Steps in the Right Direction

Oct. 1, 2006

Did you get a raise this year? Did it keep pace with inflation? Even if the amount didn’t have you leaping tall buildings, chances are no one has reduced your annual salary 1 percent a year for the past seven years.

Did you get a raise this year? Did it keep pace with inflation? Even if the amount didn’t have you leaping tall buildings, chances are no one has reduced your annual salary 1 percent a year for the past seven years.

Essentially, that’s what happened to U.S. physicians, according to a study released in the summer by the Center for Studying Health System Change, indicating that physicians’ wages for medically related activities slumped by 7 percent between 1995 and 2003. Most of it was attributable to lower levels of fee payments from commercial and government payers. To add insult to injury, here is how the “job” of physician and surgeon is described on the U.S. Department of Labor’s Web site: “Many physicians and surgeons work long, irregular hours; over one-third of full-time physicians worked 60 or more hours a week in 2004.” What a deal: Time-and-a-half work hours but at a steadily declining rate of pay.

Most doctors are well compensated—no one argues that point—and I would bet that all doctors net a better take-home than I do. But thousands of doctors are more than doctors; they are employers and local businesses, too. Physicians themselves represent the revenue-generating “talent” in organizations—that is, those with the billable hours—that also employ practice managers, coders, billers, receptionists, nurses and medical assistants—all of whom probably received raises between 1995 and 2003. Physician practices rent millions of square feet of space in hundreds of urban and suburban business outlets. They spend millions on medical equipment and office equipment. They write gazillions of prescriptions that keep both big pharma and patients alive. While they might want a healthier six-figure take-home, doctors nevertheless remain major contributors to the U.S. economy.

It was a joyous morning in Washington D.C. on July 18 when the CCHIT (Certification Commission on Health Information Technology) announced its first 18 certified ambulatory electronic medical record (EMR) products. Mike Leavitt discussed electronic connectivity and systems interoperability and said that in the future, that’s how entities that want to do business with the government will do it—period. But then he described, during a Q&A session, the future purchase of EMRs by physician practices as a situation in which those who make the financial investment may not be those who reap the initial return on investment.

How many paragraphs can start with, “It’s to the credit of the U.S. government that …”? This one can. It also was a joyous afternoon in August when the entire healthcare sector saw the results of good faith efforts to reduce the stringency of Stark and anti-kickback legislation, and to loosen restrictions on entities that want to donate healthcare IT to physician practices, with stipulations for what is essentially known to all patients—and now to physicians—as a copay requirement, in this case of 15 percent.

It’s about time. The big government EMR mandate looms large on the horizon. Whether they make high-, low- or medium six-figures, physicians nevertheless soon will be required to use EMRs in their practices. Mandates of the scope that President Bush, the Department of Health and Human Services and Medicare are supporting are mandates that require a financial shoring up. They require creating an environment that supports physician practice acquisition of purposeful healthcare IT and at a price that doesn’t add more insult to more injury. ‘Atta boy,’ government. You’re getting there.

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