Thursday, July 17, 2014

Future of Medical Practice

O blindness to the future!

Alexander Pope (1688-1744), Essay on Man

Physicians are blind to what the future holds, for the future depends on factors beyond their control.

These factors include:

• one, the outcome of the November 4, 2014 midterm elections;

• two, the results of next open enrollment period from November 15, 2014 to February 15, 2015;

• three, variations in state politics and policies in response to Medicaid and ObamaCare;

• four, the confusion of the public and its health care illiteracy on ObamaCare (they dislike it but do not want it repealed) how much the ObamaCare numbers from the initial October 1, 2013 to April 31, 2014 rollout will raise federal costs and health care premiums;

• five, the impact of external political events such as the immigration crisis, U.S. economic health, Middle East turmoil, and the unstable Ukrainian situation.

Physicians cannot know these things because they rest on the outcome of political battles now being waged for control of the U.S. Senate, battles over which physicians have little control. If the GOP wins the Senate, ObamaCare is in deeper trouble than it already is; if the GOP fails, political ObamaCare paralysis will continue. If premiums rise dramatically between now and November 4, 2014, it will bode badly for Democrats.

Difficulties in predicting how all of these uncertainties will, in turn, rest on these imponderables which the Physicians Foundation has identified as critical issues to watch.

• One, the trend towards “consolidation” and “monopolization.” Health plans and health systems are consolidating into ever larger entities designed to control premiums and costs. Hospitals are hiring doctors in record numbers; regional monopolies are growing; smaller practices are shrinking in numbers; costs and premiums are rising, doctors at the margins are resisting by joining the direct pay/concierge movement.

• Two, growing regulatory burdens. A 2013 Physician Foundation survey indicated doctors already spent 22% of their time on paperwork. This percentage of time away from patients will grown when the October 2014 for ICD-10 coding kicks in and increases the number of codes from 7,600 to 69,000.

• Three, public , physician, and employer confusion over the health insurance exchange outcome numbers and what the numbers mean. Specifically, physicians wonder how much their reimbursements will decline, whether they will be overwhelmed by new patients, or whether their patients will simply disappear into thin air because of those narrowed health plam networks.

• Four, overcoming electronic health record (EHR) shortfalls. To say that promises to EHRs to cut costs and increase efficiencies have been a disappointment is a colossal understatement. EHRs costs money to install and maintain, cut productivity by as much as 30%, do not contribute to the clinical narrative and understanding of the patient, and, to top it all off, do not communicate with each other or with hospital systems.

• Five, health system stalemates: no permanent solution to the Sustainable Growth Rate (SGR) problem, which hangs over physicians’ heads each year like the Sword of Damocles , threatening to cut their reimbursements by 25% or more; lack of any federal action on tort reform; and disruption of Medicare and Medicaid reimbursement because of disputes over physician fraud and criticism over physicians are the primary cause of the rise of health costs.

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