Wednesday, October 20, 2010

Scuttlebutt from a Grassroots Medical Society Meeting

Last night I attended a medical society meeting bringing together three Connecticut county medical societies. The meeting featured a debate between a Republican and a Democratic candidate for Congress. I will not comment on the candidate’s respective positions on the health reform law. Instead I will share with you my reading of the 250-person audience.

Unrest among Physicians

Practicing independent doctors are restless. With malpractice reform and the Sustainable Growth Rate (SGR) formula unresolved, physicians fear for their future. Nobody is being fooled here. Doctors know delegating malpractice reform to a demonstration project just kicks the can down the road. And everybody knows on November 3 Congress will temporarily fix the SGR by keeping it the same or raising it slightly. Doctors want the SGR junked. The candidates agreed, but no one spelled out a concrete alternative. How to pay doctors remains a political conundrum. One physician said that the AMA had failed to represent doctors effectively, and no national organization had stepped forward to fill the void.

Uneasiness about Accountable Care Organizations

The sentiment on the push for accountable care organizations (ACOs) was that these organizations are a formula for hospital and government control. One observer snidely commented, “They ought to be called Accountable Control Organizations.” He said to me ACOs are just another name for PHOs (Physician Hospital Organizations) and for capitated payments. Both concepts, he said, had failed in the past and would not gain traction this time around. There were doubts hospitals and doctors could effectively “collaborate,” without hospitals seizing control because of their superior administrative, capital, and marketing skills.

Decline of Private Practice

Among those to whom I chatted, there was a sense that private practice is in freefall because of lowered reimbursements, rising expenses, and political and economic forces stacked against private practice. These forces include rampant hospital employment of physicians, increased regulation and scrutiny of performance, demands for installation of expensive electronic medical record surveillance systems, and a tendency among government reformers to either dismiss the role of private physicians or to portray independent practitioners as scapegoats responsible for rising health costs. Physicians feel the call for patient-centered care, as exemplified by care centered in “medical homes,” had been ignored. This seemingly was affirmed by the fact neither candidate for Congress was aware of the medical home concept.

Medical Care Now Strictly a Business

There was a feeling of despair that medical care had become a business rather than a profession managed by outsiders who had no sense of what transpires in the exam room or at the bedside. As one physician noted, “This reform bill is about insurance reform not health reform. It has nothing to do with the patient-doctor relationship.” Another commented,” The reform bill reinforces the status quo. It skips over the fact that we are an over-specialized nation with a doctor shortage.” The reform bill, many felt, focused too much on the special business interests, rather than on the health interests of physicians and patients and the fundamental reasons behind high and rising costs.


This was a glass half-empty meeting.

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