Monday, April 21, 2014

Doctor Diplopia and Decoupling from 3rd Party Payers**

Doctors have one eye on the patient and one eye on the clock.

David J. Rothman, who studies history of Medicine at Columbia University of Physicians and Surgeons

Four  articles caught my eye today.
1)                  Leslie Kane, Carol Peckham,  Medscape Physician Compensation Report,  April 15, 2014

2)                 Greg Freeman, “Medicare Op-Outs a Viable Physician Strategy , “ Health Leaders Media, April 17, 2014
3)                  Roni Coryn Rabin, “ 15 Minute Visits Take a Toll on on the Doctor-Patient Relationships, “ Kaiser Health News, April 21, 2014

5)                 Jacqueline  Fellows,  “Reform Puts Vice Grip on Physician Groups , “Health Leaders Media, April 20, 2014 
The first article from Medscape was particularly startling.  It contains the news of a survey of 24,000 physicians in 25 specialties  by the American Academy of Private Physicians.   The news is that 27,000 doctors are now in direct independent/concierge practices and 81,000 are participating in cash-only practices.   The usual figure reported is 5000 in concierge practices with no mention of cash-only practices.

This would indicate a mass exodus from 3rd party payments.   

This, in turn,  as reflected in the other 3 articles,  may cause these new realities.·        
  •  Doctors are opting out of Medicare and Medicaid in significant  numbers. 
  • Many  doctors cannot afford to  accept new ObamaCare health exchange plan patients which  carry with them low reimbursements.   
  • Physician groups  are caught in the ICD-10 , regulatory,  reform vise.   
  •  Neither doctors  or patients like the “hamster wheel” environment in which patients must be seen at the rate of 15 minutes or less for doctors to meet their bottom-line,  pay their overhead, pay their staff, and keep their doors open.
Hence, the doctor diplopia phenomena in which doctors must keep one eye on the patient and one eye on the patient.    It may even require a third eye,  with the other eye on the computer screen,  and a third hand (the first two are needed for examining the patient) on the computer keyboard.

Tweet:   Pressures on doctors to see more patients at less pay  are causing a physician exodus from  3rd party practice to  direct independent  cash-only  practices.


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