The following email string from earlier today from physician leaders is very telling and tragic. The email discussion starts with this:
Many of you will recognize some of the themes in this piece written by a frustrated young physician who has made the tough decision to leave her practice. Some of you might have struggled with the same issues discussed in this essay.
Here are two quotes from her thoughtful essay:
“The phenomenon of patients as customers, the cultural rise of entitled incivility, and trusting Dr. Google more than their doctor has eroded some of the pleasure of patient care.”
“In the past decade, physician groups have been purchased by hospitals and conglomerations. Rather than being recognized for individual excellence by patients voting with their feet, this has resulted in doctors being interchangeable cogs in a system where patients/hour and shifts/month dictate value.”
Two physicians responded with the following:
As physicians, WE make the wheel go around. Yet we have allowed our knowledge, our expertise, and our unmatched dedication to be devalued by hospitals, insurance companies, politicians, etc.
I think that the more we are called providers and we do not educate the public about the time commitment and education that physicians put in to become the master of the profession then we lose. … medical students are very talented. We need to make this news because we are the only ones who can provide quality care and provide the impetus to decrease costs We are the only ones equipped to do so. The MD degree has tons of value and it is not an interchangeable cog in the wheel.
So true. My law practice focuses on representing physicians, which includes helping them evaluate and participate in opportunities as they deal with the onslaught of onerous laws, rules, and regulations. I constantly must remind my clients that physicians are and remain the sole source of value in healthcare. Notwithstanding that, many physicians, young and old, constantly ignore good opportunities for their practices because they are intimidated into choosing the wrong ones.
As the public member on the Board of Governors of the Florida Medical Association, I am pleased at the FMA’s focus (1) on lobbying legislators who are notoriously ignorant about physicians and the practice of medicine, and (2) on educating its members so that they can better understand and evaluate what is going on in the business of medicine.
I worry whether we can make a big enough impact quickly enough.
No other profession is faced with less respect or more demands or higher expectations than allopathic and osteopathic physicians.
This is not about “socialized” medicine, Obamacare, or anything other than economics. It has always been about the money. We are happy to make physicians work harder for less, and that has been happening for years. People don’t care because they have drunk the Kool-Aid from the insurance companies and the government that the medical profession is the problem with healthcare, and a misinformed public accepts the view that somehow physicians are the enemy.
The Harvard Law School Blog, Bill of Health, recently posted an article entitled “Contraceptive Mandates and Conscience – All Objections Are Not Equal.”
… studies show that medical professionals may object to services based on clinically false information. … If medical professionals make decisions based on ignorance, one can suspect that lay employers and patients do as well.
This suggests that individuals often lack the information necessary to truly assess their stance on morally controversial services. While the law does (and should) play a role in protecting conscience, it seems unsatisfying when such protection is granted to those holding underdeveloped views, and at the expense of (and detriment to) those seeking legal medical services.
This seems so simple and logical. We do not let employers make other health-related decisions for their employees, why do we let some employers make reproductive decisions for their employees based on a religious view not shared by their employees?
“The charges in this case are deeply troubling,” U.S. Attorney Dettelbach said. “Inflating Medicare billings alone would be bad enough. Falsifying cardiac care records, making an unnecessary referral for open heart surgery and performing needless and sometimes invasive heart tests and procedures is inconsistent with not only federal law but a doctor’s basic duty to his patients.”
“This doctor violated the sacred trust between doctor and patient by ordering unnecessary tests, procedures and surgeries to line his pockets,” Special Agent Anthony said. “He ripped off taxpayers and put patients’ lives at risk.”
Just another case where greed coupled with disregard for his patients’ welfare led a physician to commit fraud on the government and commercial insurers and to forsake his Hippocratic oath to do no harm. Here, the physician not only ordered unnecessary and more invasive procedures than the patient needed but also falsified nuclear test results to justify the unnecessary procedures.
While there is no way to prevent greed like this (other than locking the bastards up), I have predicted in other posts that the migration of medical reimbursement from procedure based to quality of care of the patient will reduce the incentive to perform unnecessary tests and hopefully reduce this kind of fraudulent activity.
So, we have two decisions from two different U.S. Circuit Courts of Appeal, Halbig v. Burwell and King v. Burwell, and coming to two different conclusions as to whether it is permissible to provide financial subsidies to residents of states which refused to establish their own health insurance exchanges.
Here is some background of the two cases (from the Daily Kos, 7/27/14, “The Halbig Case: or, the banality of conservative evil“):
[T]he Affordable Care Act expands access to health care by allowing states to create insurances exchanges on which private companies can sell insurance plans that meet federal standards. To help ensure affordability, the ACA subsidizes a certain portion of the premium on a sliding scale based on income. If a state either cannot or will not set up an exchange, there are also plans available on a federal exchange.
So far so good, right? Wrong. Because of the fervent opposition to the law, most states with Republican-controlled statehouses opted not to participate by building their own exchanges, and instead watched passively as their citizens became eligible for plans subsidized under the federal exchange. Just one problem, though: the authors of the Affordable Care Act did not seem to anticipate that states would refuse to establish exchanges out of political spite. Consequently, the provision of the Affordable Care Act authorizing the payment of subsidies refers specifically to plans under state-based exchanges, but does not explicitly authorize subsidies to help cover plans sold by the federal exchanges. The IRS issued a regulation that federal exchanges were eligible for premium subsidies. But a group of anti-Obamacare plaintiffs, headed by an attorney from the Federalist Society, argued that because Congress had not expressly mentioned subsidies to plans under the federal exchange, those subsidies were unlawful. And that argument won the first round in the DC Circuit Court, whose panel ruled that regardless of whether Congress intended the subsidies to also be available to plans under the federal exchange, a strict reading of the legislation said otherwise.
Let’s be honest. These cases are not about the stated Constitutional challenge that the President and the IRS have gone beyond the statutory authority of the Affordable Care Act. They are about politics and the continuing attacks on the President through the rant against Obamacare.
There is no concern about law or justice — and the political maneuvering is more insidious because it hides behind black robes.
If we start with the assumption that politics and politicians should have the goal of helping their constituents, under what theory does one bring these cases when the desired result will deprive millions of Americans of the health insurance that they have purchased? How have so many lost so much perspective and purpose?
The “class war” that the President is often accused of promoting is really being fueled by a conservative myopic minority. Their willingness to hurt innocent citizens of less means who are seeking health insurance and rely on the subsidies provided is just bullying aimed at achieving some political end and helping no one. Isn’t it time this immorality stopped?
Here is my view — Of the contradicting decisions, one is clearly right, and the other wrong. Getting to the right result, however, is really only politics hiding under black robes.
A very important topic that can get providers into hot water if they do not take the time to understand the requirements of their managed care contracts and Florida law.
By: Karina Gonzalez
Balance billing occurs when a provider collects from a patient the difference between the amount billed for a covered service and the amount paid for that service. Balance billing does not apply when collecting deductibles, copayments or coinsurance.
Under Florida law, a provider may not balance bill a patient for any service, if an HMO is liable and responsible for payment. Contrary to what many people believe, this is true whether you are in-network or out-of-network. Even hospital based out-of-network physicians, such as anesthesiologists, pathologists, radiologists or emergency room physicians cannot balance bill HMO members where the hospital has a contract with the HMO or there was authorization given for an episode of care.
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From Healthcare Intelligence Network — essentially a sales promo for their book. According to HIN, a successful physician compensation strategy includes organizational goals, governance, and physician engagement. This is slanted from the healthcare organization viewpoint.
Nevertheless, still worth a look.