Thursday, August 29, 2013

Why Doctors Are Wary about Swapping Horses in Midstream
It is best not to swap horses while crossing the river.
Abraham Lincoln (1809-1865)
The Obama administration is asking doctors to swap horses to transition from independent practice to government managed care. ObamaCare redefines the role of physicians from acting as independent practitioners to being members of coordinated health care teams. Many physicians are skeptical of this transition.  They prefer private competition with physicians as personal patient advisors to government-driven coordination within larger organizations.
Government policies that encourage this swap are.
·         Accountable Care Organizations – integrated hospital-physician groups in which hospitals and doctors share savings by achieving greater efficiencies through more coordinated care.

·         Bundled Payments – Fixed payments to physicians and hospitals for episodes of care.

·         Quality Reporting -  Publically accessible information on “quality,” as judged by computer data.

·         Price Transparency – Publically accessible information on prices.

·         Pay for Performance -   Reimbursement policies that explicitly reward “quality.”

·         Electronic Health Records – Government incentives that reward or punish doctors for “meaningful” use of electronic records to create a national interoperative system..

·         High-Deductible and Consumer-Directed Health Plans – Promotion of plans that encourage consumers to pay-out-of pocket with tax-free money.

Why are the majority of doctors, based on numerous surveys,  so skeptical of these federal policies?
Because the policies represent and are emblematic of:
1.      a fundamental transition from private, independent practice to a government-controlled practices.

2.       a metamorphosis from clinical judgment a point of care to managed judgment from afar.

3.       A  change from personal decisions for individual patients within the doctor’s office to managed decisions based on population-based data.

4.      A  definition of “quality,” based on quantitative data rather than on patient satisfaction  meeting patient needs through doctor-patient decision-making.

5.       A belief that patient “coordination” by teams will be better, more efficient, cheaper, and produce better outcomes than individual attention and careful listening to patients and their problems.

6.       A feeling that outside management by nonclinical “experts” should supersede agreements between patients and doctors as to what course is best.

7.      A consensus that opinions rendered by elitists is superior and more reliable than commonsensical decisions by patients and doctors.

8.      A mindset that cumulative and detailed documenting is more important than intuitive  doctoring.

9.      A belief that coordinated care will end duplication,  unnecessary care, and bungled handoffs and make care better and less expensive.

10.  The  idea that health care coordination with teams of health care professionals. will make federal health care spending more “fiscally sustainable.”

Tweet: We need to examine trade-offs  of Obamacare “coordination”vs. competition policies on  price, quality, outcomes, and patient satisfaction.

Source: Katherine Baicker and Helen Levy, “Coordination versus Competition in Health Care Reform,” New England Journal of Medicine, August 29, 2013.

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