Heartfelt with Dr Melissa Walton-ShirleyView all posts »
Medicare "doc fix": Which doc? which decade?Mar 12, 2012 11:08 EDT
The recent piece, "Ten-month Medicare 'doc fix' passes Congress, heads for White House," by Robert Lowes, outlines the subtle beginning of our federal backlash against hospital acquisition of physicians. It is the first official retaliation for the assault on private-practice medicine in America and shakes the very foundation of the 10-year trend of physician purchases endured in our country. Patients who have been forced to swallow the bitter pill of hospitalist programs may see an inkling of hope to have their office physician provide their care in the hospital setting again . . . someday. But no matter how hopeful, this is an exceptionally odd piece of legislation. It proves that the US is the only healthcare system on the planet that cannibalizes itself regularly; but why should be we surprised?
We live in a fickle political environment that tolerates tolerance for a season and then elects an ultraconservative at the next cycle. We retaliate against the "Reagans" by electing "Clintons" and can often find no middle ground. Our voting public's thirst for change is never quenched and therefore, expectantly, neither is that of our own government. Over the past decade, hospitals purchased scores of talented internists who astutely managed critically ill patients and set them in offices to treat sore throats and colds. Hospitalists whose greatest goal is a timely discharge took their places. Private cardiologists who resisted acquisition ran to their offices to hunker down and see as many patients as they could fit into a daily schedule to withstand the onslaught of change threatened by reimbursement trends. Now, this new legislation starts the subtle unraveling of the very financial structure that engineered that series of gross missteps in the hospital acquisition of private practitioners. No matter how you slice it, it has not been good for patients, at least not on the local fronts of small communities.
The planned Medicare pay cut to the private sector in the next 10 months was previously slated at $18 billion. With the new legislation, lawmakers will essentially "rob hospital-acquired Dr Peter" to" pay "private practitioner Dr Paul." According to Robert Lowe's piece, federal payment cuts to hospitals over the next 11 years will amount to $7 billion less in Medicare funds that "make up for unpaid deductibles and copayments owed by patients." Adding further insult to injury, hospitals like the one in my community that serve "a disproportionate number of low-income patients also would receive $4.1 billion less in Medicaid payments." Rightly so, the American Hospital Association fears it has been mortally wounded. They followed the earlier reimbursement signal to load their ranks with tons of freshly acquired private doctors to run their sweatshops and are reeling at this governmentally directed homicidal/suicidal ideation for their now nearly fully implemented plan.
The projected 11-year plan toward sweeping change in reimbursement will be another tough course to navigate for those who began private practice in the golden era of medicine and then chose a life of what for some has amounted to an indebted servitude to hospital institutions. Although hospital acquisition was a welcome respite for some, a forced move for others, and a safety net for new physicians, this new legislation signals a new downside. I am lucky to have practiced during the 1990s and early 2000s. It was a wonderful era of self-direction, hard work, and adequate pay. Although "physician greed" is often blamed for our debacle, it's a miniscule portion of what has driven us to the brink. Insurance companies give their CEOs ridiculous annual incomes of up to $4 million per year, thus driving down reimbursement to physicians for those sectors. America's aversion to early detection, our abhorrence of a diet that actually nourishes our bodies, and the choice to run away from an adequate fitness program as our only form of exercise have placed us in a precarious position. Add to this our unfathomable resistance to providing a timely PCI for all Americans and the dragging of our feet toward a smoke-free society, and the result has been a workable formula for governmental bankruptcy. We are suffering for our couch-potato mentality and our obsession with "procedures and pill fixes." We reward sloth. We abhor prevention. We have convinced ourselves that "big is beautiful" when we should embrace the attitude that "big is lethal." Free love has certainly not been "free," with scores of single-parent families resulting from that movement who now struggle to make ends meet. Our focus should have been on the coordination, not the division, of healthcare efforts on the behalf of providers and their hospitals as well as the education of our public. Hospital acquisition as the fix for this mess will be labeled a predictable failure because nothing is going to work until we change the way we behave ourselves as individuals and become a team again. To place us as physicians on different pages with different agendas made for a haphazard and confusing "bad read" of a novel. Predictably, when patient care is billed as the focus when truthfully it's really the "business of medicine" and bonusing CEOs for profit, our true mission fails.
The newly projected reversal in reimbursement trends will have taken only about seven years to cycle into our routines. That's pretty quick in the world of medicine but not quick enough for those who have suffered the greatest lack of consortium and absence of camaraderie of our careers, when our brothers and sisters in private practice were ripped from our midst. It resulted in an era of lesser patient care. The crevasse created by the axe of hospital acquisition has once again started to experience a shift of the tectonic plates, but unbelievably it is being pushed by the very government who fostered the first destructive series of earthquakes to begin with. I just hope we don't all fall in it and disappear before a real workable plan can come to fruition, and then at that, we won't have too long to get comfortable before it starts all over again.