Three Trends Independent Practices Can Benefit From

; Jonathan J. Bush, MBA


November 28, 2012

Editorial Collaboration

Medscape &

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Leslie Kane, MA: Hi. I am Leslie Kane, Executive Editor of Medscape Business of Medicine. I am here with Jonathan Bush, Chairman and CEO of athenahealth, a medical billing and technology company. Jon, thanks so much for taking the time to be with us today.

There are many changes going on with payments to physicians and medical practices. What are some of the trends that you see?

Jonathan Bush: The biggest change is the idea of physician responsibility for the larger budget. There is now a financial opportunity and potential risk associated with care that happens outside of the examination room. For doctors who are in independent practice, which I know a lot of your readers and viewers are, this is an enormous financial upside because it makes it possible for a doctor to actually profit, to increase take-home pay by reducing the total cost of healthcare by getting aggressive about the way that ancillaries and days in the hospital are utilized. So that is kind of exciting.

The downside is that it is much more complicated. You still have claims that you need to file daily for the professional services that you do in the office. But now you have what we call the "metaclaim," which is the ability to keep track of all the spending that is going on. For all the activity that is going on outside of your office, you can survey it, bring it back, analyze it, and then claim your role in any savings that were created. It is more complicated but more exciting.

Ms. Kane: What should physicians do to prepare?

Mr. Bush: Physician practices, particularly those that want to remain independent or at least have the option of remaining independent, need to get onto the cloud. There is an increase in the complexity of payment rules. There is now not just the claims from day to day but the metaclaim, of what the total spending of your patient population was that you need to account for. There is a need to clinically integrate with information systems of the other parts of the healthcare supply chain.

When a company like athenahealth makes a connection to some epic system in a hospital, every doctor in the market that ever uses that hospital is now clinically integrated with that hospital. Each of them does not have to keep track of that. There is an icon that they can see. When they click it, they are connected. To do that independently -- to buy software, try to set it up, and connect -- it is a Sisyphus-type task. It is not going to work.

The other thing that physicians need to do is assert their independence. They need to start saying, "I know that I am so valuable to the hospital that they will connect and cooperate with me in the way that works for me." I think a lot of physicians are being cowed right now by their hospital, and that is not going to be good for them. If they get into a marriage, it better be a good marriage that they like, that they want to be in -- not one that they are feeling cowed into, because the rage at the end when their rates get cut won't be pretty.

Last, they need to start thinking holistically. They need to start seeing the whole care picture. It is actually kind of exciting clinically. Instead of only thinking of what you are doing within the walls of your examination room or the follow-up letter that you are going to send, you are now increasingly the commander of a whole island of care around a patient or around a population. You are actually in there making decisions and looking at results. It is almost a promotion to medical director for every doctor. I know that it has a real financial upside. You make more money by making healthcare cheaper with this activity, but it is also intellectually challenging.

Ms. Kane: It sounds like excellent advice.

Mr. Bush: I hope so.

Ms. Kane: I would like to thank Jonathan Bush from athenahealth for being with us today. I am Leslie Kane from Medscape. Thank you for joining us.