Tuesday, February 21, 2012

Doubling Down on the Sick, the Old, and Doctors Who Care for Them

Doubling down – To engage in risky behavior when one is already in a dangerous situation.

Urban Dictionary definition

February 21, 2012 - The news for the day comes out of Colorado. A survey of 100 Colorado primary care doctors indicates two-thirds refuse to accept or will limit care to new Medicare patients (Colorado Public News, February 21, 2012).

Here is how the reporter explained the methodology of the survey:

A survey of Colorado primary care doctors found most are reluctant to take a new patient on basic Medicare, the government health insurance for people 65 and over.

Colorado Public News
called family, general practice and internal medicine physicians across the state, using the nation’s official website that lists thousands of doctors the site claims treats patients on Medicare. Of 100 contacted, only 34 said they would readily accept a new patient."

"Of the remainder, 40 said they would not add a new patient on traditional Medicare. Another 26 limit new clients, making decisions on a case-by-case basis, or placing patients on waiting lists of up to six months. That adds up to 66 – or two-thirds – refusing or limiting new patients."

"The questions focused on traditional Medicare, which is used by most recipients.
Several doctors said they hesitate to take Medicare patients because Medicare doesn’t pay enough, pays late, and can require a nightmare of paperwork and repeated telephone calls.”

A survey of 100 doctors is not big enough to be statistically significant, but it is a danger sign for Obamacare. The health reform law cuts $575 billion out of Medicare over the next 10 years, just as 78 million baby boomers are entering Medicare at the rate of 12, 000 a day over the next 18 years and as 32 million are scheduled to enter Medicaid in 2014.

This is at a time, when the Association of American Medical Colleges estimates by 2020, there will be 45,000 too few primary care physicians and 46.000 too few surgeons and other specialists.

In my 1988 book, my title asked “And Who Shall Care for the Sick?”

I was referring then to the deleterious effect of managed care on the physician supply. Now the same question applies to Medicare, which has adopted similar techniques of business management to control physician economic and clinical behavior.

These techniques include: pre-treatment certification, utilization review, standardization of care, treatment of medicine as strictly a business rather than a profession, quality and outcome management, capitation, bundling, and codification of fees with funneling of payment to doctors who follow government mandates.

These management techniques come at a price – physician shortages because of the decreasing attractiveness of medicine as a profession. Doctors do not look favorably at third party intervention into clinical affairs, whether by government or corporation. Bright students may respond by not becoming doctors. Doctors may abandon the profession, refuse to accept Medicare or other 3rd party patients, enter into cash-only, direct pay, or concierge practices devoid of third party payers.

The magnitude of the physician shortage, and who shall for care for the sick, is not apparent yet. But it may when the Physicians Foundation completes its e-mail survey of 650,000 physicians this year. The survey will ask how doctors react to reform and what they plan to do in the near future.

The survey results will come after the Supreme Court decision on the constitutionality of the individual mandate and other aspects of Obamacare and before the November presidential election.

Meanwhile and after, the sick and the old still be with us, and they will demand and seek doctors to care for them.

If government continues to double down on doctors, the doctor shortage will accelerate. Declining access to doctor care will become a political time bomb.

Tweet: In a survey, two-thirds of Colorado primary doctors say they will not accept or will limit care to Medicare recipients.

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