Key Opinion Leader Says Healthcare Reform Handcuffs Doctors

Neil Chesanow


January 20, 2015

How Healthcare Reform Handcuffs Doctors, Creates Issues

In a recent wide-ranging Medscape video interview, bioethicist Arthur L. Caplan, PhD, spoke with ob/gyn Scott D. Hayworth, MD, CEO of the Mount Kisco Medical Group, a multispecialty group in New York's Westchester County that will include 450 physicians caring for up to 400,000 patients as of January 2015.

In the interview, Drs Hayworth and Caplan discussed the challenges of physician practices remaining independent today; the problem of electronic health records (EHRs) turning physicians into "data entry clerks"; the overreach of the Health Insurance Portability and Accountability Act (HIPAA) in protecting patient privacy to the extent that ob/gyns are afraid to post photos in the office of the babies they deliver; the lack of liability protection for physicians in the Affordable Care Act (ACA); pressure from the federal government to practice "cookbook medicine"; the negative impact of new technology on medical practice; and managing inflated patient expectations in a new era in which cost control is a priority.

For physicians, these are emotionally charged issues, and their comments reflected the anger and frustration many feel about the state of medicine today.

"I work in the urgent care field," a family physician wrote. "The average patient is in the clinic about an hour. My face time with a patient is roughly 8-10 minutes. The rest of the time is spent inputting the history and examination onto the computer, most of which is unnecessary material. A patient with a simple urinary tract infection requires a full page of notes. A simple follow-up for a minor recheck of a problem again requires a full page of notes. There is little time to really sit and talk to the patient about their illness and preventive care."

"The evolution of the EHR is driven by the administrative drive to convert our charts from being medical chronicles of an individual patient's condition to an itemized list of services for billing and for 'look-down' analysis by third parties," charged an otolaryngologist. "The probably well-meaning, really smart folks driving this have a blind belief that all doctor/patient transactions can completely and accurately be described by a set of service and diagnostic codes. The entire medical transaction these days is geared toward completing a billable document. Any benefit to the patient in the transaction is becoming incidental."

"I envision everyone traveling with a chip/card/thumb drive with all their pertinent health info on it, accessible by plugging it into the health facility's computer," an internist wrote. "That would significantly drop health care costs by eliminating redundancy. Has Dr Hayworth's multispecialty group thought of that approach?"

"A concern of mine is the amount of debt we physicians will hold for our patients as a result of their high deductibles," a pediatrician commented. "For example, the Bronze Plan in my area has a deductible of $6350 each year. In other words, we will need to collect our fees in full each time the patient is seen until he or she reaches their deductible. If just 10 patients run up a bill on their deductibles and cannot pay, you're looking at an unsustainable $63,500 loss to your practice."

"One would assume, with this blame-Obama game, that the Republican Party has a better idea for reforming the by-all-accounts dysfunctional, anachronistic healthcare system," a neurologist notes. "Yet the silence from the right has been deafening!"

"Do not blame all with the same brush," a psychiatrist shot back. "Obamacare is 100% a Democratic Party creation. The destruction of health care and the degradation of doctors is all the Democrats' doing."

"I am being driven out of business by Obamacare," a surgeon lamented. "As an independent solo practitioner, my rates continue to be cut. At the same time, all these regulations extort more and more money out of the practice. My payroll taxes have gone up, and I've been forced to fire staff to cut costs. As a bonus, my personal health insurance has doubled in cost, and I indeed 'couldn't keep my doctor.' I see on these blogs that we need to be 'noble' and that medicine is almost a 'religion' for some. I don't care how noble or altruistic I am. If I can't pay the practice bills, the practice doesn't stay open!"

"Dr Hayworth hit the nail on the head when he spoke of data entry we are forced to record, and how it saps our time and energy from patient care," an internist agreed. "Is it worthwhile?" he wondered. "Does it lead to better outcomes? Is this population-studying better than patient-encountering?"

"Most physicians find themselves now in a very unfriendly physician practice climate, unfortunately," a rheumatologist commented. "Bureaucrats are telling us how to practice our profession, and they don't have a clue about seeing patients on a daily basis. All the factors that made US medicine the best in the world are now being destroyed. And in the effort to improve our declining health care state of affairs, the people who know best—physicians—are not being asked at all."


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