Thursday, January 16, 2014

What Doctors Expect in 2014**

Blessed is he who expects nothing, for he shall never be disappointed.

Alexander Pope (1688-1744), Letter to Gay

Doctors do not have high hopes from ObamaCare for 2014.

The Physicians Foundation,   a  nonprofit 501C4 Organization devoted to advancing the mission of independent private practice (“In Store for 2014: New Health System Reforms: New Physician Woes,” January 2, 2014, Forbes),  forecasts these developments.

1.      Monopolization of healthcareAuthors of of the article,  Louis Goodman and Tim Norbeck, President and CEO of the Physicians Foundation, predict  accelerating  hospital-physician consolidation with increased physician employment by hospitals.  This employment, they forecast,  will result in higher payments for physician services by hospitals and may  produce  regional hospital monopolies.  Health plans will also consolidate, leaving physicians fewer options. This will push doctors into larger health systems, and  creating regional monopolies.

2.      Growing regulatory burdens  -  These burdens will mount in 2012 for doctors, who already spent 22% of their time on nonclinical paperwork.  In October 2014,  a new ICD-10 coding system will be implemented, causing a jump from 7600 codes to 69,000 code/ This will necessitate even more non-clinical paper work and more staff to handle regulatory burdens.

3.       Confusion surrounding health exchanges  - As if increased coding were not enough, clinicians can expect massive confusion among patients, physicians, employers, and health plans over health exchanges.   Doctors anticipate lower reimbursement rates,  more low-paying  Medicaid patients, and exclusion of some of their existing patients.  Many groups may not accept  patients from health exchange plans.  Many of the new plans,  accustomed to emergency room care where no copays or deductible exist,  may be confused about how office visits are paid for.

4.       Overcoming HIT shortfalls – Lack of utility of existing EHR systems will continue to be a problem, not only the expense of installing and maintaining the systems, but the training of staff required to use them,  the fact that they do not communicate with other systems, and the 30% drop in productivity in using the systems.   For many physicians, EHRs have not increased practice efficiency or effectiveness.
5.      U.S. health system deadlock -   Among physicians, there are growing concerns that ACA implementation, particularly, is not being properly managed; tort reform under ObamaCare is unlikely,  and resolution of the Sustainable Growth Formula (SGR) dilemma  is not in the offing. Government stalemats over Medicare and Medicaid add to payment, administrative,  and access pressures.

In a related article, Dr. March Siegel , a New York City internist, reports in the New York Daily News that ObamaCare will expand Medicaid.  This expansion, he claims, will clog emergency rooms, cause more doctors not to accept new Medicaid patients (40% do not currently do so),  and create difficulties for primary care doctors who wish to refer to specialists,  most of whom do not accept Medicaid patients. 

Siegel concludes:  “Nearly  4 million Americans have signed up for Medicaid expansion in 25 states and in Washington, D.C.  The remaining 25 states are reluctant to take on the billions of dollars of administrative costs that the federal government will not cover. This will have terrible consequences for American health care, for Medicaid insulates patients from real costs of treatment.   But it doesn’t insulate doctors from the pain of administering it on the cheap.”

Tweet:  Doctors  who do not expect ObamaCare to deliver better health are patients will not be disappointed.

**(If you wish to comment or need more information,  email me at, or call me at 1-860-395-1501.  I am available for writing columns or articles  and for speaking engagements.   I would be happy to publish your comments on my blog, which is currently getting 4000 to 6000 page views each day. If you are interested in being a sponsor for this blog, feel free to contact me.)

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