A Conversation With ... Dr. Tom Landholt

You were featured in the 2006 PBS series “Remaking Missouri Medicine” for the clinic’s willingness to embrace electronic medical records technology. How has EMR changed the way you practice medicine?
It turns out, my restaurant background, based in customer service and product quality, works really well in a primary care setting. In our clinic, we see 90 percent of patients the same day. A third of our patients have no insurance, and we are able to use our savings of overhead – we run a very efficient ship -– to offer discounts for cash-paying patients to support that population and provide them primary care.

When they introduced electronic medical records, it was a very good management tool. With my background, I was able to take those and make a clinic run efficiently. I was at Cox when they introduced EMR. Senior Vice President Dr. John Duff was instrumental in bringing EMR to Springfield, and we happened to be his first clinic. With my business background, I took that and ran with it. I consult on EMR and how to run an outpatient clinic effectively and efficiently.

Have recent advances in EMR technology shaped the industry?
Not so much within the clinic, but really with communication outside the clinic. For instance, we now upload immunization records into the Missouri state immunization registry with our own interface engine. We also can send out our labs by secure messaging. It’s these interfaces with other institutions that are kind of the next phase, not just wire up the clinics, but wire all these health care providers together. EMR also enables us to be financially viable. Without electronic tools, the cost of overhead soars. It is the investment in, and especially the wise use of, electronic tools that allows a small practice to be economically viable.  I teach seminars to physicians across the country on that very subject. Paper based medical records simply will not have the tools to compete or participate in the future of health care. One will need to interact with an Health Information Exchange to get discharge summaries, labs from ERs, etc. If your office cannot get in the health information stream, you will be looking to be employed by a system that can provide those tools to you. Without EMR, we would have to sell our clinic to one of the hospital systems.

The ACA was billed as a law to help provide all Americans with equal access to affordable health care. When fully implemented in 2014, do you think the law will fulfill its promise?
I hope so, but the proof is in the pudding. From my reading of it, there will be some improvements in access to health care. It will force insurance companies to act like insurance companies, by spreading risk over large populations of patients. They are virtually requiring people to have a primary care doctor, but in a positive way by giving them annual preventative health physicals without deductible or co-pay. Last week, we got a letter from United HealthCare and they are going to incentivize all of their insured population with a Visa gift card if they simply go get their free preventative health care physical. Studies show if you have a primary care doctor and you use them, you can prevent illnesses down the road. We are quite encouraged that if these health insurance exchanges do provide inexpensive access to health care, people will take advantage of it. A third of our population doesn’t have health insurance.

Is there a silver bullet to fix the American health care system?
A silver bullet? No. I think from my study of it, I would like to see a modified version of a single-payer system. I’m personally a fan of the Singapore style of health care system. I did a little bit of consulting for the holding company that runs health care in Singapore and they have a very intriguing model. They have a combination of a graduated payroll deduction to pay for health care, but it’s also purchased on the open market. It’s a very level playing field. There isn’t a single silver bullet that will kill the biggest problem, but if everybody would work together for a change, we could at least make a level playing field. Then the dollars will balance out in a way that is a little more fair.