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 Physicians will develop a much more visible presence on the Internet
in the coming months and years, and the Web will allow physicians to
cut their practice overhead by outsourcing many business operations
currently performed in their offices, according to an informal poll of
physician leaders and consultants. These experts also predict that
e-mail and hand-held computers will change how physicians and patients
interact and that more health care business will be conducted over the
Internet as physicians, health care provider organizations, and
American consumers become more savvy about how the Internet works.
Out of the top 10 trends that physician leaders and consultants have
identified for the year, five relate to how physicians are using the
Internet to do business. The other five trends are: a continued rise in
the number of procedures done in physicians' offices, pharmaceutical
manufacturers' continued use of physicians to conduct new drug trials,
continued growth in the use of specialists, increasing mobility among
physicians seeking more attractive practice opportunities, and
integrated delivery systems will continue to shed the physician
practices they acquired in recent years.
1. Physicians' presence on the Internet will increase dramatically.
James Adams, MD, a cardiologist in Larkspur, Calif., commented that
physicians will need Web sites because so many businesses are doing so
today. "This is a no-brainer," he said. "Out here, everybody and his
mother has a Web site."
Some 37% of physicians use the World Wide Web, a proportion that almost
doubled in two years and that is expected to continue to rise,
according to a study released in December by the AMA. The AMA based its
figures on interviews with 1,084 office-based physicians and compared
the latest results with those of a study done in 1997. The earlier
study showed that only 20% of physicians were using the Web.
The latest survey showed that 41% of physicians used a computer in 1999
and of those who did not have access to the Web, 58% planned to begin
using the Web within six months, the AMA said. The AMA survey showed
that more physicians are using the Web to promote their practices and
to send information to patients.
Use of the Web will grow as companies offer free Web space and
assistance in building Web sites to physicians nationwide. Physicians
will soon find that having a Web site will be necessary to practice
effectively, according to the experts.
2. Many health care transactions will be conducted on the Internet. The
amount of business related to health care that will be done over the
Internet will be more than billion annually, experts predict. Doug
Emery, a health care economist in Salt Lake City and president of
Zoadigm Health Systems Inc., a company developing global fees for
episodes of care, believes billion may underestimate the total. "The
Internet is making every health care product a commodity," he says.
"Health care business on the Web could become a multitrillion-dollar
worldwide phenomena." Tom Ferguson, MD, publisher of The Ferguson
Report, a newsletter in Austin, Texas, that reports on physicians' use
of the Internet, says that while the sales figure of billion is
impressive by itself, the Web's effect on the patient-physician
relationship will be even more dramatic. "The best option for
physicians is to jump onto the Internet now," Ferguson says. "The train
is leaving the station."
3. The use of hand-held computers will grow sharply. Palmtop computers
which allow physicians to access Internet data, make patient encounter
information more accurate, and outcome studies more feasible and
relevant, will render obsolete many office-based computer systems, the
experts say. Lloyd Hey, MD, a spine surgeon at Duke University, has
been among a number of physicians at Duke who are working with
hand-held computers and believes they have helped the university to
increase revenue while also saving almost ,000 per physician. What's
more, the computers have helped physicians to increase dramatically the
amount of data they capture for patient charts and for outcomes
research.
Not all experts are convinced, however, that hand-held computers will
be useful initially. Bernard Rineberg, MD, an orthopedic surgeon in New
Brunswick, N.J., and a member of the editorial Advisory Board of
Practice Options, is skeptical about them, saying their use will not
increase sharply for a time. "A steep technological learning curve
still exists," Rineberg says. "Using them adds complexity, not
simplicity." The best option for physicians considering using hand-held
computers is to ask colleagues who use them in their practices how they
have helped them to increase efficiency. Approximately 25% of
physicians are currently using some form of palmtop device.
4. The number of procedures done in offices will continue to rise.
Procedures done outside of hospitals will continue to increase as fees
for managed care and Medicare continue to drop. David Kohmesher, an HMO
executive at Heritage Medical Systems, in Reseda, Calif., believes that
soon only the most seriously ill patients will be treated in hospitals.
All others will be treated in physicians' offices, at home, and in
other less costly settings. The question for physicians is to determine
whether they can do procedures safely in their offices. To answer this
question, physicians may need to have their practices evaluated by a
consultant or other expert who advises physicians on practice risk.
5. E-mail communication with patients will become common. Physicians
will use e-mail to schedule patient visits, provide information to
pharmacies and to patients about prescription refills, transmit lab and
other test results, and to provide health care information to patients.
E-mail will minimize the problem of telephone tag and serve as the
conduit for the bulk of patient communications. Neil West, MD, a
pediatrician who is medical director for Millennium West, a physician
group in Tucson, Ariz., says that even though e-mail will become more
common, physicians will still need to meet with patients. "We must
schedule a time for patients and doctors to talk," West says.
Physicians should survey their current patients to see which ones use
e-mail and use that information to communicate and educate patients and
to market new services. Many Americans who use e-mail to communicate
with family and friends may gravitate toward progressive physicians who
communicate with them electronically.
6. Pharmaceutical manufacturers will continue to contract with
physicians for drug trials. The search for new pharmaceuticals will
mean manufacturers will continue to outsource clinical trials to
physicians. This work will become an important source of revenue for
many physicians. Harold Kaiser, MD, of the four-physician group Allergy
and Asthma Specialists in Minneapolis, and a member of the editorial
Advisory Board of Practice Options, has found pharmaceutical trials to
be intellectually stimulating and rewarding. His group has been doing
trials for 10 years. "But it isn't easy," he says. "It requires a
concerted effort by the entire staff."
7. Some specialists will continue to do well. Those specialists who
perform lifestyle or life-saving high-technology procedures will be in
demand. "Specialization adds value," says Emery of Zoadigm Health
Systems. Managed care plans that recognize the value of specialists may
see lower costs. UnitedHealth Group, the large managed care
organization in Minneapolis, has entered into an innovative incentive
arrangement with a health plan-United HealthCare of Florida (UHC)-in
which UnitedHealth Group will pay UHC more for meeting certain quality
goals related to cardiac care. UnitedHealth Group believes quality
specialty care will produce lower costs overall.
8. The Internet will let physicians outsource certain business
operations. Physicians who practice in small groups or who work
independently will find the Internet will allow them to outsource
certain practice management and business functions. William DeMarco,
president and CEO of DeMarco & Associates, physician consultants in
Rockford, Ill., believes physicians will find this option useful
because it will free up management time. But it may require physicians
to invest in information systems. "Physicians will still need to get a
good information system that not only takes care of the technical and
billing aspects of a practice but communicates with patients and helps
with the e-commerce aspects of practice development," DeMarco says.
Several companies are marketing these services to physicians.
9. Physicians will become more mobile. Physicians will seek practice
opportunities in other parts of the country or will pursue different
careers both within and outside of the practice of medicine. Ferguson,
of The Ferguson Report, comments, "Physicians will also become
'virtually mobile' and less limited by geography in part because of the
Internet. As a result, they will be able to live and work where they
want."
10. Integrated delivery systems will continue to shed physician
practices. A survey last fall by Ernst & Young, CPAs and health
care consultants in New York, showed that 96% of large integrated
delivery systems were losing an average of ,000 per physician per year.
These large systems will not continue to tolerate such losses and so
they will cut their physician staff members. Susan Keane Baker, a
physician consultant in New Canaan, Conn., says, "A growth industry in
the next decade will be those lawyers who specialize in dismantling
hospital-physician marriages." Hospitals and other provider
organizations, such as physician practice management companies, have
been eliminating physician staff members over the past two years.
Written by: Richard L. Reece, MD
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