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…..

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

  1. Well said.

  2. Conrad Derrick

    Clearly there are problems with the ACA, but rather than totally repealing it, I would be interested in hearing your suggestions for reforming it. As a consumer/patient, I liked the parts of Obamacare that stopped lifetime caps on coverage, prevent exclusions for treatment of preexisting conditions, and extended coverage for college age children until age 25 (although frankly that had been a provision in my family’s group health insurance before the ACA). What do you suggest to control the exorbitant cost of healthcare? Hospital charges and prescription drugs are so expensive that, if there weren’t set charges that insurers negotiate and the government mandates, no one could afford them. The idea that free market economics will control the costs obviously doesn’t work. So, as a well-educated physician, what do you propose is fair to everyone?

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