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The need for high-cost technology and dealing with low reimbursement: we are at the tipping point. With the current high dollar investment in medical records and other expensive technology, how do we face this squeeze?

When reimbursement is not lowered, we see this as success even though reimbursement has not been raised. What a conundrum. How misleading is it when we are told that primary care saw a 2.04 percent increase and specialists saw a 2.19 percent increase. (Average for both primary care and specialty care).

Wow, an increase in physician compensation – oh wow, a raise. NOT….. Physician compensation is what is left after all other expenses are paid. I cannot tell you of a single practice, whether small or large that realized this increase, unless a group has undergone some type of major re-structuring with; employees cuts, consolidation or some form of significant revenue center implementation. And I will go even further, that if any of your colleagues tells you anything different, they are “drinking the punch.” Expenses for your practice have increased this small insignificant amount just when you open the doors. Even when we have “perceived” that we have maintained Medicare reimbursements as a victory each time the quick fix by Congress happens at the ninth hour, we are only fooling ourselves—again.

We know that third-party payers tie reimbursement rates to Medicare allowables. Then under this logic, would we not see this also as a win? Of course not, when looking at the financial reality. Again, as in any other discussion, how do we not include the sustainable growth rate into this “logic?” We can’t if politicians (all politicians) believe in the numbers paper pushers give them, because they will not engage unless they think it may have an impact on them. What do they not understand?

Ok, enough of this. Let’s discuss how we deal with what we are currently facing, unless the lawmakers in Washington have a reality check as their constituents find it harder to gain access to healthcare.

The issues here are a short term ‘fix’, the same as when our lawmakers seem to look at issues to get re-elected and play politics with us.

We need to look at partners to help with the high costs of staying proactive technologically. Seek help finding financial sources outside of our individual practices or silos. Find partners that we feel comfortable with, trust and understand in moving forward. Find revenue sources to maintain and hopefully grow.

We will, unfortunately, still have to balance being reactive and with trying to be proactive.



Bill Appling, MBA, FACMPE, is president of Watkins Uiberall Health Care Consulting. He has faculty appointments at the University of Memphis in the Fogelman College of Economics and Business, where he teaches in the Masters of Health Care Administration program.

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