For Immediate Release
Date: Nov 6th, 2009
Contact: By Barry Schumer, MD
Don’t Balance Health Care Books by Shortchanging Physicians
All primary care providers support improving our health care delivery system. In a recent op-ed piece on reform (August 19th NY Times), president Obama points out that he has the AMA \"on board\", but fails to recognize that most practicing physicians believe his reform plan falls short of providing the beneficial change he promises.
Increasing access to care will require that reform measures address the critical shortage of primary care providers. Studies confirm that thoughtfully managed primary care services result in reduced costs of care and increased patient satisfaction. No reform plan has yet created the incentives that will facilitate increased numbers of young physicians choosing careers in primary care and slow the loss of providers to premature retirement.
Failure to increase provider numbers will create bottlenecks in the care delivery system that will be more than an inconvenience for patients. A system that is unable to respond in a timely fashion to patient needs is one which potentially damages patients, delays care, increases risk of complication, increases inappropriate use of emergency room services and therefore adds to expense.
Obama promises that health care reform will \"bring skyrocketing health care costs under control\" and cut \"billions of dollars in waste and inefficiency.\"
Physicians have been down this road before and know that such claims mean only one thing for them - further cuts in reimbursements that have already been under a stranglehold by Medicare and private insurance for the past 20 years.
Inflation adjusted incomes for physicians have been unchanged during a twenty year period of unprecedented increase in costs of care delivery for providers. During that time, the same legislators who have failed to respond to provider pleas for more equitable reimbursements have voted themselves a 300% increase in salary.
But President Obama has suggested that increases in reimbursements for primary care will need to be put on hold while more pressing elements of health care reform are addressed.
Reform will mandate physicians purchase expensive electronic medical record technology, spend billions more to comply with quality review and fraud and abuse prevention programs, and absorb the patient care responsibilities necessitated by the addition of previously uninsured patients into the health care system.
Rather than asking providers to further “tighten their belts” as President Obama has suggested, government needs to examine alternative ways of achieving savings that could be used by our country to fund health care access.
Mention of serious tort reform is conspicuously absent from health proposals made by President Obama and Congress. Fear of litigation contributes untold billions of wasteful spending on care annually. Physicians order costly imaging studies such as MRI’s and hospitalize patients for precautionary observation all in the interest of protecting themselves from frivolous and potentially career-ending litigation that could result should their choice of a conservative and less costly treatment become a target of litigation.
In America, we are bombarded with television solicitations from lawyers recruiting patients who may have been the victim of unintended medical error or “failure to diagnose.” No other country tolerates this sort of un-professional conduct while simultaneously blaming their health care system for the costs generated to prevent or defend the accusations that result.
The pharmaceutical industry has contributed mightily to cost increases over the past decade with expensive direct-to-consumer solicitations for non-generic medications. This practice puts physicians in the middle between patient expectation and society’s desire to control spending.
Billions of dollars are spent by pharmaceutical companies to develop and market so called “me-too” drugs that represent unnecessary additions to classes of agents with more than enough existing options for patient use. These medications provide market share for pharma without any measurable care benefit for patients or physicians who frankly, have no real use for them.
Would it not be logical to look for easily achievable savings from tort and pharmacy reform rather than continue to ask providers to work for 1985 wage scale in 2009 to finance health care?
Regarding care affordability, physicians know that increases in costs over the past 20 years have been associated with technological advances that have resulted in dramatic improvements in the early detection and treatment of a long list of serious health problems.
As an example, the aggressive treatment of patients suffering heart attacks with angiography and stents provide significant improvement in survival and reduction in heart damage. This returns patients to work and reduces future medical expenditures. Thus, increased spending brings dollars back to society in savings politicians fail to acknowledge.
Politicians express outrage over health care costs while they and many of their constituents routinely invest in fifty inch plasma screen TVs, SUVs, iPhones, and expensive entertainment and sporting events - none of which provide any benefit to our nation\'s health but are considered to be a right of citizenship.
As technology continues to advance, promising \"affordability\" may be a difficult guarantee unless we decide as a society to either delegate the needed funds to pay for care or choose to forgo future technology advances and their benefits in the interest of preserving our current lifestyle choices.
Government reform promises \"quality\" care and plans to measure and mandate it by utilizing the Physicians Quality Reporting Initiative (PQRI). This costly program reviews physician records and measures performance based on government generated standards for \"prevention, chronic and acute-care management, surgical care, resource utilization, and care coordination.\"
Historically, patients have never had difficulty identifying quality nor making decisions regarding where, when, and from whom they wish to receive their care. Government attempts to measure, mandate, and reward quality will cost billions to accomplish what doctors and their patients work out daily in the privacy of the examination suite at no cost to either.
To deliver quality care, physicians require a well-trained staff, an appropriately equipped office space, updated medical education, a compassionate heart, and more than anything else, the time to listen, the time to examine, the time to explain, and the time to connect with their patients. Sadly, current reform addresses none of these aspects of quality care.
Reducing fraud and abuse in the Medicare program is a frequently mentioned concept that could free up dollars for care delivery. True fraud is easy to identify and appropriately prosecuted.
But legislators eager to look for ways to finance reform overestimate the problem as they lump together those who cheat the system with legitimate providers merely attempting to receive fair and equitable reimbursement for their time and efforts spent on behalf of patient care.
On August 1, a new program to identify Medicare fraud was launched in an effort to identify physicians suspected of inappropriate billing for services. Medicare has hired independent contractors who will receive a flat percentage of every dollar they can retrieve from physicians. These \"bounty hunters\" will extract as many dollars as possible from providers assumed to be guilty until proven innocent with the dollars collected used to justify the politician\'s claims of abuse that prompted their hire.
Most \"fraud\" claims turn out to be differences of interpretation of the contents of an indecipherable 200 page coding manual provided by Medicare that requires \"coding specialists\" to interpret but will be used to bolster the accusations of physicians’ misconduct. Medicare has knowingly created a conflict of interest with auditing firms that will inappropriately put doctors in the middle and force them to spend time and money to fight claims of impropriety.
Can our government afford to run off qualified practitioners from a health care system described as being in crisis mode and reduce patient access in the process? The harassment of ethical and honest physicians by Medicare and insurance companies does nothing to aid efficiency, quality, access, or the affordability of health care.
As they rush to judgment, and prompted by a president who has described health care as \"a ticking time bomb,\" politicians have drafted legislation while failing to consult either the 80% of Americans who are happy with their care or the practicing physicians upon whom the success or failure of reform will ultimately depend. It is not surprising, then, that politicians may create legislation that misses the mark on so many fronts that it is hard to believe anyone will truly consider it \"reform”.