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Issue Date: October 2007

What Do Doctors Want From Health Reform?
Doctors’ attitudes toward health reform will help to make or break any reform proposal. Seeking to define trends among physicians, Sermo.com, a company in Cambridge, Mass., has established a Web site under a contract with the American Medical Association. Wall Street firms seeking health care trend data pay for part of the cost. Only licensed physicians can visit the site and post comments, and Sermo encourages them to join in the discussion forums. Reading the responses to a variety of posts, it’s possible to get an idea about what physicians are thinking. In general, the physicians who write for and post comments on the site distrust large integrated systems that reduce them to protocol-following functionaries. They also question the value of retail clinics and disease management systems in which they do not participate directly. It should come as no surprise that physicians remain wary and even hostile toward managed care, regarding its managers as intrusive, ill-informed, and obsessed with cost, not quality. They also seem to think that information technology is overrated.

Payers Call for More Focus on Quality
In the past few years, health care organizations have begun to define quality of care and to establish quality measurement tools to assess the processes and outcomes of care. Some of these initiatives have focused on data collection and measurement and have resulted in the identification of significant variations in how care is delivered. These efforts are affecting physicians in every specialty including oncologists, rheumatologists, pulmonologists, and allergists. A number
of these efforts are aimed at improving care for patients with chronic conditions in part because such care is costly and there is a rising number
of patients needing such care. But other specialists have been affected as well. The American College of Rheumatology, in Atlanta, says the focus on quality will affect how physicians treat patients and how physicians are reimbursed for services.

Groups Develop New Models of Care
Compensating for the loss of revenue resulting from declining reimbursement, many physician practices are offering new services to patients. Practices are opening pharmacies to serve their patients and patients’ families, developing partnerships with other physicians, and providing psychological counseling. Among the physician specialists who have perhaps been hit hardest by declining reimbursement are oncologists and so the strategies they are developing may be most useful to other physicians seeking new strategies in a challenging environment.
“Revenue must come from somewhere,” says Teri Guidi, president of the Oncology Management Con-sulting Group in Pipersville, Pa. “Whether it’s joint ventures with radiologists, acquiring their own imaging equipment, or new service lines, virtually everyone has to look at new revenue streams.”

Simple Changes Boost Productivity
Simple changes in physician practices may pay off big in practice productivity, quality, and satisfaction. Many physician leaders regard large integrated multispecialty clinics as the most rational solution for solving small-practice woes; in other words, work together in large systems or die. Fitzhugh Mullan, MD, author of Big Doctoring in America: Profiles of Primary Care and a family doctor on the board of editors of Health Affairs, describes these physician leaders as “system doctors,” because they are medical directors of large health systems. In his book The Innovator’s Dilemma, Clayton M. Christensen, a professor at the Harvard Business School, says that “disruptive solutions” can undermine even the best managed organizations, even large medical groups. A disruptive solution is a new technological invention, product, or service that eventually overturns the existing dominant technology or product in the market. Simple, convenient, and powerful innovations aimed at the low end of the market disrupt large organizations. In health care, the market’s low end is primary care physician practices, and the high end is large multispecialty organizations. Like all large organizations, they may be mismanaged, develop bloated overheads, become overly bureaucratic, and may not appeal to physicians who seek more autonomy. In short, large organizations are complicated bureaucracies, and many, if not most, physicians do not feel comfortable in complicated working environments.

Three Estate Planning Mistakes to Avoid
Like many successful professionals, physicians are often so busy dealing with their practices and attending to their personal lives that they often fail to take the time to address the important challenge of creating a tax-wise estate plan. Not having an estate plan means it is likely that physicians are unaware of three of the most common estate-planning mistakes and how to avoid them. Fortunately, there are simple tools that physicians can use to elude the unnecessary costs that result from poor planning.
The three common mistakes are:
1. Losing half of life insurance proceeds to taxes
2. Leaving property to the IRS
3. Losing 70% or more of pensions, 401(k) plan proceeds, and individual retirement accounts (IRAs) to taxes unnecessarily.

Recruiter Says Practices Are Changing as Medicine Becomes More Specialized
In this interview, Phillip Miller. the vice president of corporate communications with the recruiting firm of Merritt, Hawkins, & Associates in Irving, Texas, discusses a book he co-authored, Guide to Physician Recruiting–First Edition (Practice Support Resources, Inc., 2007). He also is the co-author of an earlier book, Will the Last Physician in America Please Turn Off Lights: A Look at America’s Looming Doctor Shortage. Miller has more than 19 years of experience in the physician recruitment business. He spoke with Editor-in-Chief Richard L. Reece, MD, about the changing nature of physician practices.