Thursday, October 2, 2014

ObamaCare and Medical Innovation

It would be good therefore, that men in innovation would the example of time itself.

John Milton (1608-1674), Paradise Lost

I look upon medical innovation from two points of view:

One, from top-down ObamaCare policies.

• Two, from bottom-up ObamaCare affects on physicians.

One, In today’s WSJ, Scott Atlas, MD, senior fellow at the Stanford’s Hoover Institute, describes the impact of the Obama administration’s policies - new taxes of $500 billion, including a 2.3% excise tax on medical device companies profits, medical device companies cutting workforces and moving headquarters abroad, FDA delays in approvals of new innovations for 31 months, compared to 7 months in Europe; foreign entrepreneurs trained in U.S. returning to their home countries for more opportunities. Atlas says the U.S. has long been considered the world’s number one medical innovation center, but the rest of the world is rapidly catching up ( Scott Atlas, MD, “ObamaCare's Anti-Innovation Effect: Socked by New Taxes, U.S. Health-Care Technology Companies Are moving R&D Centers and Jobs Overseas,” WSJ, Oct. 1, 2014).

Two, here I will argue that ObamaCare has effectively robbed physicians of their most precious asset: time.

It takes time:

• To become a doctor – 12 to 18 months depending on your specialty. Most doctors don’t enter workforce until their late twenties to mid-thirties.

• To see and evaluate patients – listening to their stories, examining them, doing procedures, ordering and interpreting tests, managing and training your staff.

• To respond to phone calls and emails and to coordinate care.

• To deal with paperwork, 3rd party hassles, to keep up with the literature, to attend educational meeting for certification.

What affect does ObamaCare play with respect to time?

ObamaCare, in the opinions of physicians, often deprive them of time to do their jobs. Time is spent dealing with consequences of 20,000 pages of new regulations. Time is spent finding just the right code among the 70,000 new ICD-10 codes. Time is spent entering patient-data and exam findings in data-hungry electronic medical records. Time is spent justifying procedures and tests for third party insurers, avoiding audits, and possible malpractice suits. Time is spent simply trying to defend one’s autonomy , to coordinate care, to keep up the deluge of information spilling out the Internet and academic research.

The problem is there is only so much time. To be effective as a physician, you need time to do what needs to be done. As Peter F. Drucker (1909-2005) commented: “Time is a unique resource. The supply of time is totally inelastic. Yesterday’s time is gone forever and will never come back. There is no substitute for time.”

But how can a physician create more time? How can they find more time, manage time, consolidate time?

Physicians can delegate routine tasks – data gathering, prescription renewal, history taking, and routine exams – to others – nurse practitioners, physician assistants, medical assistants, office nurses, and receptionists. They can have patients create their own medical histories using computers based on age, gender, chief complaint , social, family, and personal stories , as is done with the They can avoid time-wasting meeting. They can spend all their time in their office practices, and refer patients to hospitalists.

Or, the can shed the time –consuming tasks and demands of ObamaCare and third party insurers - by going into direct pay independent practice. These practices include concierge medicine, cash-only practices, urgent-care centers, and direct pay ambulatory surgical and diagnostic facilities.

These new practices , now participated in by 7% to 13% of physicians rest on this premise: doctors can control their time, they can schedule their own procedures, they can set aside time for patients only, they can avoid third party paperwork, and they can save time by restricting paperwork, sometimes call busy work, for their own needs and the needs of their patients.

But these approaches to saving time comes at a cost: physicians may be practicing outside the bounds of traditional medicine, Medicare and Medicaid, and insurance coverage; they must often severe bonds with many loyal patients who rely on third party payment; they must endure the criticism of those who say they are creating a two-tier system for those who pay and those who cannot pay.

The new breed of independent doctor will argue the new medicine is more convenient, more efficient, more personal, and, in the long run, less costly because it avoids administrative and bureaucratic costs of an outside payer.

By making care more direct and more personal, by devoting time to the patient rather than to administrative paperwork, physicians feel they are working for themselves and their patients doing what they are trained to do seeing patients rather than working for intermediaries. The physicians' time is no longer spent making money for vested interests not directly involved in patient care.

No comments: