Tempus Fugit, Especially if You’re A Physician

Time flies when you’re having fun, getting old, or you’re an independent practicing physician. There’s only so much time. It’s a perishable commodity. Once it’s gone, it’s gone, never to return again.

Physicians know these truths. They know they are paid to spend time with patients or perform procedures. They know they are not paid to spend time in meetings or on paperwork, searching for the precise ICD-10 code, of which there are now thousands, or feeding data into an electronic health record (EHR) , or trying to decipher an EHR which has been sent to them.

These truths help explain why many physicians are acting the way they are.

• They are hiring nurse practitioners, physician assistants, scribes, and medical assistants for a variety of tasks - to record drug information, take histories, do physicals, and prescribe medications – to save time so they can use their time to focus on what only a physician can do.

• They are organizing and owning “focused factories” – free-standing facilities that maximize use of the physician’s time so that they concentrate on what they do best and know best, diagnosing and treating disease. In these facilities, they organizing the work flow and time flow to do quickly and efficiently what they are trained to do.

• Physicians are interested in setting up physician-owned specialty hospitals , in which specialists can make maximal uses of their time without competing with other physicians for slots in hospital operating rooms. Traditional full-service hospitals, which are obligated to take all comers, particularly Medicare and Medicaid patients and the uninsured, complain these physician-run hospitals are “cherry-picking,” selecting those patients and those procedures that pay the most and rejecting those who pay less or not at all.

As a result of this perception, Congress in 2010 banned new physician-owned hospitals from opening. An independent study published in the British Medical Journal, just released, with Daniel Blumenthal, MD, of Massachusetts General Hospital, concluded that overall, physician-owned hospitals do not cherry-picking.

Blumenthal says, ““By and large, physician-owned hospitals have virtually identical proportions of Medicaid patients and racial minorities and perform very similar to other hospitals in terms of quality of care.”

The 2010 federal health care law not only banned new doctor-owned hospitals but also limited growth of existing ones. Legislation introduced in May 2015 in Congress that proposes to lift these restrictions is opposed by the main industry group, the American Hospital Association (AHA). The 2010 federal health care law not only banned new doctor-owned hospitals but also limited growth of existing ones. The new legislation introduced in May in Congress proposes to lift these restrictions is opposed by the main industry group, the American Hospital Association (AHA).

A bill was introduced in May 2015 in the House to lift the ban on physician-owned hospitals, but there is no companion bill in the Senate. As things stand now, it seems unlikely Congress will lift the ban on physician-owned hospitals. The American Hospital Association has a more powerful lobby, and full-service hospitals employ millions of workers, and are often the single biggest employer in many communities. There seems to be little interest in making specialists more efficient or in saving them time.