Monday, September 14, 2015

Why Aren’t Physicians Asked to Help Reform Health Care?

The title poses a perplexing question. Why isn’t physician participation an integral part of health reform decision making? After all, physicians provide the care, order the tests, prescribe the drugs, and perform the procedures that form the basis of modern health care and account for the bulik of health care spending,

Yet, according to a 2012 Physicians Foundation Survey of 650,000 doctors, 82% of doctors said they felt helpless and could play no active role when it came to influencing health reform. Perhaps that’s why in a similar 2014 survey, also by the Physicians Foundation, only 3.7% gave ObamaCare an A, and 75% gave it a C, D, or F.

Why are doctors bypassed when it comes to reforming care? After all, doctor incomes make up 25% of all health costs, and their orders are said to account for 80% of costs, and they are on the frontlines of care where critical decisions are made.

Why are doctors so seldom asked for health reform input?
Do those outside the profession know more curbing costs and managing care than those inside? Do outsiders know more than insiders about patients’ problems? Do government officials, insurance executives, hospital managers, and other overseers possess the knowledge and know more than doctors about what will save money, improve outcomes, and enhance efficiencies?

Will data fed into electronic health records and transformed into algorithms replace clinical intuition ? Will giving doctors incentives to join with hospitals into Accountable Care Organizations (ACOs) actually save Medicare money? Does forcing doctors to spend 20% to 25% of their time on coding claims, solving billing problems, meeting credentialing criteria, asking for pre-authorization, and complying with regulations improve care?

I do not know the answers.

But I know a revolt is brewing among doctors about having more input into reform. In late July, an organization United Physicians and Surgeons, held a conference with 40 speakers in Colorado, designed to address the issues of restoring physician autonomy, protecting the doctor-patient relationship, and resetting relationships with overreaching government and insurer relationships.

And I know an article by leaders of the Physicians Foundation had an article in the September 1 issue of Forbes Magazine entitled “Why Aren’t Physicians Part of the Health Reform Conversation?” You won’t find the names of practicing physicians as a authors of the Patient Protection and Affordability Act or any other piece of health care legislation.

Why not? Here I leave solid ground. I suspect the reasons are that outsiders believe physicians themselves and their organizations need to be reformed.

They believe outside management is necessary to reform care.

They may not trust physicians to be compensated for what they order or do because they believe physicians act out of personal gain rather than patient benefit.

They may think many if not most tests and procedures are unnecessary and do not result in health improvement or better outcomes.

They may believe American physicians, particularly specialists, make too much money.

They nay harbor the belief that data monitoring, artificial intelligence, electronic health records, and doctors and hospitals working in tandem in Accountable Care Organizations using federal guidelines will modify physician behavior sufficiently to save Medicare money, although this has yet to be proven.

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