Monday, April 29, 2013

Uncertainty, Physicians, and Health Reform
Today there is uncertainty about regulatory policy, uncertainty about monetary policy, uncertainty about U.S. fiscal policy and the national debt…At Vanguard, we estimate that policy uncertainty has created a $261 billion drag on the U.S. economy.
Bill McNabb, chairman and CEO of the Vanguard Group, “Uncertainty is the Enemy of Recovery,” Wall Street Journal,  April 29, 2013

The American College of Physicians hopes that the legislation will address key priorities on coverage, workforce, and payment and delivery reform. The goal of the PPACA is to help provide health coverage to most Americans, improve access to primary care, and lower costs.
Robert M. Doherty, “The Certitudes and Uncertainties of Health Care Reform”,  May 18, 2010, The Archives of Internal Medicine

Physicians say they are unsure where we will be and how we will fit in three years.  Ninety two percent of physicians in this survey agreed with that statement. Only 2.7% strongly disagree. There is tremendous uncertainty, and uncertainty always invites uncertainty and lack of confidence.
Interview with Walker Ray, MD, chairman of research committee, “Physicians Foundation Survey of 630.000 Physicians,  Chapter in New Voice of Health Reform: The 3Rs- Rhyme, Rhetoric & Reality,  Book Number Two, The Physicians Foundation – A New Voice for Physicians,  Medinnovation Press, 2013

The only certitude about the health reform law, aka Obamacare, is that it passed on March 23, 2010 without a single Republican vote.   Its fate has been uncertain and its unpopularity has persisted  ever since. 

Reform  uncertainties about Obamacare for physicians are legend.

·         Whether it will survive the November 2014 mid-term elections, or will be repealed or delayed.

·         Whether its health exchanges, the pillar of Obamacare, can be implemented, given their costs, and the decision of most states to cede responsibility for implementation to an unprepared federal government rather than to themselves.

·         Whether the uninsured and those 4 times below the poverty line will decide whether to participate in the exchanges, thus making them viable and reliable.

·         Whether Congress will modify or repeal the Sustainable Growth Rate formula for physicians.

·         Whether CMS will continue to reduce reimbursements for specialists,  who comprise two-thirds of the 550,000 physicians who bill Medicare and whether CMS will pay primary care physicians enough to attract and retain these physicians.

·         Whether the impact of increased premiums and lack of hiring by businesses will effectively derail or indefinitely delay implementation.

·         Whether mandates and incentives to install electronic health records will be sufficient to overcome the lack of utility of current systems and the costs to install and maintain EHRs.

·         Whether the concept of Accountable Care Organizations has legs  and whether it will actually achieve “savings” to offset costs of  establishing these new entities and maintaining them.

·         Whether becoming employees of hospitals and integrated care organizations  will achieve its promises of economic security,  balanced life styles, and malpractice avoidance without giving up physician  autonomy and integrity and raising patient costs.

Physicians’ concerns about uncertainties is not whether reform is on their side, but whether they can afford to pratice under its costs, rules, and regulations, and whether Obamacare is on the side of patients, their access to care, and cost of that care.

Tweet: Physicians have uncertainties about the health reform law, and these uncertainties  profoundly effect how they act and what they do.


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