Tuesday, August 25, 2015

On Moving the Physician Movement Forward

There are always two parties, the party of the Past, and the party of the Future, the Establishment and the Movement.

Ralph Waldo Emerson (1903-1882), Notes on Life and Letters of New England

On July 20-26, 2015, a new physician organization, the United Physicians and Surgeons (UPSA), held a conference, dubbed the Summit at the Summit, in Keystone, Colorado.

The conference featured over 40 speakers. Speakers represented many physicians and physician organizations, both bearing workable innovative ideas. The conference was designed to restore physician autonomy, protect the patient-physician relationship, and reset relationships between overreaching government and corporate entities.

Conference attendees were enthusiastic about this physician Movement to restore the voice of medicine.

But inevitable questions arose: Where do physicians go from here? How do we sustain the movement? Where will funding come from? What form will the Movement take? How will physicians inform hundreds of thousands of fellow physicians and millions of their patients about grievances of physicians, their ideas for the future, and what can be done to improve quality and convenience and confidentially of care?

The challenges are daunting. Private practice and ownership of those practices are declining. Fee-for-service reimbursement is shrinking. Government and the public tend to trust large integrated organizations more than individual physicians. Physicians are not united. They are splintered into numerous state and specialty societies , and many owe their allegiance to their hospital employers. Older and younger physicians think differently, as do male and female physicians, as do specialists and primary care physicians. ObamaCare health exchange plans offering subsidies to 11 million patients already exist. And last, but certainly not least, there is no widely accepted organization, like the American Medical Association, whose membership has dropped from 85% to 15% of physicians, to represent practicing physicians. Given these realities, how do physicians maintain the momentum of the movement?

The Physician Movement has no single driving force. It reflects the general dissatisfaction of physicians of how the system is evolving and where it is going. The Movement is diverse. It will be composed of direct care practices devoid of government and insurer oversight. It will consist of groups of physicians complying with rules of the Establishment. It will feature collaborative ventures between hospitals and physicians, physicians and employers, and physicians and patients.

There was no shortage of ideas at the conference – direct patient care (concierge medicine and all-cash surgery centers), a moratorium of electronic health records, expedited ICD-coding, credentialing changes, independent practice associations competing with corporate entities, physician unions, new forms of health insurance, and national alternatives to ObamaCare should it be repealed or replaced.

The hottest ideas at the moment are to disseminate videos of the various speeches presented at the conference for distribution, to create 30 minute videos for other physicians and the public at large explaining the need for a physician movement.

I have an idea of my own: to transcribe the 40 speeches given at Keystone into a single Kindle e-book for sale to larger audiences.

Finally, I believe physicians need to spend more time developing collaborative ventures with hospitals and insurers and employers without compromising the principles of any of the participants. One form this could take would be bundled pricing for disease episodes or hospital admissions with discounted fees for physicians and hospitals with back-up reinsurance should the total fee exceed estimates. This could be workable alternative to Accountable Care Organizations, which have not worked well because of government regulations. Another form rapidly evolving are primary care practices offering bundled services for a fixed retainer price.

Hospitals and insurers are not going away. They are twin pillars of the current system. Work with them but keep your distance and maintain your core patient-protection principles.

Encourage development of physician-owned and directed focused, efficient, and convenient ambulatory diagnostic, treatment, and surgery centers, The future will be outside hospital walls in convenient community locations.

Meanwhile we physicians should reaffirm our commitment to the principles of individual freedom and choice, to the sanctity of the patient-physician relationships, and to limited government and corporate intervention. But we should distinguish between what we cannot alter, what we must accept, and what we should embrace. We should help design principled reforms that can win majority support to include a diversity of opinion.

For more information on the work and progress of the United Physician and Surgical Association, see letmydoctorpractice.com.

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