Next year, he's counting on bonuses from Medicare for e-prescribing and physician quality reporting which will translate to a "10% bump in Medicare next year, and $18,000 for meaningful use."
Some of the commercial plans he deals with are paying a little more for his services than for others who can't prove quality outcomes, but "I don't think it's enough," he says. "They might have to give a pay raise for primary care docs to help pay for the aggravation that goes on in switching to a value from volume basis. No one wants to volunteer to do this. It's something I had to do."
He hopes that other small practices won't despair that they can continue to exist under healthcare reform, because he sees small practices as an essential part of the continuum of care.
"I hope the smaller practices never go away, and I hope there's not large corporatization of medicine," he says. "I've had to exert a lot of leadership and we're struggling to keep current with the cost of having two nurses, three nurse practitioners and the cost of investing in an EMR. It's Marcus Welby with computers. It was expensive to do what we did, and there's no real reimbursement--salaries haven't gone up—but we're not in it for making lots of money."
Patient centeredness doesn't always mean doing what the patient wants, he adds. Instead, it's about having the time to re-establish a relationship and understand what's going on through the patient's eyes in the context of community and support systems.
"This is team medicine. It's a very difficult, time-consuming transition but it's one that docs are going to have to make."