Tuesday, November 30, 2010

The Media and the Physician Reform Message

In 1967 Marshall McLuhan and Quentin Fiore wrote The Media and The Massage (Bantam Books). McLuhan, the principal author, said it is often the media itself, not content, that transmits the meaning of most messages.

McLuhan frequently punned on the word “message,” by changing “message,” to “massage age, “ “mess age, “ and “massage.” In other words, depending on the media used, you can “massage” the “message” to mean what you want it to mean for a mass audience.

Think about this for a moment. The media is not impartial. The New York Times routinely “massages” its “message.” So does CNN, the Wall Street Journal, The New York Post, Fox News, MSNBC. ABC, and all those bloggers, left and right out there, including me.

My bias is to defend private practice and patients they serve.

No matter what your political leanings, the media has been reluctant to highlight the plight of private doctors, caught in the squeeze between declining revenues, rising expenses, high educational debts, the physician shortage, overwork, government penalties for noncompliance, malpractice threats, and reform uncertainties. Yet, amongst the media, little sympathy exists for reform’s impact on physicians.

Few media outlets recognize the stark reality that without private physicians to provide care, without adequate compensation to cover practice expenses to care for Medicare and Medicaid patients, health reform may be a sham – a delusion that federal entitlements to cover 34 million more citizens, and probably 50 million more through health exchanges, while cutting costs and redesigning the entire system, at one fell swoop, defies the laws of economic reality. Universal coverage without universal access to physicians is meaningless.

But that reality may be dawning. The vehicle for change is a thoughtful 110 page white paper, Health Reform and the Decline of Physician Private Practice, a collaboration between the Physicians Foundation, a 501C3 corporation representing physicians in state medical societies, and Merritt Hawkins, the nation’s largest physician recruiting firm. These physician advocacy organizations know their facts on the ground, and through careful studies and surveys, they have been monitoring and documenting how physicians are reacting and will react to the health reform law. The reality is that anywhere from 10% to 50% of private physicians may opt out of Medicaid and Medicare if Congress doesn't modify, "fix," or scrap scheduled Medicare SGR (Sustainable Growth Rate) cuts, which would lead to a massive physician access crisis.

National Public Radio (NPR), government subsidized outlet generally considered to be “liberal” by conservatives, broadcast this message on November 29. Message is in italics.

Doctors Blame New Health Law For Death Of Private Practice

Of all the scary scenarios predicted for the new health law this is among the scariest: A new survey of doctors predicts the rapid extinction of the private-practice physician.

A survey of some 2,400 MDs from around the country found nearly three quarters said they plan to retire, work part-time, stop taking new patients, become an employee, or seek a non-clinical position in the next one to three years.

But are these changes really the result of the new law?

Doctors responding to the survey seemed to think so. “Doctors strongly believe the law is not working like it needs to – for them, or for their patients,” said Lou Goodman, president of the Physicians’ Foundation, who conducted the survey.

But most of the provisions of the new law affecting doctors and patients haven’t taken effect yet.

And slightly more doctors said that the lack of a fix to the Medicare physician pay issue is a bigger issue for them than the actual overhaul; by 36 to 34 percent.
The paper that accompanied the survey says all those docs leaving their practices will be replaced by a managed care employee or “concierge” doctor who will require an upfront annual payment.

The bottom line, however, is buried at the bottom of the news release about the study. It comes from the advisory panel commissioned to write the paper on the effect of the new law on doctors:

Despite its many problems, healthcare reform was necessary and inevitable and many of the changes mandated by the ‘formal’ reforms likely would have occurred on their own within the ‘informal’ delivery of care, owing to economic and demographic forces.

In other words, things were changing anyway, with or without the passage of the Patient Protection and Affordable Care Act. Blaming the new law just gives doctors a convenient scapegoat.


Note the “massage” of the “message, ” particularly the use of the words “blame” and “scapegoat.” NPR implies that doctors are unfairly attacking government health reform for physician failures. In this era of “mess age,” I suppose everybody needs a “scapegoat.” With NPR, private physicians are the “scapegoat” and are to “blame.”


Anonymous said...

great blog

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BobbyG said...

"My bias is to defend private practice and patients they serve."

But, what proportion of your active patient panel pays cash? What relative percentages of your income are derived from [a] private cash retail payers, [b] commercial 3rd party payers, and [c] public entity 3rd party payers?