Welcome listeners from ReachMD! I am pleased to be hosting the ReachMD Poll, where I will introduce a topic on-air and you can have your say and vote on important health issues.
Health care reform is imminent, and the coming year will present many challenges for the medical profession. What are the top health care issues that you will face in 2009 as a practicing physician?
Here are a few that come to mind.
Physician reimbursement. Medicare is soon scheduled to cut physician payments in excess of 20 percent and cash-strapped states are slashing Medicaid reimbursements. At a time when the costs of running a practice are increasing, this blow would cripple many practices. Linking physician pay to patient outcomes, so-called pay for performance, is one often-discussed approach to mitigate the payment cuts. This has been controversial as the reward in payment is not commensurate with the costs of implementing the systems to measure performance.
Physician shortage. President-elect Barack Obama’s goal of covering every American is noble. But there is a well-known primary care shortage, with only 2 percent of Internal Medicine residents pursuing primary care, and patients waiting months for an appointment. Without physician access, newly insured patients will flood the already crowded emergency departments, further driving up spending.
Adoption of electronic medical records. The transition to digital records would cost hundreds of billions of dollars, with doctors bearing the brunt of the expense. That’s why despite the potential advantages, such as reduction of medical errors and cost savings, only 13 percent of physicians have made the transition to electronic records.
Rising malpractice premiums. Obstetricians are refusing to deliver babies. And there is an exodus of physicians to states with a friendly malpractice climate. Patients lose as physician access dwindles. With nowhere to turn, they are likely to delay care. Or go to the emergency department, where the most expensive care often takes place.
And one that didn’t make the cut, but still important:
Transparency of health costs. More patients are subject to high deductible health plans, a trend that will surely increase as businesses look to curb health premiums. There is currently no reliable way to find out how much tests and treatments cost. Depriving patients the opportunity to make informed choices about their care.
If I didn’t cover your issue, you can add it in the comments below, or call into the ReachMD Listener Line at 888-639-6157 and record your comments (portions of which may air).
I encourage you to vote in this week’s poll, located in the upper right column of the blog.
Please suggest future ReachMD Poll topics by emailing Poll@ReachMD.com
topics: reimbursement, shortage, emr, malpractice, transparency
Scrubs
{ 4 comments… read them below or add one }
You left a BIG one out Kevin . . . and that is REAL ACCOUNTABILITY for all of the people/institutions hovering over and around the practice of medicine . . . from the businessmen of medicine (i.e. hospital/practice administrators), to insurers, to the pencil-pushers in government programs, to the politicians “overseeing” those programs, to lawyers.
Doctors have been hammered for well over a decade - selectively singled out as wholly accountable for every wrong - when, in fact, so much of what we do depends upon and is affected by the actions of others.
And, when it comes to accountability in the equation of medicine, those “others” have gotten a free ride - or free license to skim off the top.
To coin a phrase, it’s time for a CHANGE.
P.S. Some personal accountability for patients would be nice as well. It ain’t all free - whether patients are paying for, insurers or the government.
There are so many negatives facing a small practice in implementing EMRs includign high cost of acqusition, high ongoing costs, very hard transitions, and in my view, dubious improvement in patient outcomes. Also, the temmplates are filled with nonsense, you can’t communicate with anyone else except to print and fax, etc. Maybe the best argument is to cue the coders? I really do not think we are there yet.
I’m a big fan of your emphasis on the lack of access to primary care, but you so often forget to mention those of us who *specialize* in primary care, Family Medicine specialists. Yes, only 2% of IM residents are going into primary care. That’s why we’re here! We are an important component of strengthening the primary care network in this country.
Our specialty is of course plagued by lack of interest in primary care; many slots go unfilled or are filled with people who are unable to be competitive in other residencies. Interest in Family Medicine has decreased significantly over the past decade. But we’re also part of the solution, don’t forget us!
Perhaps some of those who went into internal medicine initially hoping to practice primary care would have been happier in Family Medicine. Unfortunately as soon as they enter the world of IM they are bombarded by specialists, hospitalists, and proceduralists and have very little primary care exposure. In my residency program, only 2 of the 8 people who specifically entered the primary care track are actually planning to do primary care. These are people who self-selected to do primary care upon graduating medical school, so something happened in those 3 years to make only 25% of them want to continue in primary care. Something is very wrong in the public view of primary care providers, but even more disturbing is how we are viewed within our own profession.
Consumers may never see the savings appreciated by the Pharmaceutical Companies being denied access to their toolbox of freebies because corporate America always finds a way to fritter away their resources. It will be refreshing to see their Barbie and Ken doll sales reps reach back into their cranium rather than their goodie chest for conversation starters and to explain the validity of why anyone should prescribe or consume their product.