A recent survey of 1,000 physicians, part of the soon to be released Physician Sentiment Index (PSI) done on Sermo, confirms what many of us already know; we as physicians have remarkably little insight into the business underpinnings of our profession, and even less optimism about the future of our profession. While 82% of physicians state that they have a "clear" or "vague" understanding of what cash flow is, only 25% of respondents could select the correct definition from a list of options. Perhaps most striking, a disturbing 70% of MDs surveyed believe their financial situation will be the same or worse next year. While this isn't surprising, after all we went to medical school, not accounting school, it is certainly not encouraging and makes me wonder if these trends are linked.

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As physicians, the loss of control of our financial fate is inseparable from the gradual demise of our profession.

By any measure, doctors find themselves in an increasingly untenable position. Payers have long had intrinsic advantages over physicians and even shifting to fee-for-service introduces unique challenges to physician owned and managed practices. I have discussed these challenges for over a year now, and even predicted that companies or technologies would come along that help address inefficiencies and the information imbalance that exists between payers and physicians. This week, Sermo will announce a partnership between Sermo and athenahealth. Positioned between the doctor and the payer, athenahealth pools the collective experience of thousands of physicians' claims data into something called a rules engine to help even the playing field between physicians and insurers. In key metrics, such as claims rejection rate, accounts receivable, and yes cash flow, athenahealth has shown that technology can help physicians directly benefit from one another.

I believe the appeal of companies like athenahealth and Sermo is their unique ability to allow individual physicians to leverage many of the same technologies and strength in numbers that the insurance companies have long benefitted from. For the healthcare industry, it is the opportunity to help level the playing field. For physicians, it is the opportunity to turn the billing process into a strategic advantage, increasing the ability for us to stay in practice and provide the best possible care to our patients.

So, the discussion for the community…..do you think EMR, EHR, and/or billing technologies can be used to improve the financial independence of physicians?

Daniel Palestrant, MD

Founder & CEO

Sermo, Inc.

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Not since the days of monopoly busting and Standard Oil has anti-trust been such a contentious topic in American politics. Today, Teddy Roosevelt has been replaced by Nancy Pelosi and the oil barons have been replaced by……doctors? The healthcare debate is quickly turning into a dog fight about monopolies and price controls, and in doing so, unveiling some of the dark truths about how the money really flows in this country's largest industry.

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Turns out antitrust law has become so contorted and subverted that it now serves the interests of those it was meant to regulate far more than those it was meant to protect. This past week, the FTC announced a consent decree with Roaring Fork IPA, a physician network in Colorado ( click here). Of course, this is less than a week after the Speaker of the House announced that she will pin her party's hopes of resurrecting healthcare reform on repeal of the 1945 McCarran-Ferguson Act, a little known antitrust exemption that benefits the insurance industry ( click here).

So why has antitrust become all-the-rage-all-of-a-sudden?  The Sherman Antitrust laws were originally intended to prevent monopoly behaviors, however, it has become a key tool in keeping physicians as indentured servants in our healthcare system.  As Medicare continues to reduce payment rates, more and more providers are choosing to opt-out rather than contract to deliver services at a loss. Most notably, the Mayo Clinic chose to do this a few weeks back ( click here).  What is fascinating, however, is that the FTC is claiming that the Roaring Fork's decision (unlike Mayo's) constitutes an anti-trust violation so egregious that it is worthy of an investigation and the consent decree.  With 65 physicians, Roaring Fork represents well less than 1% of the physicians in Colorado, so why the anti-trust concern?

The answer lies in the cozy relationship between the insurance industry and the FTC.  Insurers are determined to make sure that physicians are kept from having any leverage nor allowing market forces to create a balanced supply-demand between physicians and patients.  The net goal of both is keeping physician payment artificially low, while maximizing insurance company profits.  For physicians, Roaring Fork should be a wake up call to accelerate their efforts to decrease their dependence on third party payers and their adoption of technologies and services that can even the playing field.

Today we are witnessing a Kafka-esque sequence of events.  Teddy Roosevelt, the original trust buster, would literally bust out laughing if he could see the incumbent political party pinning their hopes for their highest profile political effort on repeal of an anti-trust exemption, while the government chases after……..doctors, for ostensibly violating this same law.  Only in America.

Daniel Palestrant, MD

Founder & CEO

Sermo, Inc.

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Originally Posted to the Sermo Community
By: Whatagas, Anesthesiology

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Today the FTC announced a consent agreement effectively killing the Roaring Fork Valley Physicians IPA. A major point of the FTCs contention was that the IPA's refusal to present contracts to members based on medicare payment rates represented price fixing by the IPA! In other words, if you don't accept medicare's fixed pricing, you are price fixing.

Here's a brief analysis:

http://blog.mises.org/arch...

and here's the actual FTC complaint:

http://www.ftc.gov/os/case...

Originally Posted to the Sermo Community
By: chinita, Pediatrics

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How do you counsel parents with toddlers who "humps?" Here are 2 recent cases:

2 year old boy living with both parents, only child. Since about 6 months old, he "humps" pillows and other objects mostly before he falls asleep. The humping seems to be soothing to him.  Parents initially thought it was funny and video taped it but stopped showing them after someone commented on it being perverted. I counseled them it appears to be a soothing behavior and to teach him to do it in private. No shaming. He now only does it occasionally in private in his own bed.

3 year old girl with recently separated parents. Living with mom and 5 year old brother. Since she could crawl, she would also hump objects. Again, it appears to be soothing. Mom tried to ignore it. Also tried to encourage girl to do it in private without shaming. Since parents separated, things have gotten worse. She's now undressing herself in public to hump objects. Mom found her naked humping brother's Transformer toy. This one I referred for therapy. There was DV between parents. No physical or sexual abuse per mom. Genital exam and UA were normal.

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