MIPS or Merit-Based Incentive Payment System has become a topic of discussion recently, and it’s predicted to have a significant impact on the income of physicians who currently see Medicare patients. It’s a new payment system that will provide annual salary updates to physicians based on four “performance indicator” categories: quality, resource use (efficiency), clinical practice improvement, and meaningful use of EHR. What they have essentially done is combine the Physician Quality Reporting System (PQRS), Value Based Payment Modifier (VM), and Meaningful use into one program. Now according to most sources, MIPS doesn’t apply to everyone, however since the trend is to take Medicare as the standard, it could be predicted that soon you will see other payers (and whole health care system) begin to default to this payment model or something similar sooner or later.
There was a time when our worth as physicians was not tied to the number of tests we ordered (or did not order), how many patients we saw, or when we closed our charts. It was more tied to the quality of our actual care (as determined by clinical outcomes), and the relationships that we built with our patients. Over the years, the attempt to create standards of care (which I do believe was an attempt at improving the system), has morphed into somewhat of a dictatorship run by insurance companies, government officials, and healthcare executives that are driven more by money than the welfare of patients. These entities treat medicine like it’s a cookie cutter process while we know that patients are individuals and there has to be some variation in care from time to time. Furthermore, the parameters for “efficiency”, “quality”, and “meaningful use” are created by high paid executives that are not on the front lines of day to day medical care. They have no clue about the actual clinical atmosphere of daily practice. They arbitrarily set these parameters based on data sets that are not necessarily reflective of the true day to day operations practice.
As a result we are being forced into a “work more, earn less” model, and this is, in part, what is ultimately driving physicians to burnout earlier and earlier in their careers. The decreasing reimbursements, and resulting decrease in salary and income potential that is happening creates an additional burden when, we still have to deal with the hundreds of thousands of dollars we spent getting this education.
I was talking to a burned physician mom recently and the topic of RVU’s came up in our conversation. As she shared with me how her hospital organization was shifting their model to RVU based on productivity, and how this was going to significantly decrease her salary unless she increased her patient load (even though she was already seeing 20–25 patients/day). In fact, she was worried that she would actually have to pay back the company because she didn’t feel that in her current state she could do much more than she was already doing. She was working 5 days, staying at work until 6 or longer, taking charts home every day (and often charting on the weekends). She barely had time to spend with her children and husband. When she was around family, she stated wasn’t really “there” but instead on the computer trying to catch up from the prior week’s charts and inbox. Sadly, this is not the first time I had heard this story. In fact, I cease to be amazed at the number of physicians I speak with who are suffering at the hands of these so called value based models.
So how do we deal with this? The truth, it seems, is that we have little power over what the “powers that be” are doing, but we have control over how we approach our careers given the environment.
Unfortunately, most physicians are trained that there is only one path as a physician and that is to graduate from medical school, do residency, and get a job as an academic, researcher, or clinician. If the physician is lucky (meaning either they know the right people or they kill themselves working to “prove they are worthy”), they might get into leadership or hospital administration. Most physicians, however, will continue to suffer because they never really become aware of their true value, and how expansive the opportunities for “outside the box” physicians can be. We were never taught things like business and entrepreneurship.
Things like early Financial planning and investing, realizing the value of our credentials beyond clinical practice, and considering additional sources of revenue are our access to reclaiming our power (and value) in this industry. At this point, sitting around waiting for “the system” to come to its senses and change is a set up for more of the same: devaluation and the hamster wheel to burnout.
Maiysha Clairborne MD is an integrative medicine physician and coach who helps other physicians reclaim their time & create their ideal career. She is the author of The Wellness Blueprint and Eat Your Disease Away. She can be reached at www.stressfreemommd.com