept – one that I wouldn’t term so much as a “revolt,” but rather an abrupt about-face, all in the name of better patient care at lower costs. I’d definitely attend a session at HIMSS led by Dr. Beauchamp. I bet it would be a full house.

  • To share my own experience, I ran a similar practice back in 2003 to what Dr. Beauchamp was envisioning here. I used the available technologies (EHR, electronic ordering, prescribing) back then to help me run my clinic (I was the only one, no other staff). I saw Medicare and Medicaid. It worked really well for 3-4 years. Unfortunately, running a low-overhead practice also puts you at the mercy of changes beyond your control that will cause expenses to rise. These happened within a short period of time starting in 2009. The first one was the HITECH act which caused my EMR cost to skyrocket due to certification costs. The second was the recession that caused expenses (rent, utilities, insurance) to rise as well. This was also all in the setting of stagnating insurance reimbursements and the inequality of reimbursements for primary care in general. Because of the damage done to my practice as well as its toll on my own physical/emotional health and to my family due to these challenges, I had to end my practice. However, my heart is in the fight to change these forces that affect primary care physicians, especially those like Dr. Beauchamp, who are struggling to break free from the current system (insurance as well as the health IT issues that make practicing primary care a challenge). My open source EHR project (noshemr.wordpress.com) is my attempt to level the playing field to bring electronic health record access to small and independent outpatient practices that choose to break free from this current health care system. I’d be glad to help Dr. Beauchamp in any way that I can and I’d be glad to speak more about my project and see where it fits with his practice. I also blog about my practice at aboutfamilyhealth.blogspot.com.

  • Hi Dr. Beauchamp

    I am impressed by your resolve to go against the grain and make a positive contribution to the changing healthcare environment.

    Dr. Chen, I commend you as well.

    Dr. Beauchamp, please feel free to connect with us and we will make sure that your EHR is completely free, fully configured for your practice to address all the initiatives that you envision. Since our EHR is comprehensive, you will be able to do the billing and claims directly from the system without having to rely on additional resources to do it for you.

    Since ours is 100% web based and mobile enabled, you will be able to access records from anywhere and any place.

    We are directly interfaced with LabCorp who you are trying to partner with and all your orders and results will be transmitted electronically, while addressing all the other intitiatives as well.

    Please do consider this as our contribution to the intitiative you are about to undertake.

    I can be reached at 201-415-0682 or anthony@ehiconnect.com

    Sincerely

  • […] I think the most pressing reason that practices are interested in relationships with hospitals is based on the changing reimbursement models. It will be impossible to access the ACO money that’s coming without tight ties to a large number of organizations. One way to achieve this is for a healthcare organization to acquire all of the various healthcare organizations that will make up an ACO. I think that’s part of what we’re seeing now and I’ve discussed before how this might be the way hospitals avoid the cycle of doctors leaving. Although, we’re already seeing signs of doctors leaving for new medical models. […]

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