July 24, 2011
Small medical groups (1-5 physicians) are more likely to consider regional, niche and start-up EHR vendors according to a KLAS study reported on in a recent issue of Health Data Management.
In medium-sized (6-25 physician) medical groups, 61% of practices are buying their first EHR and 35% are replacing an existing one. Those seeking replacement EHRs cited the vendor being “slow to update” or “meaningful use” as their main reasons.
In the medium-large (26–100 physician) segment, the study found 30% of practices are replacing their systems because of missing functionality. Fifty-two percent are buying new EMRs, and the lion’s share of these groups (67%), are purchasing client-server solutions.
For those of us working in the EHR industry, the findings are not surprising. For example, it is logical that small medical groups and solo practitioners would select start-up vendors for two reasons. First, the larger, brand name vendors don’t market to this segment. Second, start-up EHR vendors tend to offer their products at much lower cost than brand names.
In addition, it is not surprising that they seek niche vendors since many of these groups are specialty physicians. A number of vendors have designed their product to fit certain specialties (e.g. orthopedists, podiatrists).
High-volume specialty practices have unique needs, since these offices see a high proportion of new patients and more total patients in a day. The practices need to be able to collect patient vitals and demographics easily and physicians need to enter and retrieve data quickly.
KLAS has a reputation for presenting accurate information. Since their studies cost $1,000 and up for non-physicians, many of us have to rely on press reports to see the data.
July 18, 2011
The AMA News reports that IPAs are growing again after a “period of stagnation.”
The president of a New York-based IPA said “When you go back and you look at the ’90s, IPAs formed for defensive reasons because the health plans were economically credentialing doctors and hospitals. Now it is much more of an offensive philosophy than defensive. The current strategy for IPAs is to attack the gaps in the delivery system to improve accountability. It’s very different.”
Another expert notes that IPAs are uniquely positioned to take care of ACO-required populations of 5,000 or more.
Here in California, we have had IPAs for more than 30 years including a number of very large IPAs that assume medical risk (capitation).
I was at CIGNA Healthcare of California, as director of public relations, when the great “for-profit” medical group wave crested in broke in the 1990s. Anyone remember Friendly Hills Medical Group?
Friendly Hills bought some 30 healthcare clinics from CIGNA in 1994. They and a number of organizations believed there could be significant profits from purchasing and operating medical groups.
Most of these enterprises assumed too much debt, could not successfully negotiate managed care contracts and saw patients flee to competitors. Many wound up bankrupt.
Conditions are much different now, particularly with the proposed ACO regulations. Even if the current ACO regs change, it’s clear that the concept of tightly controlling care (with or without capitation) is very appealing to federal regulators.
The article reports that there are currently some 500 IPAs with 120,329 primary care physicians and 144,080 specialists across the country. The number is expected to increase this year as physicians seek new ways of associating. These physicians don’t want to give up control by selling their practices to a hospital or a larger practice, but want some of the benefits of a larger organization.
July 5, 2011
“It was the best of times, it was the worst of times.”
That is the classic opening line to Dickens’s great novel about the French Revolution, A Tale of Two Cities. With the latest news about aging research, that sentiment could well apply to the 2011.
Here is the great contradiction: just at the moment when scientists are unlocking the key to aging, enabling some individuals to live to 120, the average life expectancy in the United States is expected to fall!
First the good news. Reuters reports that Aubrey de Grey, a biomedical gerontologist and chief scientist of a foundation dedicated to longevity research, said that scientists are close to having the “tools to cure aging.”
He describes aging as the lifelong accumulation of various types of molecular and cellular damage throughout the body.
“The idea is to engage in what you might call preventative geriatrics, where you go in to periodically repair that molecular and cellular damage before it gets to the level of abundance that is pathogenic,” de Gray explained.
The article notes that more and more people are living past 100. In Japan alone, there are now more than 44,000 centenarians.
A different report in Health Affairs finds that for the first time in the nation’s history average life spans will be shorter for young Americans than for their elders.
The reason is basic (and preventable): Americans born after 1965 are more likely to be overweight than people born before. Also, the age at which those younger generations hit the point of being overweight is far earlier than it was for previous generations.
The Health Affairs research finds that Generation Xers, Gen Yers and the kids coming up behind them (i.e. born after 1990) are developing chronic illnesses like diabetes and heart disease at higher rates.
Thus, they will bear those illnesses for a much longer portion of their lives, so the toll on their bodies will be that much worse and their life expectancy shortened.
Commenting on this research in Hospitals and Health Networks, Bill Santamour writes, “Every generation works to make sure their children and grandchildren have better lives than they did. Shouldn’t we be doing everything we can to make sure ours also continue to have longer lives than we do?”
We may not get a soft drink tax, but San Francisco has banned Happy Meals and Michelle Obama has gotten a few more kids to exercise.