Physicians as Economic Powerhouses and Tech Laggards

They generate $1.6 trillion in economic activity, but as a class, physicians are slow to upgrade and adopt technologies that would make them—and the nation's healthcare system—more efficient and less costly.

The general public is getting some mixed signals these days from physicians.

The American Medical Association came out with a report this week that says that physicians generate about $1.6 trillion in economic activity, support 10 million jobs, and are "vital economic drivers at state and national levels."

I won't quibble with that figure. Physicians are among the most highly educated, highly trained, highly respected, and highly compensated professionals in our country. It would only make sense that we trust them to have a key role in supervising the nearly 20% of the economy that the healthcare sector occupies.

On the other hand, we have another report this week about efforts to wean doctors away from fax machines. That's correct: Fax machines. I had to double check the article to make sure it wasn't a satirical piece from The Onion.

Why are some of these "vital economic drivers" still using 1980s technology? Did they get a special closeout deal on thermal paper down at the office supply store during the Y2K scare? Perhaps it was part of a package deal that came with a beeper, a mimeograph, and a rotary phone.

At many physicians' offices patients still have to fill out paper forms and medical histories every time they go for an office visit. Take-out pizza joints and auto lube shops use more sophisticated, consumer-centric IT than many physicians, because most retailers are light-years ahead when it comes to customer satisfaction and delivering value.

So far, consumers have put up with a healthcare system that treats them as an afterthought. At some point they won't. And that change will occur quickly and probably sooner than anyone expects, now that consumers are responsible for more of the cost of their care through high-deductible insurance plans.

Therefore, while physicians boast about controlling $1.6 trillion of economic activity even as some of them continue to use cumbersome, antiquated technologies to collect and share patient information, they shouldn't be surprised when the government steps in and mandates health information technology upgrades.

Yes, there are still a lot of snags and snafus associated with electronic health records systems, but this industry-wide movement toward EHR was not done in a vacuum and it didn't sneak up on us. I was sitting in the audience at Vanderbilt University in May 2004 when President George W. Bush said that EHR would be a national priority.

I don't know of any other industry or sector of the economy that has had to be forced by the government to enter the digital age, nor been given such a long lag time and financial incentives to get up to speed.

ICD-10 Delays
Technophobia was in bloom last month when specialty physician associations allegedly convinced Congress to delay by at least one year more–again–the implementation of ICD-10. History tells us that ICD-10 was ready in 1992 and that every advanced country in the world has already adopted the code set, including China, Thailand, and South Africa.

And just as with the EHR mandate, ICD-10 didn't sneak up on anybody. If you didn't have plenty of warning that this was coming, you were asleep.

The American Health Information Management Association was so certain that ICD-10 was a done deal that they nearly destroyed what they reasonably assumed were obsolete ICD-9 instruction manuals. Now, twice-burned AHIMA won't certify for ICD-10 until it is up and running. Community colleges across the country are pulling those old ICD-9 texts out of the dumpster and scrambling to retrain many of the 40,000 students who naively thought they'd have a job coding ICD-10 on Oct. 1.

Instead, they'll be learning a medical coding technology that was adopted in 1979, a year perhaps best remember for the Iran hostage crisis, and the debut of The Dukes of Hazzard. I am struggling to make an analogy here with any other huge, data-reliant industry that would advocate for a shift away from say, Windows 8.1 to MS-DOS.

Pay Data Transparency
Also this month, physicians' associations were bracing for the worst when the Centers for Medicare & Medicaid Services released Medicare payment data on individual physicians, a data dump detailing the use of taxpayers' money that the American Medical Association and other physician groups had fought for years.

Why the trepidation? So far, the data is showing that the vast majority of physicians provide competent care at a reasonable cost to a challenging patient demographic. Predictably, many of the outlier physicians who've received millions in Medicare dollars grabbed the headlines for a day or two. But even many of them have legitimate and commonsense explanations that the public will accept. The few docs who are ripping off the system should be exposed.

While a growing number of providers understand that healthcare can no longer operate under business models from the 20th century, a significant minority still do not. Payment schemes are shifting from volume to value and that shift will require a tremendous amount of data to support and verify outcomes for large groups of people.

Turf Battles
There are problems on at least two other fronts.

Physicians' associations in many states are fighting rearguard actions to limit scope of practice for nurse practitioners and higher highly skilled clinicians. This is a fight physicians are going to lose. Their best option now is to negotiate surrender on favorable terms.

And deep-pocketed drug store chains and other retailers with a long history of meeting consumer demand see the value of walk-in clinics and they will lobby hard to expand their purview. It's common knowledge that there aren't enough physicians to provide adequate access to care, and that's a problem that will only get worse in the coming decade as more physicians retire.

More importantly, this is what consumers want and it's not clear if some physicians' associations understand this. The American Academy of Pediatrics, for example, recently stated that "retail-based clinics are an inappropriate source of primary care for children because they fragment children's healthcare and do not support the medical home."

This may be true in some cases, but the AAP's nuanced arguments about the continuum of care might be lost on a wage-earning single parent who's got a bawling two-year-old child with an earache at 9 pm on a Friday and no place else to go, other than the nearest hospital's emergency department.

Instead of criticizing the proliferation of walk-in clinics, physicians' associations should ask themselves why this is happening. Clearly someone in the marketplace is attempting to meet a consumer demand. Perhaps physicians' associations should urge their member physicians to do more to expand their office hours and make themselves more available to the public after hours and on weekends.

Jump or Be Pushed
We have heard many of the arguments for why some, but most certainly not all, physicians are so reluctant to embrace change. Many docs and their professional associations may have perfectly legitimate reasons for resisting a particular policy or technological mandate.

Here's the problem: If your response to EHR, ICD-10, and other innovations or data releases or consumer trends is "no" or "not now" or "there's no value in it for me," then people are going to stop asking you. They're going to make you do it, or they're going to find someone else to do it for them.

One reason why physicians are the object of government mandates is because a significant percentage of these "vital economic drivers" often appear unwilling to take on the task by themselves.