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  • Doctors Pushing Back on Obamacare Consolidation

    It’s not just the majority of American voters who are itching from the rash of regulations, taxes and government bureaucracy that has stemmed from Obamacare. Small physician groups aren’t ecstatic with the White House’s latest effort to cajole them into swallowing some bitter pills regarding their day-to-day operations.

    This week, several Obama administration officials, including a former member of the National Economic Council, published an article in the Annals of Internal Medicine that urged doctors to “embrace rather than resist change” coming from the new health reform law, which passed in March. These changes include the likely demise of many small physician practices as part of “vertical organization” approaches that would promote more hospitals and large-group practices.

    “Physicians who embrace these changes and opportunities are likely to deliver the greatest benefits to their patients, the health system, and themselves,” according to the article, which was written by Nancy-Ann DeParle, Dr. Ezekiel Emmanuel and Dr. Robert Kocher.

    But doctors are not buying the Obamacare agenda. Robert Lowes, writing for Medscape Medical News, reported that leaders of several physician groups, including the American College of Physicians, believe small practices should still be a viable delivery method in America’s health care system.

    Health policy expert Robert Moffit detailed in a new Web Memo that regulation in Obamacare regarding Medicare payments irrevocably changes the doctor-patient relationship, undercuts physicians’ freedom to remain in smaller private practices, and threatens the continuation of fee-for-service medicine.

    Not only will doctors likely be “coerced into standardizing patient care,” Moffit said they’ll also face pressure to participate in an Accountable Care Organization (ACO), a voluntary grouping of health care providers that agree to be accountable for the overall care of Medicare fee-for-service patients they are assigned to.

    “In other words, the ACO will provide the bulk of [Medicare] beneficiaries’ primary care services…While consortia of health care providers (including university hospitals and large clinics) have experimented with the concept, ACOs are still a work in progress.”

    Health officials in the Medscape article expressed concern that such regulation would prompt more doctors in small-group practices to leave medicine altogether. “If a physician’s only choice is to join a large corporation, we’re going down the wrong path,” former Heritage visiting fellow Dennis Smith said in the article. “We have the greatest health care system in the world because physicians have been independent.”

    Approximately 32 percent of American doctors practiced in solo or two-physician offices in 2008, while 15 percent practiced in group offices of three to five physicians, according to a recent physician survey by the Center for Studying Health System Change

    Posted in Obamacare [slideshow_deploy]

    8 Responses to Doctors Pushing Back on Obamacare Consolidation

    1. Stephen Gervin, MD P says:

      not acceptable

    2. M. Frank Wellington, says:

      This article from the Annals of Internal Medicine from earlier this week is the match that has finally lit a fire under all private practice doctors around the country. Doctors should be writing letters to every newspaper in America as well as talking to their patients about the future of the doctor-patient relationship. The doctors should use the propaganda article as proof that the federal government will stand in the exam room with you and your doctor from now on.

      If you are not mad yet, GET MAD!!

    3. Anonymous, North Tex says:

      Pasternak's Dr.Zhivago only had to deal with the toxicity of the Bolshevik-Marxist/Leninist apparatchiki. Today's U.S.physician is dealing with a much greater terror: namely the "government-healthinsurance industry-media complex."

      Furthermore, individual American physicians, many of whom are driven to near destitution by these forces ,are the only defense for patients who will be subjected to the "mercies" of the ACO standardized "one size fits all" medical care paradigm. If Heritage Foundation truly believes in individual liberty, it should actively support release of physicians from antitrust constraints to which no other group of professionals is subjected.

    4. Anonymous, South Car says:

      "embrace rather than resist change" is equivalent to telling the rape victim to relax and enjoy the experience.

    5. Keith Barrett, M.D., says:

      Too late. I left private solo practice as a general surgeon over a year ago because I saw the writing on the wall. I could barely make overhead as it was, and far too many months I took home no pay for myself. I am now employed, saving as much money as I can so I can have the option to leave medicine altogether should it become necessary. I'm only 43, and I never would have guessed I would feel that way a few years ago. I have no idea how much longer I will be able to afford to be a physician.

    6. Kevin, New Hampshire says:

      I live in a fairly rural area, with few options for primary care. Unfortunately, about the only primary care available is an hour's drive, and involves one of these types of healthcare corporations. The care is abysmal at best and criminally negligent at worst. As an example, during my yearly physical, for which I am billed 349.00, I brought up the subject of smoking cessation with my physician, and asked him to prescribe a nicotine replacement therapy, to which he replied: "I can't discuss that with you during this office visit, you'll have to make a separate appointment for smoking cessation." The idea being that they needed to charge me, and my insurance company for a new office visit. I explained how far I had to drive, but was firmly told he wouldn't discuss it with me. I was dumbfounded, and decided that was the last time I'd deal with this corporation, and now drive two hours, just to see a singular primary care doctor. It is virtually criminal what has happened to our once great healthcare system.

    7. Joan, New Mexico says:

      Can anyone reference a government run healthcare program or system anywhere in the world which actually works? (i.e. delivers superior care at a reasonable price and with which patients are largely satisfied). I think not.

    8. AJMD, Indianapolis, says:

      I am a family physician, and started out charging $26 for the average office visit, and my patients came in for an average of 3.4 visits per year, which included a comprehensive annual physical. This was $4 higher than the other doctors in the area, which helped offset the extra time I'd spend with the patients. They appreciated that, and gladly paid the extra $4. Now, a mere 20 years later, their 'insurance' allegedly covers the visits, which I still provide at the same frequency, although my profit per visit has dropped from $12 (which would equate to maybe $18 now with inflation) to $14 in current dollars. My patients average co-pay is $30 towards visits that average $140, overhead is now $70 vs. $14 years ago, PLUS a $56 'kickback' forced discount we have to provide to the insurers. So, I make a bit less (and do proportionately more paperwork vs. actual patient care), the patient pays a bit more (remember that in addition to the co-pays, they likely have a deductible larger than the 3.4 x $26 or $88.40 that was their ENTIRE primary care cost per year before insurance got involved).

      The insurance companies are allowed by government to conceal their typical $900/month premiums by selling the product to employers, who charge the employee a token 'participation' fee of maybe $150/month – only after a layoff does the worker realize his/her premiums (for an inferior product, no less) have skyrocketed. Since employers typically change plans fairly often, and patients change jobs, the insurers play "hot potato" with the patient, preferring short-term savings to long-term cost-effectiveness (much less good HEALTH outcomes that don't actually translate into 'savings' for them).

      Since overhead has risen to about $4.00 a minute for the average family physician, AND fees are 'capped' so the patient can't be "balance billed" (and some stupid patients/voters think this is a 'good' thing), at the 15-minute mark the doctor is 'out' $60, and knows that a 99214 office visit may reimburse $72, and he'll have 10 minutes of paperwork/dictation/test results review between patients, so he's going to potentially make $12 for 25 minutes work, even if he does all his paperwork after his staff goes home (thus avoiding the extra $40 in overhead he'd pay while he does the paperwork). Not bad (I have a busy and efficient practice, and make about $23/hr for my stress and education). HOWEVER – when that patient asks "Oh, one more thing…" and it takes a mere three minutes, the income drops to ZERO. If the doctor stays in the room five extra minutes, then the overhead goes up $20, and he's LOST $8.00, for a patient visit/paperwork interval of 30 minutes. Making negative $16/hr, vs positive $30/hr may be the result of being "nice" or "thorough" enough to answer that extra little question or look at that extra spot on your leg.

      We used to do it eagerly, for the same reason the restaurant eagerly serves you a bowl of soup with your meal, or an extra piece of pie for take-home…you PAY for that. Today, thanks to the GOVERNMENT "regulating" to assure "quality" and "cost-effectiveness", your doctor will likely blow you off, make you come in for another visit (and co-pay, and missed work, and gas money, and fragmented, error-prone care)…because you WON'T pay for that extra time. In fact, under most insurance contracts, it would be ILLEGAL for you to do so.

      Same thing for stuff that COULD be done via telephone; it may take twenty minutes to go over a test result, whether face to face or via phone, yet there will be an overhead incurred, and the physician does deserve some compensation (if you don't think so, ask the chick at the drive-through about your dizzy spells, not me). I've often told patients that I'd rather call them the results for $10, but instead THEIR INSURANCE forces me to make them come in for a $35 co-pay, half-day missed work, boring time in the waiting room, paperwork to fill out, and all sorts of money sucked out of their income by their employer that goes rattling around to pay for it, and to pay insurers and my billing people to argue about paying for it.

      That's what we've gotten thanks to abandoning the "free market" in health care.

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