Friday, January 10, 2014

Physicians,  Heel Thyself

To cause someone to act in a disciplined fashion, to force someone to act in a more disciplined manner.

Idiom, to bring someone to heel

The health care law is designed to bring physicians to heel – to force them to act in a manner the Obama administration believes will  cut costs, widen access, and improve access.   

These are all good intentions, and as one wag remarked,  is a significant  mission of the Obama-inspired Good Intentions Paving Company – to pave over the streets of physician autonomous enterprise.

Not surprisingly, physicians, an independent lot accustomed to autonomy,  do not like government intervening and meddling into their practice lives.  Consequently, physicians,  with their backs up against the government’s bureaucratic wall,  are suffering a loss of morale. 

In a survey of 3000 California doctors,  the Doctor’s Company,  the nation’s largest liability carrier, found that 9 of 10 doctors would not recommend medicine as a profession to their children.  Furthermore,  43% said they planned to retire earlier over the next 5 years, and 60% said they thought the quality of medicine would decline under ObamaCare.

What are the doctors’ chief complaints?

One, ObamaCare does not “fix” the Sustainable Growth Rate (SGR) formula, which this year calls for a 25% cut in physician Medicare payments.   If implemented,  doctors say this cut would reduce seniors’ access to care because doctors could not afford to accept new Medicare patients, who are entering the system at the rate of about 10,000 a day.
Two, ObamaCare expands the Medicaid population for people making up to 138% of poverty ($15,856). The Congressional Business Office (CBO) projects this will add 12 million Medicaid patients by 2015.  Various sources say 1/3 to ½ of doctors now longer accept new Medicaid patients.  The numbers are hard to pin down and vary from state to state.  For doctors, the problem is that Medicaid on average pays only 58% of private pay and comes with reams of red tape.

Three, ObamaCare burdens doctors with the three Rs (Rules, Regulations, and Restrictions).  It is estimated the health law has generated 20,000 new regulations.  A raft of new federal agencies – including the Patient-Centered Outcomes Research  Institute (PCORI),    the Independent Payment Advisory Board (IPAB), and Pay-for-Performance (P4P) programs – create and police the 3Rs.  Doctors must conform and comply with standardized guidelines, or suffer loss of income , if they exercise their own clinical judgment and violate the new rules.

Four,  ObamaCare decrease physician morale and exaggerates doctor shortages, which according to the Association of American Colleges, will reach 91,500 by 2020.   ObamaCare estimates it will reduce physician income by 40% by 2020.   This loss of income,  when coupled with lack of tort reform and mounting piles of red tape,  makes medicine less appealing to the best and the brightest.    In effect,  it often forces doctors to “process” patients at the rate of about one patient every 15 minutes to make ends meet.

Five,  ObamaCare, by design and by consequence,  compels doctors to participate in large organizations, known as Accountable Care Organizations;  induces them to go to work as hospital employees for a secure income and to meet malpractice and education expenses; to join larger physician groups and to networks;  and, if all else fails, to abandon traditional practices dependent on 3rd party payment and to form direct pay practices (concierge and retainer practices) to offer  more  satisfactory income, spend more time with patients, and to provide a higher and more accessible  level of service.

Tweet:   ObamaCare tries to discipline doctors to become more efficient by decreasing income and autonomy and forcing them into government-compliant organizations.

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