Doctors eye cure for inefficiency

All the consolidation that took place in the health care industry in 2009 could have a surprising benefit for patients: greater strides toward efficiencies in customer service.

That's because larger doctor practices that swallowed up smaller ones have deeper pockets to upgrade their information systems and other infrastructures, which the Obama administration is touting as part of health care reform and which studies have shown consumers are demanding.

These upgrades include transferring medical records from shoe boxes and file cabinets to computer systems, as well as instituting a payment system that insurers increasingly use to tie how much doctors get based on their performance or their adherence to certain quality measurements.

By instituting such measures, patients spend less time repeating their medical histories and waiting for an appointment.

"Some of these tools are very expensive, and they don't make sense for smaller practices because they don't have the financial wherewithal to implement them," said Alwyn Cassil, spokeswoman for the Center for Studying Health System Change.

According to a study this month by the Center for Studying Health System Change, a national health policy research organization, solo and smaller doctor practices are less likely to:

--Use care management tools, such as nurse managers who can coordinate patient care.

--Issue reports on physician performance.

--Conduct "group visits," which a physician uses to educate a group of patients suffering from the same illness or disease at the same time.

Often, the larger systems have the latest in technology, allowing them to offer patients better access to the latest standards and quality measures, particularly if the system is connected to an academic center or a bigger network that allows them to share best practices.

For example, Utah-based Intermountain Healthcare and Pennsylvania-based Geisinger Health System both have hundreds of physicians and highly coordinated health care practices whose electronic medical record systems are already in place, putting them way ahead of the national curve.

Analysts say it's harder for solo practitioners and those in small doctor practices to break away from seeing patients to attend an educational conference or have the luxury of bouncing ideas off colleagues in the office.

"If you're a busy physician, giving an educational pamphlet to your patient is quick and easy, but most researchers think it's less powerful than other, more demanding interventions we found were used much less often," said Dr. Emily Carrier, a senior researcher at the Center for Studying Health System Change.

About 33 percent of doctors are in a one- or two-person practice, according to the most recent statistics available from the Center for Studying Health System Change. A decade ago, the number of doctors in such practices was about 40 percent.

Some of the nation's largest health care systems say they have seen an uptick in doctors from smaller practices wanting to join them.

Advocate Medical Group, one of the largest health care systems in the Midwest, this year saw more doctors from solo or smaller practices join the company, which contributed to the 10 percent jump of employed physicians in 2009 to 700.

"The number of discussions with physicians interested in employment ... has more than doubled in the last six months," said Dr. Jim Dan, president of physician and ambulatory services at Advocate.

Analysts expect the consolidation trend to continue because hospitals and some doctors, including specialists, are expected to have their payments squeezed under health care reform.

Even those doctors who may see higher payments under health reform, such as primary care physicians, will look into joining bigger practices because of the capital needed to upgrade their offices, analysts say.