| Is Government Compromising Your Quality of Care As a primary care physician with decades in private clinical practice, I’m concerned that Government programs that intended to improve healthcare are becoming the demise of quality care in America. Government interventions over the last few decades have yielded a cascade of perverse incentives, bureaucratic rules that together are forcing doctors to sacrifice their independent professional medical judgment, and integrity. The consequence is clear, Governments and insurance companies will hold all the power, while doctors and patients hold none. The Coding Revolution Problems began in 1980s when Medicare imposed price controls on physicians treating patients over 65. Doctors wishing to be compensated were required to use two coding systems called the International Statistical Classification of Diseases (ICD) and Current Procedural Terminology (CPT). Together, these codes describe what was discovered by the doctor and what the doctor expected to be paid for. The expectation was that the standardized classifications would lead to more accurate adjudication of Medicare claims. What it actually did was force doctors to artificially wedge patients and services into predetermined, ill-fitting categories. Before long, these codes were attached to a fixed fee schedule based upon the amount of time a medical professional had devoted to devote a patient. It didn’t matter if was an operation was being performed by a renowned surgical expert or a doctor just out of residency doing it for the first time. They both got paid the same. As for Hospital reimbursement from Medicare the system became a game of finding as many things wrong as possible so that charges could be maximized. As a result, hospitals were incentivized to attach as many extra diagnostic codes as possible so as to increase the Medicare payday. Over time it became common for hospital to try to coax physicians into adding a few more diagnoses – especially ones that paid well. Unfortunately, as goes Medicare, so goes the private insurance industry. Insurers, starting in the late 1980s, began the practice of using the Medicare fee schedule to serve as the basis for compensation with doctors and hospitals. Again, the coding system which was supposed to improve the accuracy of adjudicating claims submitted by doctors and hospitals instead gave doctors and hospitals an incentive to find ways of describing procedures and services with codes that would yield the biggest payment. As you might expect, a cottage industry of fee-maximizing advisors and seminars arose to teach every more cleaver was of gaming the system. Soon doctors and hospitals learned that details of the coding system often meant that small tweaks meant a bigger check. That fact encouraged doctors to focus more on coding and less on patients. Today, most doctors use coding specialists, to oversee their billing departments. In turn an army of auditors oversee coding specialist and doctors. And as you might guess, let time is spent on medical needs. Is an insane billing system that significantly increases the cost of running a medical office. Another goal of the coding system was to provide a standardized method of collecting epidemiological data—the information medical professionals use to track ailments across populations. Unfortunately, perverse incentives were not foreseen. Doctors chose diagnostic code on each bill and naturally picked the code that yielded the maximum remuneration. The root of the problem is that patients are not payers. Through various tax and regulatory policies adopted on the federal and state level, there is rarely a direct interaction between a patient and a provider of a health care good or service. Instead, a third party—either a private insurance company or a government payer, such as Medicare or Medicaid—covers most costs. A June 2012 survey of 36,000 doctors in active clinical practice by the Doctors and Patients Medical Association found 90 percent of doctors believe the medical system is “on the wrong track” and 83 percent are thinking about quitting. Another 85 percent said “the medical profession is in a tailspin.” 65 percent say that “government involvement is most to blame for current problems.” In addition, 2 out of 3 physicians surveyed in private clinical practice stated they were “just squeaking by or in the red financially.” Ayn Rand’s philosophical novel Atlas Shrugged describes a dystopian near-future America. One of its characters is Dr. Thomas Hendricks, a prominent and innovative neurosurgeon who one day just disappears. He could no longer be a part of a medical system that denied him autonomy and dignity. Dr. Hendricks’ warning deserves repeating: “Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn’t.” Getting quality medical service will increasingly require selecting a doctor that offers a more personalized service. For a fee, seniors can contract with a personal care/concierge doctor that offers prompt access, adequate time for appointments, options for calling them directly, time to make good medical decisions, and advocacy when seeking care beyond the primary care doctor’s office. In Huntsville, Alabama, many view the opportunity to obtain personal care as a positive since it provides their doctor time to listen, make the best medical decisions and teach them what they need to know rather than 5-7 minute appointments where healthcare needs get kicked down the road. By providing adequate appointment time and care, this new type of personal care doctor helps keep their patients maintain the best quality of life, stay out of the hospital and avoid unnecessary procedures. Tell Me More about Concierge Physicians in Huntsville, Alabama. Exit |