Physicians are facing major challenges as reimbursements stagnate or decline, and costs increase due to inflation and increasing regulatory burdens. What's a doc to do? What NOT to do may be a good place to start.
Do not limit your activity to bemoaning the injustice of it all. Angst, even significant anger or fear, has its place. Do not, however, confuse the emotional response to a real threat with constructively pursuing solutions and mitigating damage. For instance, while RAC audits can be insulting and induce a witch-hunt, complaining about the unfairness is not going to change anything.
Do not waste your precious time with anyone who is not providing information or insight. Last week I attended a meeting about the potential of quality metrics to enhance a practice's bottom line. The stated purpose was to explain the workings of value-based reimbursement, and to describe the factors that affect whether a quality metrics program makes financial sense for a practice. I only know that was the purpose because I read the brochure.
The presenter spent the entire time listing the net fiscal consequences over a period of years of achieving meaningful use, utilizing e-prescribing, and reporting quality metrics — or not. There was no explanation as to how he arrived at his numbers, or any advice about how to evaluate the pros and cons of pursuing any or all of these objectives. The sole point was that the government is not fairly rewarding physicians for participating in the programs: The net payments dwindle and, even worse, they are taxable as income! His only advice was for physicians to tell their patients to write their representatives in Congress to insist the programs be abandoned.
The speaker threw welcome red meat to the audience, but the opportunity to bring some clarity and actionable information to complicated topics was wasted. Worse, he fanned the embers of victimhood, and that wastes energy.
Do not close your eyes and hope everything will go back to 'normal' before too much damage is done. There are two problems here:
• “Normal” has no permanence.
• Hope is not a strategy.
Do not assume that hurting you and your patients is the primary objective of the people driving the changes. At the least, do not let that assumption drive your interactions with them. Regarding the “reformers” as ill-intentioned makes constructive problem solving impossible, generating a lot of heat and little light. It is as hard for them to be open-minded in dealing with people who do not trust them as it is for you. If your only acceptable solution is to resolve all issues in your favor, you've already lost.
Do not believe that there is a solution that removes all current irritants without introducing new ones. Any viable course of action has pros and cons. Any solution — such as selling your practice and/or becoming an employee of a large group or system — that seems to solve all current problems and present no new ones, is an illusion. As I hope your father told you: Anything that seems too good to be true is. Negative consequences are not necessarily deal killers, but they always exist.
Now for the good news, even in this environment, you can influence and even shape outcomes, especially your personal outcomes. Next week I will have some suggestions for what you can, and should, do.