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No Go On A Doc Fix

The Senate has rejected the so-called “doc fix.” This means that doctors taking Medicare patients will now get 21 percent less pay for their work.

How’s that getting involved in politics working out for you guys? Not so good.

But there’s a larger issue here. Why do we keep trying to control healthcare costs by just mandating that less money be spent?

It’s failed for decades. But like a losing gambler convinced that if he just keeps doubling down he’ll finally come out ahead, people keep trying. For example, the New York Times reported on a study of the impact of pay cuts to doctors for Medicare patients with lung cancer.

The unexpected result, according to one of the authors: “Hospitals and doctors respond to changes in how they are paid.” (Really?) In this case, doctors ended up treating more patients to make up for lost income. Other doctors who didn’t want to increase their case load just decided to leave practice entirely.

As another of the doctors who wrote the study said, when you “squeeze” the system, there is a lot of change, “but not always the one you expect.”

So, why do we keep trying to “squeeze” the system?  It doesn’t work, and has all kinds of bad unintended consequences. The majority of doctor visits have face-to-face time with the doctor of 15 minutes or less. A fast-growing body of research shows that the time squeeze on doctors has a serious impact on quality. Some studies show that 20 percent of patients get with the wrong diagnosis. The leading cause?  The mental mistakes people make when they have to make hard decisions with not enough time and not enough information.

Instead of asking where can we cut, we should be asking more important questions.

Things like, how well can a doctor do his job if he goes from seeing 100 patients a week to 150? How is the quality of care affected if experienced doctors find it better to stop practicing? What happens if smart young people decide that medicine isn’t an appealing profession anymore? And, most importantly, how much more expensive is our health care system going to be if we have increasing problems with the quality of care?

So, here is a radical idea: Instead of trying to figure out ways to cut healthcare costs, let’s think about how to make sure the money we are spending on healthcare is spent correctly.

Over the next 10 years America is going to spend $30 trillion on healthcare. The real challenge is to make sure we spend that $30 trillion wisely. It needs to be spent to make sure each person has the right care. If we do this, we will look at health care differently.  We would ask: Are there enough doctors? Do they have enough time to make good decisions? Are they making the right decisions? Are patients getting the right care?

There are many people laboring to bring these issues into focus. Patients, doctors, scientists, hospitals, employers. But there remains much work to do, and doctors are critical to making this happen.

So, doctors, please, instead of trying to fight losing battles over Medicare reimbursements, fight for a real “doc fix.” Fight to make sure that the the relationship between you and your patient is at the core of our healthcare system. Fight for the ideal that whether each patient gets the right care is the only way to measure whether our system is truly any good.

*This blog post was originally published at See First Blog*

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One Response to “No Go On A Doc Fix”

  1. While being a doctor is certainly becoming more difficult with increasing patient loads and fewer doctors choosing to be general practitioners, people will continue to choose to serve as doctors whether as a result of personal interest, skill set or financial goals.

    That said, patient care may very well suffer without changes to the ways in which medicine is practiced. Doctors need to help patients and insurers understand that health care should not be managed on a service by service, charge by charge basis, but more holistically. Were payment models set up to keep people healthy rather than treat them when they are sick, doctors could conceivably achieve better outcomes with less overall effort. That would benefit doctors, insurers and patients alike.

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