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When Clarence Watridge, MD, began his speech last month as the new president of the Memphis Medical Society, he commented on the current medical environment as a paradox. Advanced technology has allowed patients to live longer while previously lethal diseases have become manageable chronic conditions. The flip side, costs of providing care are at an all time high, while physician reimbursements continue to feel the pinch. Watridge, a neurosurgeon with Semmes Murphey Neurologic and Spine Institute, has practiced medicine more than 30 years and is all too familiar with plummeting reimbursement rates. That is why he is trying to work within the medical community to foster change.

"We're getting paid less than we were than in 1985," he emphasized. "Even though we're doing it better, we're doing it with less expenditure. The time you invest in taking care of your patient is less rewarded."

This reality, along with the constant barrage of legislative issues on everything from HIT to quality-reporting, has led to widespread physician withdrawal, explained Watridge. Some are hunkering down with their patients and hoping to weather the storm, while others have retired or sought alternative employment.

The endless speculation about the economy, enforced quality and reporting provisions, and healthcare reform has wedged the gap further between physicians. Instead of withdrawing, he encourages physicians to unite to strengthen their influence among payors and policymakers.

Q: You talk about the importance of being involved in physician organizations like Memphis Medical Society. How does it benefit physicians?

A: The mission of Memphis Medical Society is to promote good health and the practice of medicine in Memphis. It's multi-faceted because we have to be involved with the legislature, the hospitals and our peers. Without considerable support and shared work by many members of the medical community, the match up between organized medicine and forces desiring to control or force their agenda on medical providers will not be a fair fight. Most of these forces are more concerned with the financial agenda than what is good medical care for patients. I think it is incumbent upon us to move into a realm where we are looking out for each other and the practice of medicine, from a survival stanpoint, economic standpoint, from legal exposures and regulatory issues. In this time of attack on the medical profession, physicians speaking together will be heard more loudly than a few lone voices crying in the wilderness.

Q: You have stated that if the majority of doctors were asked what it costs for them to see a patient, they wouldn't know. Why is it important for physicians to be savvier about the business side of their practice?

A: When you get out into the world, you find out all of a sudden whether or not you can practice your art. Then like it or not, the economics of revenues less expenses equals whether or not you can do what we do. It's no different than any other business. Yet many physicians simply trust the system of "charging this much to see this many patients." They figure if they're seeing a lot of patients, they're doing well. You want your doctor to be focused on what is good medicine, but in order to be able to be there for patients, he's got to get good advice and be in a good setup.

We have to stay at the top of our game and be lifelong learners. We've got to stay focused on "The reason that I'm here is because that patient needs me to give a good opinion." Number two, you have to be savvy about the costs of what we do, in terms of making sure that we can have a viable business entity, that our revenues will be good enough that we can see these patients, pay the help and take home a reasonable reimbursement for the level of work that we do. In my opinion, the most cost efficient care is the best care.

Memphis Medical Society has already begun to be a resource for medical practice management with the development of the "Medical Practice Survival Guide." This is a series of talks on how to figure out costs, reimbursement rates and what conditions enter into your patient/payor mix. It is anticipated that in this complex day of regulatory and financial pressures, being a resource for medical practice management will be a focus of your board.

Q: How can physicians and hospitals collaborate better together?

A: Hospitals don't understand the intricacies and complexities of paying your help, paying your malpractice premiums, rent, trying to make a satisfactory living, while we're bringing patients to them from whom they get their living. Yet they have lots of regulations that we don't understand. The more we can dialog together about, "look, this is what it takes to get it done, you need to understand what we're talking about," the better.

I think that we have to have hospitals understand that their efficiencies matter to us. If we're on time, and they are an hour behind, that's an hour out of my day, which decreases my productivity. We also need to be efficient and show up on time and utilize the resources with good stewardship and not have to have every thing under the sun just because it's a new toy. We have to work with them on equipment issues and needs and not necessarily ask for every new million dollar piece of equipment we get enamored with. Also, the hospital has to understand that equipment dies, it wears out. You have to be in this continual replenishment to keep your equipment going and have the vision to plan for the future.

Q: What realities do physicians and payors need to face about the flaws in transparency, quality reporting and pay-for-performance?

A: Most all of the things that we are really measuring now are not measuring quality, they're measuring process. Processes are linked to evidence-based medicine that says that's the right thing to do, but we're not coupling it with outcomes. Part of the problem with quality is, there are no two patients that have exactly the same issue, or outcome. You could have two patients who have the same ruptured disk, have the same operation, and not have the same outcome.

From the standpoint of having a good database, we've checked into buying products by quote, "quality agencies" that can help us to measure outcomes. Even within our group, it is extremely hard to agree upon whether the measure really measures things accurately.

Anyone who is participating in pay-for-performance right now is losing a huge amount of money just in the amount of overhead it takes to report. So that pay-for-performance is just a farce. It's a wash. I think it is going to be shoved down our throats for quote, "reporting" but it's not going to make quality better. Payors are trying to ration care, and they're trying to say we're going to ding you if you spend too much money on your patients. What makes it unfair is that the people who are picking the data for reporting are not doctors. Insurance companies are picking the data to try to steer to the cheapest doctors. If we continue to see these "quality profiles" of physicians, the doctors will quit taking care of the really sick. They'll cherry pick the patients that are going to do well, most of the time, even if you just gave them a sugar pill.

Q: You have worked in the United Kingdom as a registrar. Seeing how their National Health Service operated, how did it affect your opinion of the single-payor system and do you think it will work in the United States?

A: (In England) I saw all the time, people came in to our subspecialty, deteriorating from a tumor and they had symptoms for months and months and months. The doctors don't have access (to resources). The number of physicians is capped because of the budget. There were five neurosurgeons in our region and 2.5 million patients that might need neurosurgical care. Over there, if you needed a hip, you were put on a list and if you survived two and half years, you might get it done. If we try to go the healthcare reform, single-payer system, what we'll end up with is exactly what has failed in Canada and the UK. History tells us that the single-payer system doesn't work and I fear we're going to end up far into a socialist scenario and our tax rate is going to go up to 50 or 60 percent. This National Health Service, single-payer system, breeds inefficiency and breeds mediocrity. There are some good things, and it seems to me that we may need to do something about having a basic level of service that is made affordable for all, but you can't just give it away. You've got to make people accountable and those who can work need to work, and those who can pay need to be paying for it.

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Clarence Watridge, economic challenges, healthcare reform, Leaders in Healthcare, Memphis Medical News, physician relations

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