With a little more than 100 days under his belt, Jeff Lehrich, the new CEO of Palmetto Primary Care Physicians, is settling into the job.
Lehrich joined the Lowcountry’s largest primary care doctors group from an interim position at a hospital in Wyoming. Before that, he worked as an administrator for Kaiser Permanente in Cleveland.
Lehrich recently sat down with The Post and Courier to talk about the art of managing doctors, the Affordable Care Act and why 15 minutes of face time with your doctor is as good as it’s going to get.
His answers have been edited for length.
Q: Why did this opportunity in Charleston seem like the right fit for you?
A: It reminded me a lot of New Orleans, and I spent quite a bit of time in New Orleans. I really love working with doctors groups. I had several other options with some large hospital systems. I’ve sort of been there, done that. I’ve cleaned up a lot of messes with the hospital systems. They’re doing the same thing they did in the ’90s, which is that they’re hiring a lot of doctors but they still don’t really understand how to manage those practices. It’s sort of an art.
Q: In what way?
A: It’s a real art in that it’s not just about a little bit of billing and a little bit of quality and service. It has a lot to do with motivating and incentivizing physicians. Most hospital-owned physician practices have significant problems with productivity. They get on a salary and they sort of lose that drive to do better. It’s sort of like the difference between capitalism and socialism, I like to say.
Some of them will tie the physicians to what’s called RVUs, work units that they produce. That works to a point, but, as you probably know, the whole industry is changing from fee-for-service to fee-for-value, and RVUs are a fee-for-service construct.”
Q: Does the average patient understand the difference between fee-for-service and fee-for-value?
A: The average patient out there is confused. They don’t really know. Health care is complex at a base level, and when people get involved in the system it’s usually under not the best circumstances. They’re not going for wellness. They’re going because they’re sick. So when you’re exposed to the system, it’s complex and bewildering for many, many people.
Q: Are patients the only ones confused about the federal Affordable Care Act or are health providers confused too?
A: I think everyone is confused. The law is extremely complex, and the law, as it was written, required basically HHS (U.S. Department of Health and Human Services) to put forward a stack of regulations — it’s probably up to the ceiling, if not beyond that now — and it’s only in the early stages of implementation. I think there’s a lot of what I would call operational details and regulations that have yet to be implemented. I think there’s big delays in some parts of rolling out the whole program, if you will. I can understand everyone’s confused. And, you know a little bit, I would say, apprehensive because it’s a major change in our health care delivery system and I think there’s going to be unintended consequences.
When you dump essentially 30 to 40 million people into the market with insurance and you have an undersupply of doctors and it’s going to get worse, there’s going to be much more build-up pressure on the existing providers in the delivery systems to be able to manage and give high quality care and give good service. Economics ultimately takes hold. There’s no free lunch.
Q: How can independent physicians, operating outside a large doctors group like this one, cope with these changes?
A: That’s sort of a dying breed. The resources and the tools that are needed to run a practice, it’s getting increasingly difficult for any primary care practices to survive on E and M (evaluation and management) codes, which is mostly what primary care does, but if you’re a solo practice or a one- or two-person practice, the resources required for the electronic health records, all the regulatory requirements, billing, you know, being able to track all that stuff and do the reporting ... it’s only going to get more intense and complex.
Q: Patients complain more often now that they spend less and less time with their doctors. Is that just the new reality?
A: Yes and it’s going to get worse.
There’s not enough new providers coming into the system to, quite frankly, meet the demand. We’re going to have significant shortages in different specialties, including primary care.
Fifteen minutes is more or less the norm now. You’re going to see things like group visits.
Q: With other patients?
A: Yes. You’re going to see more and more of that kind of thing.
Q: How would that work?
A: People with certain kinds of disease, they come in for a group visit on diabetes, they come in for group visit on hypertension, they come in for a group visit on women’s disease — fibromyalgia.
They’re going to start doing that because a lot of the education and talking that a provider can do one-on-one, it’s really the same message, if you think about it, to that whole population of patients. It’s going to become more cost effective to have a group visit.
Q: So be thankful for that 15 minutes one-on-one right now?
A: That’s what I would say. That’s actually pretty generous. It’s probably going to get down to more like eight or nine or 10 minutes with a provider.
Reach Lauren Sausser at 937-5598.