Oh, the Pressures on the Healthcare Professional!!!!

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By a sizable majority, the House Thursday approved a bill to repeal Medicare’s sustainable growth rate formula. News coverage portrays the vote as a rare bipartisan victory for Congress and a win for both House Speaker Boehner and Minority Leader Pelosi. However, the Associated Press (3/27) is reporting this morning that the Senate “has delayed giving final congressional approval to bipartisan legislation permanently blocking Medicare cuts for physicians until next month.” According to the article, leaders decided to wait until after Congress’ two-week spring recess to finish the legislation. Physicians are scheduled to be hit with Medicare cuts April 1, but the “government can delay processing the payments until lawmakers return.” If Congress doesn’t delay processing my suggestion is to be proactive and not submit any Medicare claims until after Congress passes the repeal of the SGR formula or until Congress comes up with another delay in the SGR formula as in previous years.

The Congressional Budget Office said that the House bill would cost $214 billion over ten years, adding $141 billion to the Federal deficit. Nonetheless, Speaker Boehner touted the legislation as the first real reform to US entitlement programs in nearly 20 years. The 33 Republicans who opposed the bill Thursday consisted of fiscal hawks who didn’t want to vote for a measure that would add to the deficit.

It was noted in the Washington Times that medical groups last Thursday “praised the House vote and called on the Senate to finish the job.” Robert M. Wah, MD, president of the American Medical Association, said, “When passed by the Senate, the bill will put an end to the cycle of Congress passing expensive patches to extend a policy that all agree was bad in the first place.”

However, as I questioned in last week’s post-is this the answer? Remember the analysis by the American Plastic Surgeons Association. They stated that the society is voicing its opposition to what it calls a 10-year pay freeze incorporated into the proposal.

“Right now, this bill to us is a bill that everyone is just rushing to sign to get this SGR thing out of the way,” said Dr. Scot Glasberg, president of the society. “We’re tremendously thankful that there’s bipartisan support for getting it done, but getting it done doesn’t mean sweeping it under the rug, it means actually coming up with something meaningful for physicians.”

The bill’s proposed fee updates of 0.5% annually for the first five years, followed by a 0% update for the following five years effectively freezes reimbursement rates for a decade, Glasberg said.

“You have to tell me one professional, one worker, one anyone out there who would agree to a 10-year freeze on their salary,” Glasberg said. “You can’t possibly survive at that rate when there are cost-of-living increases.”

As reported by Modern Healthcare’s Paul Demko, House Speaker John Boehner and Minority Leader Nancy Pelosi brokered a $213 billion deal that would overhaul SGR, as well provide as a two-year extension of the Children’s Health Insurance Program. Funding for the package would come in part through $70 billion in spending reductions split between cuts to Medicare benefits and reductions in provider payments.

Other physician groups, including the American College of Physicians and the American Academy of Orthopaedic Surgeons backed the bill, lauding the efforts of congressional leaders to get a deal done before the current temporary fix expires at the end of March. If nothing replaced that fix, doctors would have seen a 21.2% cut in their payments beginning April 1.

“We are pleased that the bill is fiscally responsible, by putting an end to the practice of Congress passing seemingly endless SGR ‘patches’ that each time have cost taxpayers tens of billions of dollars,” an ACP statement read. “ACP strongly urges both the House of Representatives and the Senate to pass this bill so it becomes law before the current, and we hope and expect, the final SGR ‘patch’ expires on April 1.”

Glasberg said he anticipates criticism of the bill will increase as more physicians understand its details.

“I really think physicians across the country don’t know what’s in this bill,” he said. “I think there needs to be more meaningful discussion on the elements of the bill.”  It sounds like the same problem as the passing of Obamacare-stupidity or lack of information.

As the corporatization of medicine increases and the altruistic souls going into medicine lose control over their destiny, which has happened, as the government, the hospitals and CEO’s play with the lives of physicians, as everybody (including the politicians) dictates how to practice medicine to the only one who went to med school, the problems to physicians are not likely to get better rather worse. Are we left with any more dignity than Wal-Mart greeters?

In the 1990s, in Canada, there were major unilateral financial cutbacks by the government (30-50% all docs , overnight by the socialist government) there was a terrible wave of suicides, divorces, early retirements, psychotic breaks that lasted about 5 years. Many docs were overextended financially, massive mortgages etc. and when the cutbacks came, they just couldn’t see a financial way out.
One of my concerns is that in 2016, when the ACA really impacts physicians’ wallets significantly, we could see the same negative activity here in the USA. Medical societies / friends should be proactive, start talking now, offer resources, including financial education to new and old grads. The wave of retirements about to come in family doctors will just put more pressure on the remaining, I hope medical schools are addressing burnout and living within ones (very smaller) means!

I think that with the additional pressures and expenses of the electronic medical records (EMR’s) as well as what is termed Meaningless use 1, 2 and soon to be 3, HIPAA, MOC, ICD-10, the every day risk of a malpractice suit, the inestimable increased risks associated with EMR’s, the never ending demands for more documentation, the claim rejections by insurance companies, the risk of RAC and other audits, combined with declining reimbursements and increasing overhead costs leading to the need to see more patients in less time, all contributing to the overall feeling of helplessness, hopelessness, total loss of control, and decreasing job satisfaction, that any physician not contemplating suicide has simply not been paying attention. The unanswered question is really, what is the difference between those physicians that merely think about suicide and those who actually attempt it.

Replacing the opportunities for caring and compassion with the expected scientific solutions destroys the soul and smothers the human needs of the provider of personal interaction and the fulfillment that has hitherto been the hallmark of our VOCATION.
Historically, looking behind the magician’s curtain causes the physician to reach into his humanity to perform his duties. Today’s ‘transparency’ ignores the reality of the physician’s limits and imposes wholly unrealistic expectations on both physician and patient.

Medical students are chosen for a psychological profile, obsessive-compulsive, driven and singularly purposed. Result: the high divorce and suicide rate. Add to the mix, pressure for the best residencies, payment “adjustments” by government and insurance companies.
Now the government wants to tie the physicians’ income to their success to how well their patients behave and take their medication, exercise and loose weight. This is not a bad thing, in general, forcing the delivery of a value to the health of the patient. But it is unrealistic to think that we, the physicians can really control the behavior of the most noncompliant patients, the patients who become the sickest and cost the most to the healthcare system. Why should the doctors be forced to pay or be penalized???
The reward for the physician is a 0.5% payment increase in the face of 5.0%+ inflation with passing of the new “reregulation.”
I am not sure that I see the benefit, except that the politicians will not have to tackle this again……or will they? The problem is, will there be more unhappiness within the profession leading to more personal problems, dissatisfaction and contemplation of this helplessness? Also, will this all lead to the dilution factor-decreasing the numbers of well trained physicians over time to care for the increasing numbers of insured patients under Obamacare due to the unappetizing nature of this side of the profession?

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