Joseph E. Scherger, MD

One key to solving our healthcare spending problem is to invest in primary care to reduce the burden of disease in much more expensive settings, such as emergency rooms and hospitals. 

The U.S. healthcare system's fee-for-service productivity model ignores the overall responsibility each PCP takes in caring for patients and all the work that is done outside of visits for optimal coordination of care. Changes to the current care model and reimbursement are crucial to the survival of primary care. Otherwise, existing PCPs will continue to see 100 or more patients a week, and medical students will continue to choose more lucrative specialties. 

If PCPs were paid just one dollar a day for each of their patients' care coordination, primary care medicine would be transformed. Assuming that personalized care responsibility and continuous access to communication made a modest 1,000-patient panel size appropriate, that dollar a day would result in $365,000 a year before you even billed for patient visits. That would allow you to scale back your number of visits from upwards of 20 per day to around 10, allowing you to spend 30 minutes or more with each patient. 

Consider that traditional practices have gross visit revenues of about $425,000 a year, according to 

 survey data. Reduce that to $200,000 a year for lower visit volumes, and the medical home PCP would boast gross revenues of $565,000 a year. With less-than-optimal overhead expenses of 60 percent, your net income would still be $226,000 per physician-slightly above the average income for 

U.S. physicians, including specialists, according to 

 data. Of course, many more PCPs would need to be trained, but a better care model with greater professional satisfaction makes this ramp-up possible. 

If this model becomes a reality, the future of primary care would be very bright. The opportunity is right in front of us if we have the courage to change, and indeed we must change primary care if we are to save healthcare in America. 

Joseph E. Scherger, MD, is vice president for Primary Care at Eisenhower Medical Center in Rancho Mirage, California, and clinical professor of Family Medicine at the University of California, San Diego. Send your feedback to 

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A better future for primary care is right in front of us if we have the courage to change, and indeed we must change.

Viewpoint: Make more money, save U.S. healthcare

When the history of medicine in the early 21st century is written, the dominant story is likely to be the great transition from paper-based systems to health information technology. Soon it will seem like a primitive and archaic time when a patient's medical record was kept on pieces of paper in multiple locations; a great deal of it was hand-written, sometimes impossible to read. Physicians and nurses made life-and-death decisions "off the top of their heads," without clinical decision support. Only the telephone and face-to-face visits were used for communication. 

Soon, jokes about doctor handwriting will be as obsolete as jokes about banker's hours. Health care is rapidly moving into the digital age. The latent growth phase of electronic health records has ended, and rapid diffusion has begun. Within a few years, practices without EHRs will not be able to compete in the emerging era of payment tied to quality reporting. But this transition is not just about EHRs. It is about all the other functions that go along with having digital patient charts that are portable to any location. 

There are two functions being integrated into EHRs that will radically change how medical care is delivered: clinical decision support and a communication portal. Up until now, physicians have made decisions based on their ability to listen, ask the right questions, conduct the right exam, get the necessary lab and X-ray findings, determine diagnoses, and make treatment decisions. When physicians perform the clinical reasoning and decision-making process alone, off the top of their heads, optimal care is not always delivered. If you believe the Rand Corporation study, the right thing is done only 55 percent of the time (The quality of health care delivered to adults in the United States. 

A secure communication portal embedded in the EHR promises to revolutionize clinical communications between physician and patient, and among all caregivers. Imagine all patient-related communication being captured automatically in the medical record. Imagine patients helping to write their medical records with messages and questions they enter as active partners in their care process. Imagine the majority of clinical communication happening at the mutual convenience of all parties. The online platform of communication and care embedded in the EHR will emerge as the dominant means of communication in health care as much as online communication has with the rest of social discourse. 

describes several exciting HIT applications to improve the care of patients. Some of them are expensive, and physicians must choose wisely. When considering a purchase, ask three important questions: 1) Does this technology improve a core function of my care of patients? 2) Does this technology make financial sense by improving efficiency, by improving the quality of my care, and will it generate revenue? 3) Will I be able to evolve with this technology? After all, anything I buy today will need to be upgraded or replaced within three years. 

These are hard decisions. Get good advice from colleagues with experience, neutral advisers, and vendor professionals you can trust. If you do nothing, you run the risk of not practicing modern medicine. The standard-of-care bar is being raised, and HIT is essential to a competitive practice. 

Joseph E. Scherger, MD, is a clinical professor at the University of California, San Diego. Send your feedback to 	

There are two functions being integrated into EHRs that will radically change how medical care is delivered: clinical decision support and a communication portal.

Author | Joseph E. Scherger, MD

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Viewpoint: Make more money, save U.S. healthcare

Viewpoint: When considering a tech investment, ask three important questions