Four Health Reform Worry Stories

What Me Worry?

Alfred P. Newman, Mad Magazine Motto, 1955

I worry about health reform.

Worry Story #1 - Hospital health care costs about to go sky high. Health reform uncertainties are driving doctors into the arms of hospitals. Hospital outpatient activities are growing at a furious pace. Data from 2008 indicates the average doctor-based visit is $199, the average ER visit $922, and the average hospital outpatient visit $1275 (“Outpatient Care in Hospitals Is No Bargain,”Medpage, April 26, 2011). Ergo, hospital outpatient costs will cause reform-induced costs to explode. Not so fast, say the Feds. That smacks of anti-trust. Besides, we will control those costs with ACOs, which will reduce hospitalizations. Not so fast, say I, ACOs may never get off the ground.

Worry Story #2 - Doctors and hospitals will reject electronic medical records, on which the Obama administration bet $27 billion in its last stimulus plan. Don’t worry. The American free enterprise system may save the day. Cloud computing, wherein doctors and hospitals transfer software and hardware, onto the Web may save the day. Furthermore, EHR companies like Practice Fusion, Inc, in San Francisco are offering EHRs for “free” because advertising on the Fusion site pays the freight. Don’t laugh. Practice Fusion already has 10 million users, more than Kaiser at 8.7 million, the VA hospital system at 7.9 million, and the whole country of Denmark at 5.5 million.

Worry Story #3 - People will start taking the pronouncements of the Dartmouth Health Atlas seriously. For the last 30 years the Dartmouth people has come out with national breakdowns of Medicare claims, which invariably show wide variations between U.S. regions. The current report focuses on end-of-life care for people with chronic illnesses. This time around they found the percentage of deaths in hospital varied by a factor of almost four across hospital referral regions, and the average number of hospice days per patient in the last six months of life varied by a factor of more than six. They attribute these variations of hospital and specialist to ignorance or greed. No matter that socioeconomic conditions vary tremendously, that people in New York City have different expectations than in Minot, N.D. or elsewhere, and that poor people are sicker than affluent citizens.

Worry Story #4 - Health reform pressures will cause kindly solo practitioners to become obsolete. According to Greg Scandlen, a staunch opponent of Obamacare, and I quote:

“The New York Times has published a sobering article by Gardiner Harris which describes how quickly we have allowed the best health care system in the world to slip through our fingers.”

“The story keys off Dr. Ronald Sroka, a family practice physician in Crofton, MD. It says, Handsome, silver-haired and likable, Dr. Sroka is indeed a modern-day Marcus Welby, his idol. He holds ailing patients’ hands, pats their thickening bellies, and has a talent for diagnosing and explaining complex health problems. Many of his patients adore him.”

“But he is being pushed into extinction by academics like David J. Rothman, president of the Institute on Medicine as a Profession at Columbia University who is quoted:

‘Those of us who think about medical errors and cost have no nostalgia — in fact, we have outright disdain — for the single practitioner like Marcus Welby.’

“Mr. Rothman’s disdain and his allies in the insurance industry and government bureaucracies are winning the war. The article explains:

The share of solo practices among members of the American Academy of Family Physicians fell to 18 percent by 2008 from 44 percent in 1986. And census figures show that in 2007, just 28 percent of doctors described themselves as self-employed, compared with 58 percent in 1970.”

Conclusion

Maybe I shouldn't worry. It will all work out in the end. Besides, as the late Walter C. Hagen (1892-1969), the famous golfer, observed,"You're only here for a short visit. Don't hurry. Don't worry. And be sure to smell the flowers along the way." It is April 27, the flowers are blooming, and I am smelling them.

Tweet: Doctor Reece worries about hospital costs, EHR rejections, variations of end of life care, and the obsolescence of primary care.