1. A Perspective on the Private Physician Practice - A Status Report Debra Wiggs, FACMPE Trinity Management Solutions Bellingham, WA

2. Conflict The Practice of Medicine Vs The Business of Healthcare

3. Medicare (and Medicaid) Care delivery models Hospital/physician relations Healthcare manpower Technology EHR, eRx, diagnostics Transparency, payment models Administrative complexity Private Practice Today: What are the issues? “All Health Care is Local”

4. Seven year trend Medicare payment Source: MGMA 2008

5. 42% of practices will limit the number of Medicare patients they treat 19% will close the practice to new Medicare patients 45% plan to reduce staff 59% plan to reduce physician comp 53% will reduce IT investments 57% will reduce staff health insurance coverage Medicare (and Medicaid) Source: MGMA 2008

6. Models for care delivery Concierge practices Retail clinics (Walmart) Integrated delivery systems (part II) Advanced medical home (New gatekeeper/case manager) “All Health Care is Local”

7. Hospital-physician relations More practices being acquired by hospitals Call coverage Growth of physician management in hospitals Growth of non-hospital practice Hospital – physician competition… …vs joint ventures

8. The demographic tidal wave Continuing nursing shortage Other health professionals Physicians –The death of primary care? Healthcare manpower

9. Expansion of diagnostic resources and interfaces RHIO success experience is variable Slow growth in EMR/EHR adoption rates Growing evidence of EHR ROI opportunities Under use of capabilities (eg, kiosk, web portals, eRx) Mandatory eRx implementation Technology

10. Transparency Pricing for services –Requires simplification of payment rules –Consistent fee schedules Performance vs Quality –Requires accurate information –Standard measures

11. Administrative cost accounts for 30% of all the $700B+ spent on healthcare in the US is non- healthcare related expenses – Little standardization – Massive duplication Eligibility verification Standard credentialing Hundreds of billions could be saved Administrative Complexity

12. Interesting Reading/Resources The E-Myth Physician by Michael Gerber How Physicians Think by J. Groopman, MD Better by Atul Gawande, MD A House Is Not A Home: Keeping Patients At The Center Of Practice Redesign Health Affairs, 27, no. 5 (2008): 1219-1230 doi: 10.1377/hlthaff.27.5.1219 Health Affairs Medical Group Management Association www.mgma.com