The Anti-ACO / Hospital Medical Practice Consolidation

Written by: John Lynn

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.