Physicians and Journalism: Responsibly Meeting the Challenge

As a physician journalist I find myself in a very fortunate and quite unique position—I am able to reach vast numbers of Americans on a daily basis and provide them with credible (and hopefully impactful) news on health and wellness. Medical journalism is similar to the practice of medicine in that we must put the PATIENT first. Just as physicians provide patients with information they need to better understand their disease state and treatment options in a clinical interaction, physician journalists must carefully choose their words when on camera or quoted in print. In a clinical situation, there is time for questions and two-way interaction between doctor and patient. In contrast, medical reporting in broadcast media is a very different situation–there is no opportunity for patient interaction and what is said MUST be something that will stimulate further conversation between viewers and their OWN private physicians. Statements must be clear, evidence based and stories must be reported without bias.

I entered the world of medical journalism nearly five years ago. It is my job to carefully dissect and interpret new studies and provide candid and accurate commentary. It is essential that as a physician, I am able to communicate new research findings on new treatments or new health risks in a way that is non-biased and free from any external influence. Moreover, it is vital that I am able to report stories in a way that does not sensationalize or overstate the effectiveness of any particular therapy. In the last several years, we have seen numerous examples in the media in which medical journalists have behaved in ways that have not met these lofty expectations.   From Dr Mehmet Oz and his overstated claims on herbal remedies to Dr Sanjay Gupta and his heroic involvement in surgical cases while covering stories in Nepal and in Haiti, there are numerous examples from which we can all learn. Dr Oz ultimately testified before Congress concerning his choice of words when discussing non-proven therapies for weight loss and other common maladies. Dr Gupta, a well-respected neurosurgeon and medical reporter, admits that when he is covering a story in a disaster area, he always is a “doctor first” and will respond to an emergency while reporting—even though ethics dictate that journalists should never be “part of the story”. For medical journalists, it can be difficult to decide exactly where the boundaries exist between the responsibilities of being a doctor and serving as a reporter.

The Society of Professional Journalists lists four major tenets in their Code of Ethics that I think MUST be upheld by any medical journalist in order to ensure that patients are protected from mis-information and sensationalism on television as well as in the print media. I believe that any physician who is contemplating entering the world of the media must be aware of these guidelines and think about how each can specifically apply to medical journalism. Below, I have listed each of these principles (as they are listed by the Society) and shared my thoughts on how they may apply to each of us when serving as medical reporters.

1. Seek the Truth and Report

As physicians it is our duty to carefully examine new findings and analyze studies in order to determine their scientific merit. It is important to understand exactly how researchers conducted their studies and arrived at conclusions prior to reporting on any new medical “breakthroughs.” While it may be a great headline to report on a new “revolutionary” treatment, it is far better to temper excitement with the facts—while a new finding may be promising, it takes time to determine whether or not it will truly be a groundbreaking new therapy. It is important that medical journalists describe the basics of any study to the audience—sample size, randomization, and design methods—in order to help viewers understand exactly what conclusions can be drawn for a particular bit of research. Once the data is reported, it is essential that the physician journalist place the findings in context—how can the study be applied to patients and how might it impact lives.

2. Minimize Harm (Primum non nocere)

Certainly, all physicians take an oath to first do no harm when caring for patients. This principle should also apply to physicians who are reporting the news. It is essential to remember that physicians, by their very title are given a certain level of elevated credibility. Physicians who are featured on television are provided an even higher level of credibility and believability. When a physician with well respected credentials speaks to a national television or radio audience, most viewers believe what is said and do not question the source—this requires a physician journalist to carefully choose the words that they use to communicate complex ideas in order to leave no room for ambiguous interpretation. Sensationalization can produce confusion and may result in patients running for treatments that are not proven to be safe and effective in randomized controlled clinical trials. In addition, if a physician journalist is involved in debating policy or healthcare politics, he or she must remain respectful to the opposition and remember that, even though we may not agree with others, all involved are human beings.

3. Act Independently

Conflicts of interest can destroy credibility and can also lead to perceived professional misconduct. It is essential that the physician journalist is careful to avoid any outside influence when reporting on a new device or treatment. Pharmaceutical and medical device companies can significantly influence the way in which data or breaking news stories may be reported. In order to remain and perceived as unbiased reporters, physician journalists must carefully disclose ANY relationships with industry and ideally avoid accepting ANY payments or gifts from industry partners. Avoid any form of “advertising” when reporting and always use trade names rather than brand names when appropriate. Always mention alternatives and competitive drugs or treatments when discussing a particular branded device or drug in order to provide the viewer with a more complete view of the story.

4. Be Accountable

A credible and successful physician journalist must accept responsibility for your words when reporting. We all must be willing to respond to challenges and criticism in a respectful, professional way. Not all viewers will agree with your assessment of a particular story—and most certainly will not always agree with your position in a healthcare policy debate. Be ready to defend your position with vigor but also be willing to admit if you have made a mistake or error in your reporting or in any conclusion that you may have drawn. Clarify your position when required and be very transparent with your sources of information when appropriate.  Carefully determine the impact of your words–as a physician on television, you are given an elevated level of credibility.  Avoid the Dr Oz example of sensationalization and over-blowing stories.  If medical journalists are conscientious and honest, they will not likely be required to testify before Congress as in the case of Dr Oz.

What is the Bottom Line??

The practice of medicine is an honor and a privilege—every person with the degree of Medical Doctor is very fortunate to be able to utilize a particular set of gifts and skills to help others. Providing care to patients and offering treatment and even cures for chronic disease is incredibly rewarding. For me, as a physician journalist, it is equally as important to educate the public and improve awareness of diseases and their treatments. Television, radio and print media provide the opportunity for physicians to serve the pubic in an entirely different way. By discussing medical advances and drawing attention to common symptoms and medical problems, physician journalists have the chance to make a real impact on overall public health. Just as the physician has a responsibility to provide their very best to the patient when involved in patient care, the physician journalist also has an enormous responsibility to provide credible, non biased and accurate information to the public when reporting.

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What Would YOU Do With An Extra Second….Better Decide Soon, Its the Day of the Leap Second!

In medicine, I have learned that time is a precious commodity. Too often, when life slips away and patients and families wish they had just a little more time. For physicians, a little more time may make the difference in a patient’s ultimate outcome and sometimes makes the difference between making it home in time for a family dinner. Today, we add ONE second to the international world clock at midnight. Over fifty years ago, world clocks began keeping time with atomic clocks that are governed by oscillations of an atom–which are determined in part by the rotation of the earth. The earth’s rotation is slowing over time, and in order to keep these clocks coordinated with the earth’s rotation, we must add an extra second from time to time.

What Can You Do With An Extra Second?

While a second may seem like an insignificant amount of time, when you are a careful steward of time much can be accomplished quickly. An extra second can have a substantial impact—Here is my list of possible plans for my extra second:

1.  One more chance to say “I love you”

Too often, the pace of the world gets in the way. We forget those most dear to us and allow our daily challenges—both at work and at home- to take center stage. I may use this extra moment in time to make sure that my wife and daughter know exactly how I feel. Time is unwavering and unyielding. Time rarely stops—actually almost never stops—but today we have a brief pause. We must use it wisely and take advantage of the extra “time” with loved ones and remind ourselves that time spent with those we love is precious

2. An opportunity to pause before pressing send on an angry email

In the heat of the moment, many of us have sent a note that we wish we could have back. Email and electronic communication can be unforgiving. Just think if we were able to use the extra second we are given to pause before sending an angry reply. That one second to ponder the implications of an email response may actually save even more time by preventing hurt feelings, damaged relationships and tarnished reputations.

3. A chance to pause and take a breath

Lets’ face it, today’s world moves at a very quick pace. Electronic communication, social media and instant messaging leave each of us with very little down time. Just recently I flew to Italy from New York and was amazed to have active internet service for the entire flight. Rather than unplug and enjoy the beginning of my vacation, I remained connected and engaged through the flight. Much can be gained from taking a few minutes to meditate, unplug and recharge. All of us can benefit from stepping away from the business of a hectic day—just one second may help relieve stress and recharge the mind–Maybe I should use the extra second to take a deep breath, reflect and relax. If a 5minute meditation works, why wouldn’t a 1 second mini meditation work as well?

4. Send a tweet

Social Media is an excellent example of how we can reach out to others—all over the world—in a matter of seconds. We are now more connected than ever. Twitter brings doctors and patients together and makes the world a smaller place. Twitter provides for the brief communication of ideas, exchange of information and socialization all in a moment. One second is all that is needed to send a tweet. At midnight tonight, I may decide to use my extra second to push send and publish a tweet.  Maybe I will connect with a new friend or colleague.  Maybe my tweet will reach a patient suffering with chronic disease and provide them with new hope.  Maybe my tweet will make someone laugh, or (if I am really lucky) make a lonely person smile.

Tonight, we have a rare opportunity to stop time. At midnight we are able to take back time—if only for a second. I have shared a few of my ideas. What will YOU choose to do with it? Time is ticking away–we have to decide soon how to use that extra time.  Midnight will be upon us soon.  How we use it could change a life….or result in time for one more Zzzz…

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The High Cost of A Cure: The First Step in Rationing Care

Hepatitis C is one of the most common chronic infectious illnesses in the US today and affects nearly 3.2 million Americans. Complications of hepatitis C infection include liver cancer as well as cirrhosis.  Many patients with chronic hepatitis ultimately develop liver failure and will die without liver transplantation.  In the last year,  a new drug class has entered the market and is able to produce cure rates in excess of 90%.  These drugs–Sovaldi and Harvoni– are incredibly expensive and some treatment courses cost more than $1000 a day.  Typical treatment courses to achieve cure require 12 weeks of continuous treatment.  Drug maker Gilead reported that sales of Sovaldi exceeded 2.2 billion dollars in the first quarter of 2015. According to a report released by Express Scripts in 2014, spending on Hepatitis C therapy increased by 700% between 2013 and 2014.  In fact, only 1% of drugs accounted for 32% of spending over the same time period–much of this is due to the emergence of the new treatments for hepatitis.

When questioned about the cost of the drug, most pharmaceutical executives will claim that the cost is justified by the investment of time and money in research and development that led to the cure.  The cost to take a drug to market and obtain FDA approval is great but does it really justify the astronomical costs?

But aren’t they simply charging what the market will bear?

Gilead executive Gregg Alton argues that the pricing of their drug is based on what they think is a “fair price for the value that [we] are bringing into the healthcare system and to [the] patients”.  Will the price be lowered once investment is recouped?  Alton thinks this scenario is “very unlikely.”

What are the implications for Medicare?  Who will get the drug and who pays the bills?

The Washington Post reports that Medicare spending on hepatitis C therapy exceeded 14.5 billion dollars last year alone.  Nearly 350,000 Medicare beneficiaries have hepatitis C (and many are not even aware of their diagnosis) according to an analysis by Health Affairs published last year.  By law, medicare is prohibited from negotiating prices with pharmaceutical suppliers.  Taxpayers will bear the brunt of the cost–once a medicare recipient reaches 4700 dollars out of pocket, the government program’s “catastrophic” coverage will then pick up the bulk of the remaining tab. Ultimately, other medicare patients will have higher deductibles and continued “cost sharing” will result in higher costs for everyone.  My fear is that widespread rationing may be implemented and access to a life saving drug may be ultimately limited due to overwhelming costs.  Medicaid is already beginning to ration use in many states and the Senate Veterans Affairs committee has held hearings in the last year in order to question industry about the price point and to prepare to address how the national VA Hospital system will deal with the exorbitant costs of the therapy.

Here is my take–It all goes back to Reform…

Healthcare costs continue to rise–even with reform.  The Affordable Care Act is clearly short-sighted and laser focused on only certain aspects of healthcare costs.  The legislation has addressed limiting costs thru declining payments to doctors and healthcare systems.  Access to physicians, particular heatlhcare centers and certain treatments is tightly controlled and, in some cases, severely limited.  The ACA does nothing to address the other TWO major root causes of skyrocketing healthcare expeditures –cost of drugs/therapy as well as medical liability and lawsuits.  Until such time as the US adopts a national policy of tort reform (which is unlikely to happen given the power of the trial lawyer lobby in Congress) as well as price controls on expensive drugs such as the biologics for Hepatitis C, nothing will change.  Ultimately, the costs of these life saving drugs must be addressed.  If we continue in the current system, the money for these therapies will have to be carefully adjudicated.  The hints of rationing in healthcare are already here–medicaid and the VA system–a “model” for socialized medicine are already addressing ways in which they can adjudicate dollars to treat the most severe cases of Hepatitis C.  I expect that eventually we will see waiting lists for therapy and policies put in place to determine which patients will be eligible to receive higher priced drugs. Innovation is expensive and pharmaceutical companies and entrepreneurs should be rewarded for their investment and their risk–but, we must also balance the reward with what is reasonable and affordable for ALL patients seeking a cure for a potentially deadly disease.

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The Rise of the Machine: How Hospital/Practice Administrators Have Assumed Control Over Healthcare

In the past, physicians were responsible for both the business and practice of medicine.  While administrative personnel played an important and complementary role in practice and hospital management, physicians were the cornerstone.  In comparison, today the leadership structure in medicine is now an entirely foreign landscape.  Administrators DOMINATE medical practices today and, according to the New York Times, their salaries are responsible for a high percentage of medical costs.  While the numbers of physicians that are entering the workforce has trended toward a constant number (with little or no growth) the numbers of administrators has risen nearly 3000 percent over the last 30 years.

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Certainly medicine has evolved into more of a business–Physicians that are well versed in business and understand the role of the physician executive are much more successful.  It is clear that there is a role for administrators–they are necessary to coordinate and support the clinical work of physicians and those in the hospital or practice.  However, now administrators have evolved into the overlords of medical practice and are now dictating how and when and where physicians and other healthcare providers work.  Most of these administrative overlords have zero relevant clinical knowledge or experience.

The rise of the administrators has further complicated the healthcare landscape during this period of reform.  The ACA has expanded the numbers of insured and has promised to provide affordable, accessible care for all Americans.  Unfortunately, declining reimbursement and increasing reams of meaningless paperwork, documentation and “core measures” [All created by administrators or legislators] have resulted in the development of a pending physician shortage crisis in the US today.  Much like the fictional SkyNet began to control the world in the Terminator movies thru atomization, administrators have assumed control of medicine and have begun to automize the art of medicine thru protocols and algorithms–all with a complete disregard for real clinical trial proven outcomes data.  As you see in the graphic above, the numbers of new medical students continues to remain steady—very little growth.  Bright young minds are choosing other professions.

So, you may ask, how are we going to provide care to the newly insured?

Administrators will suggest that cheaper and less well trained alternatives to physicians will be the answer.  In Minnesota, for example, Nurse practitioners are now allowed to practice independently without ANY physician oversight or supervision.  Minute clinics such as those hosted by CVS and others have spread throughout the nation.  These clinics have no physician presence and are expected to make clinical decisions based on protocols and algorithms. Now, physicians appear to be a cog in the wheel and must conform to the dictums of those in power.  NO longer are physicians autonomous scientific entrepreneurs.  Creativity in medicine has become suppressed and frowned upon by those in power.  We have become worker bees in the factory of the administrative overlords.  The evolution of the administrator driven practice has left me with more questions than answers—

What has happened to the “art” of medicine?  What about clinical intuition?  IF we are eliminating this component of care completely then why don’t we simply create an army of IBM Watson computers to deliver care at the direction of the “Administrators” ?

At this point in my career, I expect the practice environment to become increasingly hostile for doctors.  For example, just this week, Congress passed a “fix” to the Medicare reimbursement schedule in order to avert yet another 20% pay cut for services.  This “fix” rolls back the antiquated formula by which doctors are paid BUT it further empowers non clinical administrators (and politicians) to determine exactly how doctors should be reimbursed.  While adding payments based on Quality (which I think is certainly a great idea) it stops short of defining quality and will ultimately allow CMS and DHHS to determine what measures will be applied. I expect that these measures will remain clinically irrelevant and lead in no way to improved outcomes for patients.

Physicians must take a stand.  We must advocate for our patients and for our profession.  Medicine cannot survive and continue to innovate without committed, caring and compassionate physicians who are allowed to do what they do best–Practice Medicine.  We must retake control of healthcare and limit the scope of power of hospital and practice administrators.  Or, as Schwarzenegger says–it will be “Hasta la vista, Docs”

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Sharing Bad News or Keeping Secrets—How Physician Communication Impacts Patients and Families

Doctors and Patients bond over time. Information exchange, education and sharing of expertise are critical activities that add to the effective practice of medicine. Delivering bad news is unfortunately an unpleasant part of a physician’s job. Honesty, empathy and clear communication are essential to delivering news to patients and their families—even when the news is unpleasant or unexpected. While communication is an integral part of the practice of medicine, not all healthcare providers are able to relay information or test results in a way that is easily digested and processed by patients. Some physicians may avoid delivering bad news altogether—often keeping patients in the dark. While a paternalistic approach to medicine was accepted as the status quo for physician behavior in the 1950s, patients now expect to play a more active role in their own care. Patients have a right to demand data and understand why their healthcare providers make particular diagnostic and treatment decisions.

Recently, a disturbing report indicated that in a database of Medicare patients who were newly diagnosed with Alzheimer’s disease, only 45% were informed of their diagnosis by their physician. While shocking, these statistics mirror the way in which cancer diagnoses were handled in the 1950s with many doctors choosing not to tell patients about a devastating health problem. With the advent of better cancer therapies and improved outcomes, now we see than nearly 95% of all patients are informed of their cancer diagnosis by their physician.

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How can this be? Why would a physician NOT tell a patient about a potentially life changing diagnosis?

I think that there are many reasons for this finding in Alzheimer’s disease and that we must address these issues in order to provide ethical and timely care to our patients.

  1. Time constraints: Electronic documentation requirements and non-clinical duties allow for less time spent with each patient. In order to deliver bad news such as a terminal diagnosis, a responsible physician must not only spend time carefully delivering a clear message but must also be available to handle the reaction and questions that will inevitably follow. Many physicians may avoid discussing difficult issues due to the lack of time available to help the patient and family process a diagnosis. We must create ways to diminish the administrative burden on physicians and free them up to do more of what they do best—care for patients. More reasonable and meaningful documentation requirements must be brought forward. Currently, many physicians spend far more time typing on a computer rather than interacting in a meaningful way with patients during their office visits. Eye contact, human interaction and empathy are becoming more of a rarity in the exam room. This certainly limits the effective delivery of bad (or good) news to patients. Priority MUST be placed on actual care rather than the computer mandated documentation of said “care”.
  2. Dwindling Long-Term Doctor Patient Relationships: Networks of hospitals, providers and healthcare systems have significantly disrupted traditional referral patterns and long-term care plans. Many patients who have been enrolled in the ACA exchanges are now being told that they cannot see their previous providers. Many physicians (even in states such as California) are opting out of the Obamacare insurances due to extremely low reimbursement rates. Patients may be diagnosed with a significant life changing illness such as Alzheimer’s disease early in their relationship with a brand new healthcare provider. When a new physician provides a patient with bad news—of a life-changing diagnosis that will severely limit their life expectancy as well as quality of life—patients often have difficulty interpreting these results. Healthcare providers that have no relationship with a patient or family are at an extreme disadvantage when delivering negative healthcare news. Long-term doctor patient relationships allow physicians to have a better understanding of the patient, their values and their family dynamics. This “insider knowledge” can help facilitate difficult discussions in the exam room.
  3. Lack of effective therapies to treat the disease: No physician likes to deliver bad news. No doctor wants to admit “defeat” at the hands of disease. It is often the case where some healthcare providers will not disclose some aspects of a diagnosis if there are no effective treatments. I firmly disagree with this practice of withholding relevant information as I believe that every patient has the right to know what they may be facing—many will make significant life choices if they know they have a progressively debilitating disease such as Alzheimer’s disease. In the 1950s, many patients were not told about terminal cancer diagnoses due to the lack of effective treatments. However, medicine is no longer paternalistic—we must engage and involve our patients in every decision.
  4. Lack of Physician communication education: As Medical Students we are often overwhelmed with facts to memorize and little attention is given to teaching students how to effectively interact with patients as well as colleagues. Mock interviews with post interview feedback should be a part of pre clinical training for physicians. We must incorporate lectures on grief and the grieving process into the first year of medical school. Making connections with patients must be a priority for physicians in the future—we must equip trainees with the tools they need for success.  Leaders distinguish themselves by the way in which they share bad news.  According to Forbes magazine the critical components of sharing bad news include–accuracy of communication, taking responsibility for the situation, listening, and telling people what you will do next.

What’s next?

As with most things in medicine, change often occurs “around” healthcare providers without direct physician input. Physicians are appropriately focused on providing excellent care and connecting with patients while politicians and economists craft the future of medicine. The issues with lack of communication of negative findings with patients MUST be addressed. Patients have a right to their own data and have a right to know both significant and insignificant findings. In order to avoid situations where patients are not fully informed about their medical condition, we must continue to remain focused on the patient—even if it means that other clerical obligations are left unattended.

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Buyer Beware: How Patients are Negatively Impacted by the Changing Landscape of the Affordable Care Act (ACA)

As the Obamacare machine continues to grind forward, many patients have re enrolled in a second year of coverage. While most have not had to use their insurance (the young and healthy crowd) others have found their newly minted coverage to be far less than promised. High deductibles, and up front out of pocket expenses, forced many covered by the exchanges to avoid seeking regular preventative care—Prevention was one of then tenets of the ACA plan. Many have found choices limited and have been forced into healthcare systems that are not their first choice.

Now, as the second year of enrollment (and re-enrollment) has concluded, many of us are concerned about the likelihood of rate hikes and changes in coverage. The Obama administration continues to tout the fact that enrollment numbers remain high and that there have been no substantial increases in premiums. However, this is not necessarily the case. Many exchange insurers have cleverly disguised rate hikes through changes in other aspects of the plans. While some advertise that there are absolutely no significant premium increases, customers who shopped carefully on the exchange site were able to find higher prices for Emergency Room visits, and higher charges for non generic drugs. For some plans this means that rather than pay a $250 co-pay for an Emergency Room visit, the customer must pay up to the yearly deductible for the same ER visit before the co-pay rules go into affect. For many, this may be a non-starter. ER visits can be very expensive and can amount to thousands of dollars in just a few hours. Many patients will find themselves having to pay a 3-6 thousand dollar deductible early in the insured year before any of the benefits begin to contribute to reduce individual out of pocket costs. In some plans, the co-payment for a routine physician visit will go down by an average of 20 dollars and many generic drugs will be covered for free. However, specialty visit co-pays will increase and the prices for specialty medications will increase by 40-50%

In an effort to promote re-enrollment in 2015, the government implemented an automatic re-enrollment system. However, this has left many patients with increasing out of pocket costs due to the fact that multiple changes have been made—such as those described above. Many patients were unaware of the need to shop around for re enrollment and are now increasingly unhappy with their plans. Ultimately the ACA and its supporters in Washington have placed statistics and politics ahead of the patient. While the delivery of quality care to the patients who need it SHOULD be the goal, it appears that politics remains the top priority. Increasing out of pocket costs and higher deductibles—many requiring payment in the first half of the year—are having the opposite affect. One of the central tenets of the ACA is to focus on prevention through promoting regular access to primary care physicians for prevention of chronic disease and its complications.   However, rather than promoting and environment where patients are engaged and actively seek preventative care, many are using the insurance simply as a “disaster plan” simply due to the overwhelming costs. While out of pocket limits and guaranteed care consume the healthcare reform talking points of the Obama administration, the reality is that the way in which the ACA is structured and implemented has actually increased personal financial burden for many.

What Can Patients Do?

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Unfortunately, much of the burden of navigating the new healthcare landscape falls to the patient. The Law itself remains a moving target—with changes certain on the horizon. We must remember that insurers are for profit entities and will ultimately find a way to make a profit—often at the taxpayer and patient expense. While many have been encouraged by the Obama administration to continue to offer affordable premiums, most have found other ways to improve their revenue streams. Whether it is thru juggling co-payments and charges, shifting cost, denying procedure approval or limiting choice, all of these changes will–in the end—negatively impact patients. As a healthcare provider, my job is to educate patients about behaviors that may improve their overall health. Now with the implementation of the Affordable Care Act, this responsibility now extends to helping my patients manage their insurance choices. While this is not necessarily a traditional role of a physician, it is important that we make sure that our patients continue to have access to the care they need—without incurring a life altering expense.

There are a few things that I think that patients can do to actively advocate for themselves and others:

  1. Stay Informed: Make sure that you ask questions of your insurer—are their changes to my coverage? How are out of pocket expenses handled? Can I see my doctor and my specialist when I want or need to without incurring a penalty or increased cost?
  2. Shop Around: Just because you have had coverage with a particular company in the past does not mean that you have to remain locked in with them. Make sure you explore all of the options that are available to you through the exchanges. Carefully question insurance company representatives so that you completely understand policies BEFORE you agree to a contract
  3. Demand Transparency: If you are unable to get a clear answer from an insurer about costs and coverage BEFORE you sign up, it is very unlikely that you will get a clear answer once you are a customer. Once you are a customer, make sure that you have a clear idea of the costs involved prior to scheduling a procedure or test. A recent survey sponsored by the Robert Wood Johnson foundation found that nearly 56% of Americans get out of pocket cost information before accessing healthcare services.

As with most things that have occurred with the Affordable Care Act, it is the patient who ultimately suffers. Insurers continue to profit, as do drug makers and hospital systems and administrators. Physicians have seen reimbursement cut to levels that have forced integration with large hospital systems. Most tragically, however, patients tend to be caught in the middle and have seen their healthcare suffer. Surveys indicate that patients are now inquiring as to cost prior to office visits, tests and procedures. Many find that they must put off necessary preventative activities and even more opt not to have needed tests and therapeutic procedures due to cost. It is clear that the ACA has missed its mark. While insuring large numbers of Americans is a noble goal, this insurance must also provide value rather than meaningless statistics to be utilized at a White House press briefing. As my research mentors at Duke University taught me during my training–with any data analysis, it remains that garbage will equal garbage out. WE must find a better way to provide affordable care to our patients. For now, insurers, hospital systems and politicians are using patients as nothing more than a “Profit Center”. As reenrollment continues through this year and the next we must make sure that our patients are armed with the old adage—“Buyer Beware”

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The Perversity of Medicare Incentives and Reform–Turning People & Patients into 10 Minute Time Slots

As the Affordable Care Act continues to impact millions of Americans through its second year of implementation, many things have become clear to both patients and healthcare providers alike–NOTHING is as it seems.  While the ACA has provided healthcare to millions of previously uninsured Americans, it has also robbed many patients of their doctors and has forced others into higher premium, lower service plans.  Even those with insurance are finding that they have little choice.  Many healthcare systems and providers are finding it impossible to accept the Exchange insurances and many long time Medicare providers are also opting out. Why is this happening?  Didn’t the Obama administration see this coming?

Of course not!  In the words of the legendary Nancy Pelosi “We have to pass it to find out what is in it…”

Courtesy of Fox News.  Nancy Pelosi "We have to pass it to know what's in it"

Courtesy of Fox News. Nancy Pelosi “We have to pass it to know what’s in it”

Well, now that we are more than a year into the program, we are all learning exactly what IS in it–more accurately we are finding out what is “NOT” in it….

Physicians have found the ACA to provide significantly lower reimbursements and Medicare continues to make further payment cuts.  If you carefully look at the way incentives within the Medicare code are structured, you begin to see that they are NOT in the best interest of EITHER the patient or the physician.  For example, a 10 minute office visit is reimbursed in some areas at $50 and a 40 minute visit is reimbursed at $140–with the reimbursement for each block of time decrementally reduced.  While physicians would much rather spend more time with each patient–working on prevention and goal setting AND actually developing lasting relationships–Medicare and other government based healthcare plans seem to incentivize the opposite.  In order to remain financially viable, a practice must see more people in less time–reimbursement favors larger numbers of short visits rather than fewer, extended, more productive visits.  Overall healthcare costs are not impacted because we are not able to spend needed time on preventative efforts.  Patients are not engaged and outcomes suffer.

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Say What You Mean and Mean What You Say!

Medicare bureaucrats and federal healthcare regulators say that they would like physicians to emphasize patient education, patient engagement and patient inclusion in decision making yet they are unwilling to compensate doctors for the time these activities require.  In fact, the current system pushes the opposite–mass production of patient visits with limited time for questions and lifestyle modification discussions.  Healthcare providers are actually negatively impacted when they spend more time with patients–often to the point of not being able to remain open and independent without “selling out” to large healthcare systems in order to meet the demands of business overhead.

Most disturbing, however, is the negative impacts these regulations and perverse incentives have on patients and overall patient care.  Patients depend on doctors to advise them and to help them make health care choices.  While patients are much better informed now–mainly due to the availability of information on the internet–they still need to have quality, non rushed,  personal interaction with a physician.  Many patients feel lost and abandoned when they realize that the time that they now get with their doctor is significantly limited or eliminated altogether (as many physicians substitute allied health professionals for themselves during routine office visits).

Ultimately time will tell.  It is my hope that we can somehow reverse the course of the Obamacare disaster in the years to come.  We must find a way to insure and care for all Americans in a way that also allows Doctors to be Healers rather than government automatons.  The practice of Medicine remains a privilege–we must all work to ensure that the sanctity of the doctor-patient relationship is preserved in the future. We must reform both the ACA as well as the often perverse Medicare code in order to allow physicians to provide what is most important to patients and families alike—TIME and PERSONAL ATTENTION.  Only then will we have a system that actually works…..