Friday, March 7, 2014


Another missed meeting Thursday night that under normal circumstances I would have attended. However I have the chance to focus on other than Plainfield issues.

OK, I have the choice of two subjects for a brief blog; the world crisis in Crimea or back to the impact of the ACA on health care. Both are complex subjects and both can have a permanent impact on our lives.

Although the situation in the Crimea is reminiscent of the early 30s in Europe where once again a reckless arrogant national leader is challenging the world by taking an aggressive course that could lead to a worldwide confrontation with millions of lives lost; I chose Obamacare since that is slightly easier to foresee.

I have been trying to make the point that medical care as I knew it is dead. The daily news in both the Times and the WSJ reinforce that statement.

“Physicians complain that the intensive data entry required in most programs, made even more intensive by federal meaningful use requirements, transforms them into clerks, slows them down, and turns face time with the patient into screen time.”

Study after study shows that point-and-click, template-driven EHR systems have sparked a big backlash against the technology. Physicians complain that the intensive data entry required in most programs, made even more intensive by federal meaningful use requirements, transforms them into clerks, slows them down, and turns face time with the patient into screen time.

This is especially true when the practice has adopted an expensive program that unlike more affordable ones can speak to hospitals and other medical groups.

This is why the individual or small group medical practice is rapidly disappearing. The recent data shows that only 40% of today’s physicians are in private practice; that is solo or four or less doctors. The costs of mandated EHRs and the penalties of not meeting artificial standards is driving doctors to become employees.

Hospitals are buying practices and have become entrepreneurs in the practice of medicine. There is money to be made in large volume practices with a captive population for ancillary services such as radiology procedures, lab testing, physical therapy, and above all the outpatient observation rooms where a patient can be monitored at a rate that is higher than that for an inpatient.

There is no rational about the hospital costs that are charged which can range for example from as much as 20K to over 100K for the same service such as delivering a baby by “C section.”

Of course those figures disappear when insurance or Medicare/Medicaid enter the picture since reimbursement is established by a schedule which can be altered by negotiation. 

Moreover many hospitals as well as physicians are excluded from various insurance plans. 

The Times reported this week that many carriers are using double standards of different networks of providers for their private plans and those from the exchanges. There are fewer area hospitals as plan members and the number of physicians, primary as well as specialists are cut to the minimum, usually restrictive to those who are most productive and efficient; seeing more patients and ordering less tests. These new plans have more restrictions on the availability of various medications. Similar action is not the same and in some diseases especially those involving the brain one drug may work when another does not. Dollars are the deciding factor; not the welfare of the patient.

But the most alarming note is not the poor quality of care that is evolving, but rather the Executive branch of the government assuming a Legislative role by changing laws either through altering by decree the terms of the law passed by congress or by issuing directives that are in essence new laws.

The latest executive action is the President again extending until 2017 the period that carriers had to discontinue their “substandard plans”.   That does not help those who found themselves last December without insurance and had to go to the Exchanges for a more expensive policy and change doctors.

These unchallenged actions are changing the intent of the Constitution and someday some President may do so much as to become a dictator.

Obama more than any President in history has usurped the Constitution's three prescribed roles of government; making laws, carrying out the law, and determining the legality of the law. That in effect in the hands of an unscrupulous administration ala Nixon can lead to a coup d’├ętat.

That is the unseen danger. Obamacare may not be just a social revolution but represent the  road to a political revolution.


  1. Moving forward is difficult in every field, more is expected from professionals in terms of documentation. Where information is power, the collection of data is paramount. I am old enough to remember your kind of medicine, and appreciate having the experience. I saw the same doc. through childhood into adulthood, when he died I saw his "young" associate.
    If my doctor was stumped, or I needed some special care there were only a few alternatives, or specialties, now there are hundreds. My back then doctor got all the reports and had personal contact with "all" the specialists on my case, mostly because they were all here at Muhlenberg, not some impersonal mega hospital.
    It's not like that today. If you are lucky enough to find a GP to be at the center of your care, they don't have the time to speak personally with all the specialists one seems to need as one ages. What they get is reports ergo; they spend a lot more time imputing data, rather than communicating.
    Health care is a major market not unlike education,
    lots of money to be made. Go back and blame Mr.Nixon for HMO's and DRG's that's where the paper really started.
    Give things a chance to even out, it's all new. Doc's may hire a whole new class of people to input the data. Medical transcribers will get more's not all doom and gloom it will balance out given the chance.
    I do miss the doctor's row all along park ave here in Plainfield though.And I miss the house call's.
    Keep well!

  2. Hey Doc, read The Anti-Federalist Papers
    by Patrick Henry (Author) , Samuel Byron (Author) , Robert Yates (Author), it details the situation we are in as forseen by some founding fathers.