Helping Physicians Focus on Patient Care
By Prudence MacKinney
Recently, I was showing a physician and his wife around town as part of the interview process for a position we have at Brattleboro Memorial Hospital. They were self-professed “city people,” looking for a safe community in which to raise their family; while at the same time they did not want to feel isolated geographically or culturally. Brattleboro obviously met a lot of their quality-of-life criteria.
The truth is that Brattleboro’s vibrant community and the proximity to New York and Boston has always been a plus when recruiting new doctors. Even as other rural communities struggle to recruit primary care providers, both in Vermont and elsewhere, we have been fortunate that quality physicians historically have wanted to establish a practice in our corner of the state.
That quality-of-life benefit has enabled physicians in our community to operate independent practices longer than other areas. But the cost of maintaining a practice is rising even as income from Medicare, private insurance reimbursement and other payment forms is going down. In response to this trend, hospitals have been employing physicians to preserve their practices to ensure that the communities they serve have an adequate number of primary care providers and specialists.
Over the past 10 years, this change has swept over the health care system to the point that most new doctors no longer think about establishing their own independent practice. Instead, they come out of residency training looking for an employment situation. Practice management isn’t something that’s taught in medical school, after all. Being employed by a hospital or large group practice means the doctor walks into an existing management structure for the practice’s business aspects (billing, staffing, facility). This ensures a stable income and allows them to focus on taking care of the medical needs of their patients.
Here in Brattleboro the need to offer employment to physicians surfaced later than in other Vermont communities but now it is the only way to attract new doctors. In order to stabilize the BMH medical staff, we have established the BMH Physician Group. The recent establishment of Brattleboro Family Medicine at 53 Fairview Street puts the number of practices within the BMH Physician Group at ten. This month, we have also relocated Putney Family Healthcare and Brattleboro Obstetrics and Gynecology/Four Seasons Midwifery to new facilities that will better accommodate their growing patient bases.
As each office attunes itself to the new appointment and billing system, we will begin phasing in the use of Electronic Medical Records (EMR). An EMR is required for primary care practices to become certified Patient Centered Medical Homes, a major focus of the Vermont Blueprint for Health. The Federal government also provides financial incentives for practices to convert their paper charts to electronic medical records. Windham County has two such practices that are currently certified: the independent Brattleboro Primary Care practice and the hospital-operated Windham Family Medicine. Blueprint for Health is great but there are rigorous certification requirements. It does help to have the hospital available to provide staffing and other resources for practices to enter their information into the state’s system.
In future years Medicare and Medicaid reimbursement will be reduced to physicians without an EMR in place. The inevitability of EMR is another motivation for physicians to seek employment as electronic medical record systems are very expensive. Once we have the EMR fully implemented we can pursue Blueprint certification for all our primary care practices.
Brattleboro still has many high quality physicians in solo or small group practices. But Windham County has also seen many primary care providers close their outpatient practices, and others are approaching retirement age. BMH Physician Group will allow BMH to recruit and retain doctors attracted to the quality of life offered by the Brattleboro community.
Prudence MacKinney is the Vice President of Physician and Business Development at Brattleboro Memorial Hospital.