By Hal Scherz, MD
It never ceases to astonish me how ill informed my colleagues are about what is currently going on in healthcare. I recently sat in a board meeting of a physician- hospital organization and the topic being discussed was accountable care organizations (ACOs). The doctor sitting next to me leaned over and asked me what an ACO was. This is a board member representing 800 physicians in contract negotiations with insurance companies!
Unfortunately, he is not an outlier. Too many of us just show up for work and then go home at the end of the day. I might be describing you. Unless doctors take an interest in the business and politics affecting medicine, they will have no one to blame when their autonomy is lost, when their income suffers, and when their patients are placed at risk. It is not sufficient just to educate oneself about these issues. Actions also need to be taken. Most doctors have the false assumption that their specialty organizations and state medical societies are watching out for them and they don’t need to do anything on their own- but they would be wrong. These organizations focus on concerns affecting only a small group of doctors and consequently, our profession is fragmented and vulnerable to insurance companies, the federal government, hospitals and other interests that take advantage of doctors. The American Medical Association should be watching our flank but instead, they are just as bad as other special interests that prey on physicians because they seek to maintain their financial and political power.
Despite the fact that the Affordable Care Act is law and the “train has left the station”, where things end up is not yet determined. In the Obama administration’s view of this issue, doctors will make less money and likely work harder for it. They are doing everything possible to see to that. Obamacare cuts $500 billion dollars from Medicare. This means that there will be less money to pay for services- decreased reimbursement for services.
There are other ways that the federal government has ensured that doctors will earn less. On January 1, the “doc-fix” comes up again. This is the sustainable growth rate or SGR that was part of the 1997 Balanced Budget Act. It means that when Medicare spending exceeds a certain rate relative to GDP, reimbursement to physicians will be downwardly adjusted. Each time that this has come up, Congress has postponed it, but the reductions have been accruing. It was put off 6 times in 2010-11 alone, but expires on December 31. On January 1st, Medicare reimbursement to doctors is set to be decreased 30%, unless the government makes an accounting adjustment of $300 billion dollars- money that we don’t have and a move that is considered unpopular with many.
One of the many hidden treasures of Obamacare is IPAB or the Independent Payment Advisory Board. It is a 15 person, unelected group of bureaucrats, within the executive branch which is given the power to decrease Medicare spending when it exceeds a certain level. Their decisions are binding, and not subject to Congressional oversight nor Judicial review. And to make this even better, hospitals are exempt from the reductions in Medicare spending until 2020, which means that doctors take the entire beating.
Just when it didn’t seem possible that the government couldn’t find another way to ensure that doctors made less money for seeing patients with government insurance, they have found a way. It came out of the “debt- ceiling crisis” and in the words of Rahm Emanuel, a good crisis shouldn’t go to waste. The Congressional Super Committee was formed to come up with an additional $1.5 Trillion dollars in cuts and when this group is unable to reach consensus, automatic cuts go into effect through a process called sequestration. Half of the money will come from defense, but the other half will come from entitlement programs- including Medicare. These cuts will once again be made in reimbursements to physicians.
As long as doctors sit back and allow this kind of behavior to continue, it will not stop. Critics of plans like that of Paul Ryan, which attempts to fix and preserve Medicare by having patients contribute something to their own healthcare, abound and continue to demagogue this issue. Until patients are once again forced to re-establish the financial connection with the healthcare that they receive, someone else will be paying the bill and calling the shots. Skin in the game is crucial to rehabilitating the healthcare system, and doctors need to be united on this point. But first, doctors need to wake up and pay attention now, before it is too late.
Hal Scherz MD, FACS, FAAP, is President and Founder, Docs 4 Patient Care.
Look no further. Our Physician makes less than $45,000/yr after over 15 years of practice and spends an average of 20 min/Patient.
I can’t feel bad for doctors “taking a hit” until I find a doctor that makes less than $200,000/yr. and charges less than $95 for an office visit where they spend all of 10 min. with you. EVERYBODY is “taking a hit” right now – NOBODY wants to sacrifice anything, threatening that quality of services, access to services will diminish, etc. Shame, shame that helping your country and maintaining your integrity to do just as good service to their fellow man as always, is less important than making the “almighty dollar”.
As a patient and consumer of health services, I am shocked at the path the government is taking us down. I foresee UK-style medicine in the future, and that’s not good for anyone. Two years ago, the company I work for started offering an HSA plan, which I joined–it’s terrific–we consumers need to understand more about what things cost, and cost sharing helps us to see that. Paying the first 3k of my own health care makes the connection clearer. However, this president has gutted HSAs. Too bad.
Also, without tort reform, how can there be meaningful cost savings. Too many physicians are forced to practice defensive medicine. My doctor admitted that she sometimes has to order tests, even though the risk is tiny, just to make sure. She, at least, discusses them with me so we can decide together.
It all comes down to people wanting something for nothing–Insurance used to be, like car or house insurance–for out of the ordinary losses/illnesses…now people expect insurance to pay for everything and squack even if they have to come up with $20 out of pocket. Ridiculous.
Stop enabling the disconnection of control of a process from responsibility for that process- i.e. get tort reform with liability being based scientific causality, not civil probability….end the application of ERISA to health care…avoid carriers that do not make premium modifications based on reversible lifestyle risk factors (which thereby force the responsible to financial subsidize and enable the irresponsible)…. and most important, learn when to say, Hell no!
IF THE PEOPLE OF THE UNITED STATES WANT UNIVERSAL HEALTH CARE THEN THE ONLY WAY THEY ARE GOING TO HAVE AN ETHICALLY VIABLE AND ECONOMICALLY REALISTIC SYSTEM (UNDER A NON FLAT TAX SYSTEM) IS TO:
1)MAKE THE POLITICAL LEADERS WALK THE TALK-I.E. THEY MUST HAVE THE SAME BENEFITS THAT THEY ARE FORCING UPON THE GENERAL POPULATION,
2)ALLOW ALL UNITED STATES CITIZENS AND TAX PAYING LEGAL RESIDENTS TO GET A TAX DEDUCTION/CREDIT FOR THE PREMIUM OF THE HEALTH INSURANCE POLICY OF THAT INDIVIDUAL’S CHOICE,
3)ALLOW ALL UNITED STATES CITIZENS AND TAX PAYING LEGAL RESIDENTS TO GET A HEALTH SAVINGS ACCOUNT,
4)ALLOW ALL UNITED STATES HEALTH CARE PROVIDERS TO GET A TAX DEDUCTION/CREDIT FOR THE CHARITY HEALTH CARE THEY PROVIDE IN OR ON THE UNITED STATES, ITS TERRITORIAL WATERS OR AIRSPACE AND
5)HAVE TRUTH IN PRICING-I.E. TELL THE CUSTOMER, THE PATIENT, THE ACTUAL COSTS OF GOODS AND SERVICES PRIOR TO PURCHASE IN NON-EMERGENT SITUATIONS.
What Hal says is so true. Doctors are in a coma!!!
When I alert a doctor, say in Utah about what damages the Idaho Legislature is doing in Idaho, he does not care as it “does not affect him”. Or when severe damages is occuring in CO, the doctor in CA does not care for the same reason.
In fact, the doctor in CO does NOT care about the horrible things that will soon affect his professional and private life!!
I think about this almost every day as this is my job as the Executive Director of the Center for Peer Review Justice.
I know that soon Physicians and Surgeons will come out of their collective coma as they will have to for their own survival. When they do, there will be an explosion of passion!!!
My favorite line was, “Until patients are once again forced to re-establish the financial connection with the healthcare that they receive, someone else will be paying the bill and calling the shots.”
But I am still left wondering what we can do. What are specific things doctors can do to create change??
Pennsylvania Medical Society has an initiative to Build Physician Leadership for exactly the purpose of placing physicians back in lead positions to positively influence Quality, Value and Community Health. some physicians have the time, some don’t. Those who don’t can support those who do. Physicians do need to take leadership. It’s not too late.
“…hospitals are exempt from the reductions in Medicare spending until 2020, which means that doctors take the entire beating.”
this is why I am no longer a member of the AMA!