June 8, 2015 - Politics

The world of medicine is a strange and frightening place in America right now, and it has many people nervous—as it should.

Hospital Crumbling

Out of frustration with spiraling health costs, the question I hear most often is, “What are doctors thinking, anyway?” As a practicing physician, I will answer that the best I can from my vantage point, which may be different for some physicians.

A number of factors currently at play in the medical care market include insurance regulations, Obama Care, the Affordable Care Act (ACA), decreased utilization incentives, Hospital hostile takeovers of smaller practices, and mandatory compliance with policies governing care delivery systems.

What are doctors thinking when it comes to:

  • Insurance regulations
    • Insurance regulations have been in place ever since insurance has existed. But in the past, doctors have known the requirements and how they were to be implemented, far in advance. The current regulations that have affected so many medical practices were ushered in under such a veil of secrecy that many doctors discovered the regulations too late. In fact, some still do not realize why their reimbursements for services have been dramatically delayed or discontinued, forcing their financial ruin.
  • Obama Care
    • This is a complex topic and is best addressed in the blog OBAMACARE’S CRUMBLING ROLLOUT—WAS IT THE PLAN FROM THE START? It deals with the intricacies of the new health plan doomed for failure.
  • The ACA
    • I will reserve this for a different blog. It requires attention.
  • Decreased Utilization
    • That’s the government and insurance company’s way of making you go to the doctor less often. If your copay or deductible is high enough, you won’t see the doctor unless you’re so ill you can barely function. The idea is that the government will save money by not having as many health care visits. There is a horrible flaw to this thinking.
      • If you have a cough and a fever but your copay is $50 instead of $15, you are likely to wait for a few days before receiving medical care. The result may be that the pneumonia that settles into your lungs is much more difficult to treat than it would have been. The result may be lost time at work, a decline in your general health, hospitalization, higher cost of more advanced medications, or death from the illness itself. This is not what might happen. This is what is currently happening. Our patients are postponing care until they reach the danger point.
    • Simply put, decreased utilization means that it’s so costly for you to see the doctor that you put it off or don’t go at all.
  • Hospital Takeovers
    • This is not a friendly takeover, joint venture or supportive partnership. This is when a large hospital system forces out smaller independent providers so that they can obtain exclusivity. That means, you don’t get a choice in what doctors you see or what hospitals to which you are admitted. You will be referred to whomever they say, not whomever you say. Your choices will be gone.
    • For this reason, some practice groups have launched out on their own to avoid the obvious pitfalls and inappropriate practices of some hospital groups in demanding exclusivity from the doctor groups. If those doctors do not conform, the heavy-handed hospitals descend on those practices and do their best to crush them before they can become competitors in the healthcare market.
    • If this sounds bizarre and far-fetched, let me simply say that it is happening right now in many communities. I do know this for a fact.

We will continue to fight the inequities of the healthcare system to provide our patients with the attention they need. It’s a battle, but we will fight for what’s right. The government takeover is just beginning. Can you imagine where we’re headed if this is where we are now?