Thursday, March 10, 2016

 Physician-Patient Health Care Landscape,  As Viewed by the Physician Foundation and Health Affairs
With the help of financial support from the Physicians Foundation,  Health Affairs, a respected source of information on the state of national health care,  devotes part of its March 2016 issue “Physicians, Prescription Drugs, ACOs, and More “ to the impact of health reform on physicians and patients.
In his lead editorial,  the new editor,  Alan Weil,  JD, M.P.P.,  a graduate of the University of California, the Kennedy School of Government at Harvard, and Harvard Law School,  formerly executive director of  the National Academy of State Health Care Policy,  makes these cogent observations.  
·         Despite the goal of  Health and Human Secretary Sylvia Burwell that 90% of Medicare payments will be shifted from fee-for-service  to value-based payments by 2019,   95% of  current payments  are fee-for-service. 

·         Physicians spend $15.4 billion compiling quality data for the government and expend 2.6 hours a week on this task. 

·         Much of the burden of recording this date falls on primary care physicians,  who spend twice as much time on the effort as cardiologists and orthopedic surgeons. 

·         Accountable Care Organizations (ACOs),  a linchpin of the Obama administration’s efforts to achieve Medicare savings by herding hospitals and doctors together   have had limited market penetration – only half of ACOs include a hospital, and only 20% of hospitals participate in an ACO.  
Since its inception in 2003,  The Physicians Foundation has been a leader  in conducting national surveys on physician attitudes and actions related to  ObamaCare and  it has just completed survey of patient reactions to the health law.   Health Affairs provides a forum for bringing attention to a larger audience of physician and patient views of how the health law effects these two vital constituencies,  who,  after all,  represent what the health law is supposed to be all about. 
As I wrote in my 2011 book The Health Reform Maze, of physicians:
“Many physicians are unhappy with the present healthcare system and favor incremental, preferably market-driven health reform.  If health reform takes effect as currently structured, as many as 60% of physicians may no longer accept new Medicare and Medicaid patients or may cut back on their services.”
And of patients,
“Sometimes we forget the healthcare system  exists  for patients, not for government, not for the medical-industrial complex, and not for physicians and other health care professionals.
In any event,  here are four verbatim abstracts from the March issue of  Health Affairs,
How physicians describe themselves:
“Physicians describing themselves as independent practice owners declined from 62 percent in 2008 to 35 percent in 2014, according to the 2014 Survey of American Physicians conducted by the Physicians Foundation. Over 70 percent of physicians would still choose to be a physician if they could do their career over, but many have important concerns. Over 80 percent report that they are overextended or at full capacity and that nonclinical paperwork takes up about 20 percent of their time. Only 10 percent of physicians interviewed in 2014 were very optimistic about the future of the medical profession.”
How physicians respond to federal  quality practice tracking:
In this issue of Health Affairs, Lawrence Casalino and coauthors establish that physicians in common specialty practices spend an average of 2.6 hours per week dealing with external quality measures. This gives rise to general questions about the future of the medical profession. To what extent will quality-tracking requirements and similar practice intrusions reshape who physicians are, how many physicians there are, and how they practice? In turn, how will these changes affect patients’ access to care? Data derived from the 2014 Survey of America’s Physicians: Practice Patterns and Perspectives, conducted by Merritt Hawkins on behalf of the Physicians Foundation, make it clear that physician practice patterns are evolving. Responding to an increasingly intrusive practice environment, physicians report that they will choose a variety of practice models likely to reduce patients’ access to care or that they will retire early, which will exacerbate the physician shortage and fundamentally change the nature of the medical profession.
How retail clinics affect healthcare costs
Retail clinics have been viewed by policy makers and insurers as a mechanism to decrease health care spending, by substituting less expensive clinic visits for more expensive emergency department or physician office visits. However, retail clinics may actually increase spending if they drive new health care utilization. To assess whether retail clinic visits represent new utilization or a substitute for more expensive care, we used insurance claims data from Aetna for the period 2010–12 to track utilization and spending for eleven low-acuity conditions. We found that 58 percent of retail clinic visits for low-acuity conditions represented new utilization and that retail clinic use was associated with a modest increase in spending, of $14 per person per year. These findings do not support the idea that retail clinics decrease health care spending.
How Patients View  Federal Drug Benefits—Prescription And Otherwise
A few papers in this issue explore a variety of topics related to drugs. Marc Elliott and colleagues report that Medicare beneficiaries are less satisfied with their prescription drug benefit than they are with other benefits, but that those in plans that integrate the drug benefit into a Medicare Advantage plan are more satisfied than those enrolled in standalone plans. Kathleen Miller and Michael Lanthier find that more than half of the new drugs approved under the Orphan Drug Act of 1983 have been “first in class.” Finally, as states increasingly adopt medical marijuana programs, Arthur Robin Williams and colleagues conclude that states with looser regulations have much higher rates of enrollment.

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