Monday, January 12, 2015

What Can Doctors Do?

Let us do, or die.

Robert Burns (1759-1796), Scots Wha Hae

What can doctors do about the sorry state of private practice, medical affairs, and health reform?

This is not an idle question. The numbers speak for themselves. Somewhere between 55% to 59% of Americans want ObamaCare repealed or replaced; 44% of doctors plan to take steps to limit access to care; 45% give Obamcare a D or F grade, while only 3% give it an A; by 60/40 margins midterm voters voted Republican, most largely on the basis of a weak economy or on ACA “trainwreck.”

In his poem The Charge of the Light Brigade,Lord Tennyson wrote, “Ours is not to reason why, ours it to do or die.” I would change this to read, “Ours is to show the reasons why, Ours is to do or die.”

Why is the private practice of medicine dying or in severe distress? There are many reasons why, which the Physicians Foundation, a nonprofit organization has articulated in its watch list.

These are things to watch.

• Watch for rapid hospital consolidation. As hospitals consolidate into ever larger integrated systems, it not only gives them monopolies but the capital and leverage to negotiate higher fees from 3rd parties , to buy physician practices and to raise fees for the physicians they employ. Salaried physicians have no control over those fees. Sometimes called “facility fees." Physicians can only refer to specialists and to departments within the hospital system that employs them.

• Watch for the volume of paperwork physicians must handle. Nonclinical paperwork and administrative and regulatory pressures now require physicians to spend 20% or more of their time filling out forms, entering data into electronic records systems, or hassling with 3rd parties to gain permission to do a procedure or perform a test. These tasks take time away from patient care.

• Watch for the introduction of the ICD-10 coding system on October 15, 2015. This dramatically expanded system, which contains a 10 or more fold increase in codes a doctor must master in order to get paid, requires more data entry and data clerks to enter that coded data into a labyrinthic maze. If codes are entered improperly, payment will not be forthcoming, audits may ensue, and even imprisonment for fraud may follow.

• Watch for increasing lack of transparency with mounting complexity of the system with confusion among those who charge and those who must pay the bills. Lawyer and journalist Steven Brill, in his book America’s Bitter Pill, highlights this confusion. He interviewed the CEO of a hospital, whose institution charged $200,000 for an open heart procedure on Brill, and the CEO of the UnitedHealthGroup, and neither could rationally explain the contents of the bill.

• Watch for lack of physician access. According to the Physician Foundation’s 2014 Biennual Survey, nearly half (44%) of physicians plan to limit access to new patients either by retiring, pursuing another career, becoming a hospital salaried employee, a hospitalist, or a locum tenens physician. Others may switch from being paid by a 3rd party to direct pay concierge practices. The reasons for these private practice switches are many – low reimbursement, exclusion from networks, harassment hassles, loss of autonomy, malpractice pressures, unaffordable practice expenses, and dissatisfaction with dysfunctional electronic health records systems.

What can physicians do? Among other things, they can make the public aware, through systematic and objective national physician surveys, of what physicians think and how they react to harmful health reform measures.

Let us watch and pray that things change for the better and that health reforms do patients no harm, distract from the doctor-patient relationship, or further limit access to care. Otherwise, private practice as we know it will wither and die.

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