I recently attended the American College of Physicians’ (ACP) Internal Medicine Meeting, the annual national conference for internists and primary care physicians. It was well attended and offered a mix of clinical presentations on new advances in medicine, seminars about the practical side of running a primary care practice, and policy updates on the Affordable Care Act.
The Internist as your Healthcare Quarterback
This group of physicians is arguably the most important in the field. Primary care physician keep our health history, coach us on healthier lifestyle choices, and they are often the first to diagnosis a life-threatening problem.
These are also the clinicians who have to triage the millions of newly insured patients while at the same time dealing with declining reimbursement rates. There is a reason why internists are considered an endangered species.
Yet there was no hand wringing or complaining at the ACP conference.
Given the challenges for this group of doctors, I expected to hear a lot of moaning and complaining, but the reality is that physicians are already moving forward with the new ground rules to build and maintain their practice. They’re embracing the changes despite more complex and tedious record keeping. Ultimately, physicians want to get everything settled so they can get back to their patients.
So what are the new challenges that physicians face?
Three areas of change are having the biggest impact on the business of healthcare for internists.
One is the growth in mandated quality metrics and measures. The Centers for Medicare & Medicaid Services (CMS) has started issuing new targets for quality. Some of the new quality targets will require comprehensive tracking, measuring and managing of data. This focus on quality metrics and measures is adding a whole new level of complexity and work to a physician’s practice.
Secondly, there are new risk and reimbursement thresholds. There is a new reimbursement matrix based on the types of quality metrics a doctor is hitting. That matrix will be used to determine whether a practice receives a bonus… or a penalty. In other words, either the reimbursement will go down or they’ll get a bonus — in some cases, a 4% to 9% bonus on Medicare reimbursements.
The industry is moving from the traditional fee for service model, where doctors knew exactly what they’d get based on patients seen and tests ordered, to a performance-based fee for patient health outcomes. The goal of CMS is to tie 30% of Medicare payments to alternative quality and value payment models by 2016 and 50% by 2018.
This means not only new reporting requirements but a new approach to patient tracking and follow up to ensure patients are compliant with a prescribed therapy regimen.
Finally, these new requirements, both the quality metrics and the outcomes-based payment models, will have a significant impact on physician office workflow. Many practices need additional staff to help track all of the new data. One new role is that of a “scribe.” Individuals are being hired to accompany a physician into an exam room to take and transcribe notes.
Doctors never needed scribes before because doctors would always take notes in longhand and the record keeping requirements were modest. Now that record keeping is getting more and more complex, physicians are being forced to find new ways of capturing notes, identifying the right CPT code and then inputting the data into the EMR.
Impact on small practices
All of these changes are having a direct impact on the financial viability of small physician practices.
One doctor at the ACP conference said that the amount of money that he would need to spend in order to implement systems to track quality measures outweighed the bonuses he would get by hitting the quality measures. The speaker responded, “Well, it sounds like at this point, your practice is too small, and you might want to consider merging your practice into another practice.”
Implications for pharma
How can pharma support primary care physicians through these major changes?
The traditional “share of voice” sales approach of saturating physicians, health systems and patients with promotional messages hoping that the company will gain good brand recognition is obviously no longer viable.
A more valuable response would be for pharma to directly address the new outcomes metrics and reporting requirements. The most relevant approach would be to show how product benefits align with clinical outcomes. This is different from simply repeating efficacy data from the most recent clinical trial.
Real world effectiveness evidence and ideal patient profiles are a start. Case studies from physicians who are integrating a pharmaceutical product in their care protocol and experiencing acceptable outcomes metrics would be even better.
With this more sophisticated content marketing approach, we would speak the language of quality and outcomes and do it in a way that would be relevant to the new world that physicians are facing.
An Example
I had drinks recently with a health care professional in the alternative pain management space. Her practice has had a profound impact on patients going through chemotherapy.
As we discussed ways to scale her business, I said, “An interesting, non-intuitive idea for you would be to reach out to and try to partner with one of the large pharmaceutical companies that specialize in oncology.
“Most of these companies have a broad portfolio of cancer drugs, but because you are actually touching their patients in a non-pharmaceutical but very impactful way, they might make a really good sponsorship partner, especially in terms of pain and depression management support.
“This partnership would not only give you growth capital for your business, but it would help position the pharmaceutical company or oncology brand as being more than just a product, but part of a larger patient-centric health solution, one that could improve its chances of demonstrating improved outcomes and patient satisfaction.”
And that’s really where I think pharma and the healthcare industry needs to move — toward a larger physician and patient-centric total health solution — where partnerships between physicians, drug companies and patients create long-lasting outcomes that benefit everyone.
And maybe we can help save internists from extinction…