Will physicians be caught in the ACO web?

In a perfect world, I agree with what this article says. A perfect world in which money is no object, patient expectations are “reasonable”, and defensive medicine barely exists. Under the “old” system, a physician could, actually, practice with only the patients best interests in mind. As time went on, and technology gave birth to new procedures and new concepts, we were forced to apply this new knowledge and provide these new procedures, otherwise, we would not be providing optimal, up to date care. And if that didn’t happen, then we could be held “liable”. Who can remember the 1970′s when the obstetricians decided that it was difficult to practice in Boston because of the burgeoning malpractice costs? In the old days, if a doctor thought that a patient should be placed in a hospital or needed a surgical procedure, then the patient got this, no questions asked. But then as the expectations among patients grew, and physicians found there was profitability in certain care models, the whole thing started to become too expensive. And physicians, too, are people, there is nothing wrong with incorporating the desire for profit into your work ethic. In many professions, profit is the main driving force, right? Then as time went on, some politicians began speaking of “medicare going bankrupt” and therefore cuts should be made.

In the old days, if your knee hurt, often times you would take aspirin, wait, and see if it improved. Today, often times you get seen by your GP who then “approves” a visit with an orthopedic surgeon who then orders an MRI and possibly a knee arthroscopy; and the knee get “cleaned out”. What was the diagnosis any way? And this all costs a great deal of money. And this concept is pervasive through all of health care. Chest pain-cardiac cath. Painful swallowing? Upper GI series, upper endoscopy. Can’t sleep? Sleep study, EEG and so forth. Health care today is way too expensive and if our government is to continue to pay for this, there is no way we can get by without major tax increases. If private payers are to cover this, then insurance premiums with accelerate. The insurance companies have to make their profits, right? After all, many of these insurance companies are publicly held, who wants to own stock in a company with poor revenues?

What about end of life care? Most physicians themselves are unsure as to how to deal with the dying patient and how much care should be applied, let alone the family making the decision. And this is where the majority of costs are born out. So while I think the physicians and other direct providers are perhaps the best ones to decide what care is necessary, there must be some element in place that will help these decisions to be made prudently. A decision that reflects not only the individual patients’ best interests, but that of society as a whole.

In
the old says, physicians were able to manage a patient in the manner they felt
most appropriate. The goal was to return to ‘normal’ as much as possible,
and empower optimal health as best the doc could. Whatever was done, if the patient had
insurance — that “claim” was paid for the services rendered –
usually without debate. Patient had
insurance, insurance company had the risk, if utilized – claim was paid for
services rendered. What was rendered was
at the discretion of the treating physician.

What changed as more PHYSICIANS were “turn-coats” and surrendered quality Patient care for the quality Personal lifestyle within the corporate America of the INSURANCE INDUSTRY, with their corporate benefits and riches. These “back-stabbers” ought to be dealt with by medical boards for their unethical, unprofessional behavior. Their concern is no more for patient needs and prognosis — or even the physician trying to manage the patient. It’s all about conserving dollars for the greedy, and denying quality care — is their only way to preserve corporate profits. That Executive Medical Director might supervise a coven of burned-out nurses, who without flinching, thrust down the rubber stamp “DENIED” on as many claims as they can, whose patient prognosis is dictated and scripted where everyone’s hands are tied — except the controlling insurance company. (Some nurses gain bonuses by how much money they ‘save’ by thumbing their noses at MD’s from primary care to complex specialists. How dare a MD allow some R.N. to second-guess them and force you back in your hole?? Yet, doc’s have ALLOWED the insurance industry to ERODE your professional decision-making ability to implement appropriate care. The medical profession as a whole, has allowed the insurance industry to TAKE OVER and OVER-POWER you. Now, they have taken over — and they will not retreat or surrender.

I blame the medical schools for not teaching physicians how to have enough balls against these parasitic corporate traitors, and the old-timers for not advocating continued independence. Any the new doc on the block that was so excited to hang their shingle and start watching the bucks roll in … for those … you allowed yourself to be manipulated and like it or not, you “joined their club” to “partner” with the insurance industry in ways you may not have intended. Now, “who wears the pants in the healthcare industry?” And, you are left trying to cover your ass? Wonder why?

So WHO is willing to step up to assert your fundamental rights as a physician who can think for themselves, rather than go along with what the insurance “Medical Director” SAYS you have to think? Who as a group of physicians have challenged any M.D. Medical Director in the corporate penthouses across America, asking them “WHO’S SIDE ARE YOU REALLY ON? DON’T YOU CARE AT ALL ABOUT PATIENTS ANYMORE?” So have they SOLD OUT? Then, NAME THEM, LIST THEM, KNOW THEM, WRITE THEM, PUT THEM ON THE SPOT. If you can ever get the doctors WITHIN the industry to be honest and ethical, and get back to the emotional roots of why they thought they could be a Healer … then, you MIGHT see some changes that empower physicians again. Otherwise, find a select few insurances who WILL be willing to put the patient’s health a little closer to the front of the claims issues — and ONLY do business with these companies. At some point, ANY benefit program will have to offer THESE insurance choices, or be shunned by employees and the public.

But, it gets back top what physicians are really willing to change, and how hard you want to fight the insurance industry. You know also, the stubborn, greedy pharmaceutical industry is as much an enemy to your patient’s Optimal Health as the Snakes in insurance companies.

Do you realize how much money the “Top Doc” at insurance companies make? So ironic, too, at insurance companies who claim to be “non-profit” companies. Laughable — if not so tragic.

So, what are you going to do about it? You know what Happens – when “Good Men Do
Nothing.” Exerting your influence to impact ACO’s may be as
crucial. While you still have, maybe,
SOME CHANCE.