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Healthcare Reform, Direct Patient Care, And The Period Of Discovery

As the period of debate over the Healthcare Reform Bill ends with President Obama penning his signature, one moment from the “debate” at Blair House stands out in my mind. A Republican Congressman sitting behind a copy of the then-current reform bill –- a pile higher than 2,000 pages –- was mocked for using such a prop. It’s complicated to fix healthcare with the laconic response to his theatrics.

Things don’t appear to have grown any simpler as we settle in for a period of discovery to determine exactly what this new law spells out for us in terms of reform. There is no consensus on whether this law will help or hinder, and I’m worried.

I cannot read 2,600 pages written in legalese. I juggle my time now to keep up with the medical literature necessary to adequately do my job and I suspect other physicians struggle similarly. All doctors fight a daily battle with time, trying to care for each patient in the best way possible (this is why many of us walk so fast through hospitals and clinics.) I hope that healthcare reform doesn’t result in less time for direct patient care. 

I suffer déjà vu when I hear reports that we must now wait for the department of Health and Human Services (HHS) to rule on how to enact reform. This is reminiscent of the HIPAA law passed in 1996 to much less fanfare. This law waited for six years before HHS had issued its ruling on privacy prying open our medical records for review by 35% of Fortune 500 companies before they make a hiring or promotion decision.

I expect Reform to continue to make headlines as new pages are translated and finally understood or as HHS rulings are issued over the years to come. This is what I mean by a period of discovery.

As an example, the article, “Health premiums could rise 17 % for young adults reports that insurance companies now charge older customers 6-7 times the rates of younger customers but the new law limits this ratio to 3:1. This may sound fair but could easily lead to a shell game being played by insurance companies.

Where is the language mandating a lower rate for older patients? Even if younger people pay more money, simple math suggests that our older citizens could face the same monthly bill without change, despite “enjoying” a better ratio. The extra money from younger patients premiums could then move directly onto an insurance company’s bottom line- and all within the letter of the new law. I am starting to understand why the insurance companies, mandated by their share-holders to show a profit, supported this bill.

Here’s another example of what we’re finding out: adding tens of millions to the Medicaid roles has led Walgreens stores in the state of Washington to announce that they will not fill prescriptions for new Medicaid patients as of April 16 because of losing money on each prescription. This begs the question: Was the effect of adding so many to the Medicaid roles studied before the bill was passed? Will primary care physicians be able to meet the demand of these new insured patients or will more doctors have to opt-out of Medicare/Medicaid to stay in business?

Well, the debate is over and the bill is now law. Much of this new law sounds fair upon first glance but none of us knows the real impact it will have on daily patient care. We can only hope it does not have the impact HIPAA had on privacy.

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One Response to “Healthcare Reform, Direct Patient Care, And The Period Of Discovery”

  1. *** Please Read this Thoroughly. It is not a Formulary Letter *** As a physician, I firmly believe that WE, The American People, must repeal, or at least modify, the Flawed “HealthCare Reform” Legislation which was recently rammed through Congress despite public protest. The AMA erred in supporting the Bill on the premise it would also repeal SGR formula and include Tort Reform provisions. It did neither! AMA disregarded the interests of its constituents and the public. Medicare’s sustainable growth rate (SGR) formula remains “law of the land” and, if implemented, will signal the end of Medicare and the “HealthCare Reform” Law. The new legislation proposes a mythical world in which everyone gets healthcare without regard to assuring the sustainability of its Human Resource (Physicians and Nurses). Physicians who currently care for Medicare Beneficiaries with the required individualized attention do so at a personal financial and temporal loss. High‑volume, assembly‑line industrial efficiency cannot be applied to Medical Practice without sacrificing individualized care. There is no remaining margin to absorb the 21.3% decrease in compensation without decreasing personnel and service, and in some cases going out‑of‑business. Most self respecting practitioners will be forced to Opt‑Out of Medicare or Drop it completely. Worthless “insurance” does NOT improve access to care.The Medicare physician payment formula has been flawed from its inception, and since 2002 Congress has had to intervene repeatedly to avert steep annual payment cuts and preserve access to care for patients.Putting another Band‑Aid on the problem is no longer a viable solution. Seniors are concerned about losing access to their physician. They are fed up with Government programs which assume they are incompetent or stupid. Our military families are concerned about what Medicare cuts mean for TRICARE. And I am concerned that it is fiscally irresponsible to put this problem off yet again. Each time Congress has passed a short‑term intervention, it has only deepened the payment cuts in future years and increased the cost of permanently resolving the problem. The time for temporary patches has come and gone. Congress MUST either implement the SGR mandated decrease in compensation and bear the consequence of Medicare’s collapse, or increase Physician compensation by permitting balance billing to and payments by appreciative, discerning patients who recognize the value of personalized medical care. Only by restoring a Market Based compensation model, respectful of patients’ perception of value, can quality of care and service be preserved.I look forward to seeing common sense restored in our Government, with appropriate Risk‑to‑Benefit analysis applied to legislation.

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