I’ve had a number of really interesting conversations with EHR vendors around the future of small practices in healthcare. In fact, many EHR vendors are focusing their marketing efforts around saving the small practice (more on that in a future post). Although, one topic that’s come up multiple times recently is how the new high deductible plans might be a tremendous opportunity for small practices.
To give credit where credit is due, I first heard this idea from Dr. Tom Giannulli (Check out this Google Hangout I did with Dr. Tom), CMIO of Kareo.
The core concept I took from talking with Dr. Tom and have since morphed with other viewpoints is that patients with high deductible plans can be more selective about who they visit for their care. This presents an opportunity for small physician practices to provide a personalized service to those patients that a large group practice or hospital owned system can’t or won’t provide.
Of course, at the core of this question is whether the small practice does offer a more personalized service than a large group practice. There are many arguments to be made that a small practice can offer a better service. In some ways it’s the eternal battle between mom and pop vs big company. We all love the idea of mom and pop locations that know are name and know our needs. In many ways small practices can provide this same level of service and relationship which is hard to create in a large group practice that’s ruled by numbers.
However, I think one challenge to this idea is that large groups could provide some services which small practices can’t or won’t provide as well. Of course, this assumes that they aren’t too distracted and immovable to actually implement change. I expect that we’ll see some patient facing services that do much better in a large group practice and that would be nearly impossible in a small practice. For example, once telehealth visits become popular, a large group practice could implement a 24×7 telehealth service for patients with emergent needs. A small practice couldn’t do this (although, they could partner with someone to offer something close).
The point is that the battle for these high deductible patients is just beginning. I usually like to put my money on the faster, more nimble organization. The problem is that many small practices aren’t that nimble. In fact, healthcare isn’t nimble (see Mandi’s post today about Inflicting Agile on the Waterfall World of Healthcare). Although, small practice can be nimble if they chose to do so.
Coming full circle, does this present an opportunity for EHR vendors? Can the small practice focused EHR vendors offer a set of features to small practices that enable them to offer a more personalized service to patients? I think there is this opportunity starting with features as simple as e-communication with the clinic, online payments, and personalized care. The real challenge for these EHR vendors is how to balance customer service focused features that patients will love against the onslaught of government regulations which bog down their development teams.
We have done this for years with a local religous group. The BIG ISSUE will be “How much will my visit cost?”
They pay cash SAME DAY OF SERVICE — no billing or anything — have a cash pay slip at their appointment. They get a lower rate — NOT the billable rate — because remember, we don’t BILL them.
If 3rd party payers want the same deal, we’ll do it, but they have to stand in our lobby and write a check SAME DAY OF SERVICE. None of them want to do that.
I guess that is one interesting way to look at it. A lower cost could be a good reason to go to a smaller practice instead of a larger one which doesn’t have that flexibility.
Actually, it is not a question of size of practice regarding flexibility. It is a question of flexibility of THINKING, and that seems to be in short supply in the medical business, which is why we are hearing so many screams of pain — in all areas: electronic, financial, practice, to name a few.
We started our practice almost 10 years ago (April 1, April Fool’s Day!) and have had to be flexible from day one to work in this environment. EMR and electronic functions were and are the rule, not the exception. It might help that we have been doing a lot of these things in another business environment for 20 years before this practice.
Since we are in the Midwest, I wonder if a “superior opportunity” (as Abraham Lincoln said) exists to incorporate new thinking in this regard. We usually have to wear lots of hats – we aren’t nearly as specialized as in large population areas – so we dive in with all of our background and draw from other areas we have worked in. For example, our IT person sets up banks and schools and then started working with medical practices, so we already have lots of security which he incorporated from the other work he does.
Medicine has been such a highly defended citadel for so long most don’t remember when they mixed with mere mortals, and that really is true of the business office/administrative side, which is where the IT things are placed.
We have to do our stretching, get our game face on, step up our game, etc., if we all want to make it through HITECH, ACA, and ICD-10. Those are all big reforms in and of themselves, and they are all coming down at about the same time. No more delays.