Monday, August 22, 2016
MORE ON TODAY'S HEALTH CARE #2
Another factor that is making the ACA an economic failure is the hospital providers who have figured out how to game the system.
To begin they have attempted to create monopolies by aggressive absorption of other institutions into their own system,
An example is RWJBarnabas Health: the most comprehensive health care delivery system in New Jersey, The system includes eleven acute care hospitals –three acute care children’s hospitals and a leading pediatric rehabilitation hospital (Children’s Specialized Hospital), plus a freestanding 100-bed behavioral health center, ambulatory care centers, geriatric centers, comprehensive home care and hospice programs, fitness and wellness centers, retail pharmacy
Nearby is the smaller Atlantic Health Systems that includes among others Overlook, and Morristown Hospitals.
All these hospitals maintain in hospital medical staffs or affiliated groups including physicians based in local offices but who have a guaranteed income from the parent system who do the billing including the coding.
The doctor’s office has become an outpatient facility of the hospital and a visit to the doctor includes a charge for using an outpatient facility, something that traditionally was included in the office visit charge but is now additional.
The system also includes a mandatory use laboratory for its affiliated practices.
Once again the government bureaucracy has made the private practice complicated and costly which has had the impetus for doctors to become affiliated with a hospital system group.
I will not go into the mandatory Electronic Records with costly systems to install and templates to fill out by check marks. The systems may not talk to another physician’s office and in some cases to the hospital’s compute
The extra office personnel needed to comply has increased the doctor’s operating cost which has to recoup in the bill for services. Since not only Medicare and Medicaid reimbursement is low balled as well as that of the insurance carriers who form networks of providers who will accept the lowest possible fees.
Physicians who will not accept the Insurance Carries fee scheduled are frozen out by the use of restricted networks.
All this has changed American health care so that almost 60% of physicians are on salary from a hospital or its affiliated networks. That alone has increased the cost of care.
Today’s health care is not patient friendly. Besides the fact that the doctor is too often spending his allotted five minutes entering data into his computer but the patient’s exam and care is done by a NP or PA. This of course impacts on quality no matter how experienced that individual
There are other stupid regulations that impact on the patient’s ease of care; such as the Medicare one that only one office procedure at a visit will be paid. Two examples; if one has an office visit with an Orthopedist one cannot have PT the same day at that office. Or, as happened to me, I had an ingrown toe nail treated by my podiatrist but although I was scheduled to have my nails could not have my nails cut within a weeks’ time had to comeback because Medicare would not pay for both procedures the same visit.
It is an unforeseen effect of the ACA that has made the one on one relationship between patient and doctor a lost art which was a major factor in having good health results.