Sunday, May 11, 2014

Embattled Physicians and Direct Pay Independent  3rd Party Divorce

I am writing this aboard a Delta Flight from Minneapolis to Hartford.  I have just delivered a keynote address to an American Association of Physicians and Surgeons conference.

“Embattled” is precisely  the right word to describe the tone of the conference.   Doctors are feeling embattled, combative, even paranoid, over growing reimbursement cuts, time-consuming,  hassle- filled, and overhead-raising  encounters with  government and private 3rd party  regulators.   This compliance-alliance frustrates and angers them.

Physicians seek and desire a free market solution,  in their eyes- a simpler, more direct, more convenient, more confidential, more private, less intrusive,  and far less costly solution - than government commandeered care.

CMS and health plan bureaucracies ensnare,  entangle, and embroil physicians. Red tape  saps their energies,  distracts from time spent with patients,  seeks to control them,  demoralizes them, alienates them from patients,  distracts them from their mission of serving patients,  destroys their autonomy, and questions  their judgment.   

Physicians  feel surrounded by enemies.   These encroaching enemies include, in no particular order,  advancing armies made up of ObamaCare partisans,  Medicare and Medicaid officials,  health plan managers and  clerks,   hospital administrators,  fellow physicians and physician organizations that have “gone over to the other side,” malpractice  attorneys,  and datacrats, technocrats and bureaucrats at every level  of the sprawling, complex,  impenetrable, byzantine  American health care “system.”   Government officials,   managers,  the media, and others far removed from the practice scene criticize and critique every physician move, all in the name of evidence-based medicine, of which there is scant evidence, even works in decreasing costs or improving outcomes.

Physicians  cringe and  are tired of being constantly  and unfairly criticized and unjustly attacked and demonized for raising costs.  They are accused of performing “unnecessary tests,” of putting money before care,  of being wasteful and duplicative, of acting in fragmented isolation, of feathering their own nests, of creating hospitals and surgical and diagnostic centers  for personal gain  rather than the good of patients and the nation. What infuriates them is that only 6% of money for care goes to primary care physicians and perhaps 20% to physicians as a whole when one includes specialists.

For physicians,  this  is not a pretty picture.  Enough is enough.  They are mad as hell, and they are not going to take it anymore.  Physicians want a divorce from the 3rd party outsiders who interfere with their work and their relationships with patients and who drive up the costs of care. 

This divorce comes in the form of something called direct pay independent  3rd party free practice, or free market care.   Under this arrangement, physicians  will be paid directly for the work they do at the point of care without  3rd party involvement.   They will be paid directly by patients or by employers for the services they perform,  not  for complying with regulations concocted by others.  

Why not cannot  health care insurance be more  like automobile insurance, with patients paying for gas and routine maintenance,  with high deductibles and catastrophic insurance covering serious accidents and illnesses.   Why not divorce routine primary care from health insurance, from 3rd party surveillance and regulatory control, just as in other free market transactions?

The principles of the free market  will govern– competition and freedom to choose - rather than policies of outside regulators issuing guidelines, creating algorithms to cover every contingency,  judging their performance,  forcing them to collect endless reams of data,  compelling them to “code” for every action, test, and procedure;   and forcing  them either to practice and prescribe  electronically  or not to be paid.   

 After the divorce proceedings are concluded,  physicians will be free, free at last, to practice as their conscience and patient needs and training dictate, rather than what and how and when  the government,  health plans, and  physician employers mandate.  

Tweet:  Among physicians,  a direct pay wave is growing to practice independently divorced of 3rd party pay by government and health plans.

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