Thursday, February 19, 2015


If you are a regular viewer you are aware that I have stated that one of the net results of the ACA will be a continued deterioration in the American health care system.

In the 70s when the swing to managed care occurred with the  HMO’s and the impact of the big  Insurance  carriers  such as Aetna, Cigna, and the Blues people  began to no longer want the imagined family doctor of their youth and of Norman Rockwell.

Instead they were willing to accept whatever Physician and Hospital their carrier would provide. The carriers that survived did so because their reimbursements to providers were only as high as they needed to be to fill a slot. The quality of care given was secondary, in fact these insurers in many cases tried to dictate how to treat a patient.

This philosophy has persisted until under the socialistic theory that health care is a government right we have had the passage of the ACA in2010. Since then there has been modifications of some of the provisions for business but the penalty portion for individuals was instituted in 2014 and will increase this year.

There has been success in that there are now supposedly 11 million enrolled under the provisions of the act. How many did so because their old insurance plan was discontinued by their carrier has not been counted.

Among one the provisions has been the adulation of the Electronic Health Record as well as some kind of predetermined standards for good doctor/bad doctor. Failure for physicians to comply with the mandatory adoption of the EHR or to meet the questionable standards which make no allowance for population differences in practices results in decreased reimbursements from the already low schedules in an increasing amount each year.

The transformation to the EHRs is a costly one and nobody took into account that various systems do not speak to each other or the hospital.

Requirements including using electronic prescription to the drugstore and increased need for approval from the carriers as well as service codlings has resulted in the need for extra staffing in an office. Although this may increase employment rates; the economic burden has been too much for the individual and small group practices. The number of such practices which was once in the majority has now dropped to well below 50%.

Instead, doctors are selling out to the Hospitals and becoming employees. The hospitals are very creative in their billing practices and there is sufficient evidence that the actual cost of treating a patient in the office setup has increased. Besides that, most of the care in these offices today is administered by NPs or PAs, not by the MDs who may or may not be physically involved.

I am reprinting part of an op-ed by Dr. Michael D. Singer who practices general surgery in Phoenix and is an adjunct scholar at the Cato Institute. I believe that it was in the WSJ this past week:
“The debate over ObamaCare has obscured another important example of government meddling in medicine. Starting this year, physicians like myself who treat Medicare patients must adopt electronic health records, known as EHRs, which are digital versions of a patient’s paper charts. If doctors do not comply, our reimbursement rates will be cut by 1%, rising to a maximum of 5% by the end of the decade.

I am an unwilling participant in this program. In my experience, EHRs harm patients more than they help.

The program was inspired by the record-keeping models used by integrated health systems, especially those of the nonprofit consortium Kaiser Permanente and the Department of Veterans Affairs. The federal government mandated in the 2009 stimulus bill that all medical providers that accept Medicare adopt the records by 2015. Bureaucrats and politicians argued that EHRs would facilitate “evidence-based medicine,” thereby improving the quality of care for patients.

But for all the talk of “evidence-based medicine,” the federal government barely bothered to study electronic health records before nationalizing the program. The Department of Health and Human Services initiated a five-year pilot program in 2008 to encourage physicians in 12 cities and states to use electronic health records. One year later, the stimulus required EHRs nationwide. By moving forward without sufficient evidence, lawmakers ignored the possibility that what worked for Kaiser or the VA might not work as well for Dr. Jones.”

He goes on to write:“what is happening today? Electronic health records are contributing to two major problems: lower quality of care and higher costs.

The former is evident in the attention-dividing nature of electronic health records. They force me to physically turn my attention away from patients and toward a computer screen—a shift from individual care to IT compliance. This is more than a mere nuisance; it is an impediment to providing personal medical attention.

The EHR system assumes that the patient in front of me is the “average patient.” When I’m in the treatment room, I must fill out a template to demonstrate to the federal government that I made “meaningful use” of the system. This rigidity inhibits my ability to tailor my questions and treatment to my patient’s actual medical needs. It promotes tunnel vision in which physicians become so focused on complying with the EHR work sheet that they surrender a degree of critical thinking and medical investigation.

Not surprisingly, a recent study in Perspectives in Health Information Management found that electronic health records encourage errors that can “endanger patient safety or decrease the quality of care.” America saw a real-life example during the recent Ebola crisis, when “patient zero” in Dallas, Thomas Eric Duncan, received a delayed diagnosis due in part to problems with EHRs.”

I am so happy that I do not have to try to treat patients under today’s pressures. I enjoyed my interactions with them and the feeling that many had that I was their personal friend.


  1. You have it backwards for me Doc - my carrier doesn't decide which physicians I use, but instead my doctor decides which carrier I use as I only choose carriers that have my doctor in their plan.

    1. Jim, you are an exception; one who is sure of providers and benefits before taking a policy. Most people buy a policy based on the premium cost, and will shift doctors if the one they have been using is not a participant. Some who have insurance through work have only the required choices and all or the ones in affordable range have restricted panels.