Obamacare turning doctors into pencil-pushers

By JEFFREY SINGER, M.D.
SPECIAL TO THE LAS VEGAS REVIEW-JOURNAL

As a general surgeon with more than three decades in private clinical practice, I can safely say that Obamacare is the culmination of the changes that I’ve seen in the way doctors practice medicine.

Unfortunately, these changes have been less progressive and more regressive, with medicine now the domain of pencil-pushing rather than patient service.

This shift has been underway for decades. It began in the 1980s, when Medicare imposed price controls and a coding system on physicians who treated anyone over 65. The regulators believed that such standardization would lead to more accurate processing of Medicare claims.

Instead, it made doctors and hospitals wedge their patients and services into predetermined, ill-fitting categories. Private insurers, starting in the late 1980s, began pegging their compensation contracts to the Medicare code-based fee schedule, effectively extending Medicare price controls into the private sector.

With the dawn of the 21st century, the bureaucrats behind Medicare decided to go a step further. The federal government imposed further regimentation on America’s physicians through a centralized bureaucracy known as the Centers for Medicare and Medicaid Services—the same bureaucracy now in charge of implementing Obamacare.

Using so-called “evidence-based medicine,” CMS instituted protocols based on statistically generalized — rather than individualized — outcomes in large population groups.

It is easy to standardize treatment protocols. It is impossible to standardize individual patients.

Patients should worry about standardized clinical models that ignore the vital nuances of their conditions. Even more, they should be alarmed that the protocols being used don’t provide any measurable health benefits. Many were designed and implemented before any objective evidence existed as to their effectiveness. Bizarrely, many protocols are not “evidence based,” despite their name.

The spread of protocols and price controls have coincided with a steady ratcheting down of fees for doctors. Meanwhile, Medicare’s regulatory burdens on physician practices continue to increase, adding on compliance costs. Independent doctors are increasingly selling their practices to hospitals, thus becoming hospital employees. As of 2011, fully 50 percent of the nation’s doctors had become employees of someone else — either of hospitals, corporations, insurance companies or the government.

But this doesn’t serve patients. The doctor-patient relationship worsens when doctors come to view patients as the hospitals’ patients rather than their own.

Enter Obamacare. Because Medicare’s price controls ripple across the entire health care industry, any changes to its fiscal stability will affect nearly the entire medical profession. Yet in an attempt to keep Medicare fiscally stable (which it needs to be, with 10,000 Americans turning 65 every day), Obamacare sacrifices the patient by pushing doctors to the sidelines.

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About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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