The United States is experiencing rapid change in health care delivery. The question is how this is going to affect your care? The answer is mixed.
In order to pay for the Affordable Care Act (ACA), Medicare has taken a hit of 700 billion dollars! The data shows there will be substantially less funds available for Medicare recipients.
One result is that hospitals are purchasing doctor's practices at alarming rates. Is this good or bad? Many sources show that employed doctors actually work less and that costs are higher. In addition hospitals typically charge large facility fees for patients just to walk into the "doctor's" office now owned by the hospital. Doctor employment relationships seem to produce the opposite results of what's needed (lower cost and timely access). These relationships are being scrutinized by the federal trade commission, Office of the Inspector General (OIG), and others.
One recent article raises a number of concerns in this trend, as quoted below:
"There are a number of reasons hospitals want to employ physicians. A major aim is to funnel patients to the hospital's facilities"
"In some cases, such facility fees can raise prices to Medicare by as much as 70% compared to what would be paid to an independent physician"
So what's good?
Pre-existing conditions are no longer a legal reason to be denied for health insurance. More people have insurance and are protected against devastating costs of a major illness. The price of health care insurance is affordable to more people, while the burden of this increased cost is shifted from Medicare recipients and to people who pay private insurance.
Where are we going?
Many thought leaders in health care believe that since costs will continue to rise, payers will begin to seek providers (larger groups and systems) that can guarantee the price for health care. This is so called "population management" which provides that the burden of financial decision making falls on the providers. The providers (doctors) are required to find the least expensive ways to manage the health of large groups of people; as with capitated contracts.
What are the solutions?
There are many possible solutions. Population based management discussed above may be a workable option for some. One solution that may help everyone results from the "portability" of health care insurance. This opportunity if deployed appropriately could drive costs down as the consumer can purchase health care insurance from any number of providers nationally. Tort reform (legal reform) is another much needed solution and has been shown to reduce costs considerably. The cost of defensive medicine has been estimated at $78 billion per year.
Ref: http://www.latimes.com/business/hiltzik/la-fi-mh-another-study-shows-why-tort-reform--20140919- column.html
The challenge of "population management" is that it disrupts the patient doctor relationship. Your doctor will typically be required to control cost by practicing statistical medicine rather than personalized medicine. When cost becomes the major deciding factor conflicts arise within the patient doctor relationship. Be certain, the age old trusted patient doctor relationship is under attack. Whatever healthcare changes come to pass, patients and doctors must work together and ensure that individual personalized healthcare is preserved. This must remain our primary mission!
Dr. Gary M. Annunziata is board certified in Internal Medicine and Gastroenterology and can be reached at Desert Gastroenterology Consultants (760) 321-2500. http://www.desertgastro.net. For more information on Desert Valley Independent Physicians, visit DesertDoctors.org or call (760) 232- 4646.
Gary M. Annunziata D.O. FACP APC
Associate Clinical Professor of Medicine, UCR School of Medicine President Desert Gastroenterology Consultants
President Advanced Gastro Technologies Inc.
Diplomat American Board of Internal Medicine
Diplomat American Board of Gastroenterology
35900 Bob Hope Drive #275
Rancho Mirage, CA 92270