Ten Wrap-Ups for Health Reform Maze Book

June 21, 2011 - In March 2011, I completed work on my book The Health Reform Maze: A Blueprint for Physicians (Greenbranch Publishing), which will be out later this summer.

The publisher has suggested I write a wrap-up of reform events taking place or gaining momentum since March. In a social issue as fluid, volatile, and controversial as health reform, a lot can happen in three months, and it has.

Here are my initial thoughts on late health reform developments.

1. Physicians in overwhelming numbers have embraced hospital employment as an alternative to private practice in response to lifestyle, business, and regulatory challenges(March 20, 2011, Gardiner Harris, “More Physicians Giving Up Private Practice,” New York Times; for further background, see October, 2010, Merritt Hawkins and Physicians Foundation white paper, Health Reform and the Decline of Physician Private Practice). The genie is out of the bottle, and the only question is which genie will lead hospital-physician organizations, a MHA-MBA or a MD-MBA).

2. Consolidation of physicians into integrated organizations, both hospital and physician-led, is growing because of compliance and infrastructure requirements which small practices cannot meet. (June 19, 2011, Richard L. Reece, MD, “The Corporate Transformation of American Medicine,” Medinnovation Blog).

3. No practice model, inside or outside organizations, has yet been found to reward doctors for “quality” and “outcomes,” rather than “productivity,” i.e., “volume” based on FFS incentives, practice survival, patient demands, and defensive medicine curtailment.(June 10, 2011,Merritt Hawkins and Associates, 2011 Review of Physician Recruiting Incentives).

4. Obamacare, whatever one thinks of it, has forever changed private practice of medicine, and its impact is best explained in Physicians Foundation White Paper, Health Reform and the Decline of Physician Private Practice, released on June 1, 2011(www.physiciansfoundation.org).

5. Constitutionality of health reform law as judged in Atlanta Appeals Court and Supreme Court will be pivotal. The Atlanta ruling will be issued momentarily (June 9, 2010, "Appeals Court Judges Skeptical of Government’s Health Care Case”, CNN Politics).

6. Polls indicating continued public resistance to Obamacare and favoring its repeal will be important indicators of outcome of upcoming Presidential election and future of medicine. (June 18, "Poll on Obama and Democrats Health Care Plan", Real Clear Politics).

7. Physician leadership will be vital in warding off access crisis for 78 million new baby boomer Medicare and 34 million new Medicaid recipients and in recommending reasonable and workable new models of care to repair gaping and widening new holes in social safety net due to physician shortages (June 21, Personal Opinion, Richard L. Reece, MD; Grace Marie-Turner et al, Why Obamacare Is Wrong for America, April, 2011)

8. The Obama administration have picked up the pace for offering waivers, now numbering nearly 1500, to organizations and even states who cannot afford to meet Obamacare health plan requirements (June 21, John Hayward, "The State of Obamacare," Human Events).

9. Ninety three percent of physicians and all major integrated organizations considered to be models for Accountable Care Organization have said they will not or cannot meet the final CMS rules for ACOs released on March 31, 2011 ( June 19, Review & Outlook, “The Accountable Care Fiasco", Wall Street Journal).

10. A growing chorus of physicians organizations, including the AMA, have expressed opposition to the idea of the Independent Payment Advisory Board (IPAB), whose 15 members would be appointed by the President. (May 8, 2011, Bara Vaida, The IPAB: Will It Change Medicare,” Kaiser Health News; April 20, “The Independent Payment Advisory Board Comes Under Fire,” www.washingtonmonthly.com).