- A prevailing opinion in healthcare holds that myriad and increasing regulatory mandates make the task of operating an independent physician practice overly fraught with challenges and likely not worth the risk.
Jeremy Luckett, MD, of Vineyard Primary Care in Owensboro, Kentucky, obviously does not share that opinion having set out on his own in 2015 after having worked as part of group practice. According to Luckett, the independence that comes with having his own practice, which currently comprises himself and a nurse practitioner, can't be matched by another setting.
That being said, plenty of challenges face Luckett and his practice as it looks to expand both its patient population and number of physicians. One such challenge was EHR adoption to improve access to patient information, which ultimately led Luckett to choose EHR cloud-based solution AdvancedEHR.
In this one-on-one interview with EHRIntelligence.com, Luckett describes his journey in setting up his own physician practice and the role of EHR use in driving quality improvements at Vineyard Primary Care. While Luckett cannot control the regulatory changes taken place in healthcare, such as the implementation of MACRA, he most certainly can influence how his patients experience care at his practice by properly implemented technology into his clinical workflow.
EHRIntelligence.com: What's the history of your practice? How challenging is operating a small physician practice in this current regulatory landscape?
Jeremy Luckett: I established the practice last June, so it's a fairly new practice. There's myself and a nurse practitioner who work here. She primarily sees urgent care visits for my patients. I have somewhere in the neighborhood of 3,000 patients and we're still accepting patients, so that number changes every day. My plan with her is: Once I get as many as I can take, then I'm going to start having her accept patients, too. The facility that I'm at has enough room for four providers, so the plan is to slowly build and add providers as we go.
It's certainly not easy. When I came out of residency, I joined a larger group practice because everyone says you can't do it on your own. There are some advantages to being in a larger group practice, but I don't feel like I have to be member of a specific practice and can have my own practice and get those advantages. I'm in an accountable care organization with some of the other practices in town, so the things you need to be bigger for you can still do and be small enough to do things the way you want on your own.
I do work very hard. I wouldn't want to work this hard if I were in the twilight of my career — I can understand that move. At the same time, I see that there is plenty a benefit to doing the things that I'm doing now while everyone else is going the other way. It makes me more marketable.
EHRIntelligence.com: What factors drove your EHR selection process? Did your experience in group practice inform you decision-making?
JL: Actually at the time, we were considering switching EHRs. I ended up choosing this one, which was one of the finalists for the other group I was with. And not that it matters, the one that they went with they're considering changing again. So they came back to me and asked me if I have been happy with the one that I got.
The product that we had previously was server-based, and there are some challenges with that. They are a traditional practice. I'm also a traditional practice. So we're practicing in the office and at the hospital. The hospital has its own EHR and if you're seeing someone at the hospital and can't access their record, then it makes caring for that patient more challenging. We wanted to have something that was cloud-based — that was the main big thing — and the one that I have is, so I can access it at the hospital or even at home if I need to do that. And particularly when I'm starting a new practice, there are so many expenses as is, not having to invest in servers and all that kind of stuff was a selling point.
EHRIntelligence.com: How essential is EHR adoption to a small physician practice such as yours?
JL: For one thing, you almost can't have a practice on paper now. You have to have some kind of electronic health record because you get penalized if you don't. If you're going to have one, then having one that seamlessly integrates the documentation that I have to do with the billing that biller has to do is very important. If I can document really well but can't get paid, then that doesn't work. If the billing side works really well but it's a pain in the rear to document on, then that doesn't work well either.
I have almost always had an EHR. Even in residency, we had electronic health records. Some of the more senior physicians probably have more trouble with that. Vendors have tried to help that — they try to integrate dictation into the EMR, for instance. I haven't had trouble with that, but I can understand how people used to doing things on paper would be discouraged.
EHRIntelligence.com: How does the patient experience EHR use during their visits to your practice?
JL: At the practice I was at before, we had laptops and brought them into the room with us. That was one of the things when I came that I didn't want to do. I didn't want to spend all my time in the room with the patient staring at the computer. What I have started to do is open up their chart in office, get a sense of where the visit is going, what their goals for the visit are and what I want to get addressed during the visit, so I have everything laid out. Then when I go into the room, I spend my time just talking to the patient. I did recently purchase an iPad because sometimes patients have a question about lab work or medications, so I have something that I can still pull up and look at. But I don't like being tied to looking at the computer the whole time. I want to look at the patient, talk to the patient.
EHRIntelligence.com: How are you preparing for recent regulatory changes as part of MACRA implementation? Are you going to be part of the Merit-based Incentive Payment System or Alternative Payment Model path?
JL: There are still some unknowns about that. Some of the people in ACOs think they are going to qualify for that pathway and they won't. I'm preparing as if I'm not. I started trying to make sure that I do everything I can to ensure that our quality is as high as it can be so that we'll be in that upper tier or at least not in the bottom tier. We almost need to have someone whose job is strictly to stay on top of all these things. That adds an expense, and you're not being paid more for it. That's certainly a challenge, but it is what it is. We're stuck with it.