Saturday, March 19, 2016

Reality Time

Reality Time
I just received the following email:
Dr. Reece, we’ve been discussing the Stakeholder Syndrome, related to how entities have become invested in developments like the ACA that they defend that which is indefensible – because they have a stake in it.

Dr. Beecher wrote this email to the MPPA folks about the syndrome, and would like you to respond.

We need to analyze the "Stakeholder Syndrome" in American healthcare today.
There is no rationale for federal or state governments, insurance companies, Pharma, hospital-clinic organizations and (establishment) organized medicine (AMA, medical specialties) to change their current third party payment business model which was cemented mafia-like with the (Democratic majority) 2010 ObamaCare cartel deal. Why should they since it works so well for them?

The AMA (along with all US specialty medical organizations) in 2008 cast its lot as a stakeholder in the new US healthcare cartel. Dr. Sue Bailey, current AMA Speaker of the House of Delegates, made that abundantly clear on March 8 in her kind and informative visit with a group of us at MPPA. [I fear there is no turning back for the AMA, Bob.] Sadly the AMA has become a de facto trade organization governed by corporations who overtly or tacitly agreed in 2008- 09 to bump off US independent medical practices.
MACRA "alternatives" such as ACOs and other managed care incentives for "providers" are window dressing for third party-provider pay-for-performance deals which are controlled and dictated by central budgeting and administrative healthcare authorities. This is the future of "Medicare for All" in 2016.

Healthcare cartels are gaining power as oligopolies and oligopolies. When if ever will United Healthcare be too big to fail? And how could it? In Minnesota, HealthPartners is now an insurance company, hospital-clinic organization, and TPA contractor for the MN Medicaid population. What is the impact of these conglomerates on healthcare costs, access and quality? Anti-trust? 

The Mayo Clinic is an outlier and valuable case study. It charges the most and (so far) has successfully refused to accept lower payments from government and private payers. Mayo has taken over many local hospitals and clinics in Minnesota. And Mayo will not take (new) Medicare patients. Mayo is frequently lauded and receives donations from patients.

Where to start?

Your thoughts?

Lee H. Beecher, MD
President, Minnesota Physician-Patient Alliance (MPPA)
Maple Grove, Minnesota

Dave Racer, MLitt
DGR Communications, Inc.

St. Paul, Minnesota
My Thoughts

Lee and Dave:
My thoughts are:

1) One, the corporate transformation of medicine, or the stakeholder syndrome, is here to stay.  Corporations, unlike private independent physician’s practices, have the management structure, capital, ability to mobilize specialists and IT technologies, and the management machinery to market to large populations, or for that matter, to market to employers.

2) 95% of physicians are "stakeholders," i.e., beholden and dependent on 3rd parties, in one way or another.  America has a population of 330 million.  Of these, 160 million are covered by employers, 55 million by Medicare, 70 million by Medicaid, 10 million by ObamaCare, 10 million by VA, for a total of 305 million.  Roughly 23-30 million are uninsured.

Getting Real

So let's get real.  What are options of small private independent physicians? Go to work for hospitals or large groups? Join IPAs.?  Depend of HSAs to funnel patients to us?   Rely on AMA?  That's ridiculous. One 15% of us belong, and we don't trust AMA?  Complain and join conservative groups like American Association of Physicians and Surgeons?  Become part of large organizations like Mayo?  Unlikely these big groups comprise only 7% of all physicians, and they are picky about who joins.

Create convenient marketable "focused factories" like diabetic clinics, pain centers, wellness centers, worksite clinics, or chains of physician-owned urgent care clinics. This is doable and is being done.
Get the feds to lighten up regulations, like “meaningful “mandatory EHRs?  Because of massive protects by hundreds of physician organizations,   HHS has taken notice and is halting  or slowing down its “meaningful” use reforms and vowing to redesign EHRs to make them more useful and physician friendly.
Go into concierge or cash only practices, which I predict 10% to 15% of doctors will do.  
The important thing is: do something. Accept reality.  Don't do nothing or sit back and curse the darkness.

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