Saturday, October 20, 2012

Scherz On Disincentives

In his 10/19/2012 TownHall piece, Dr. Hal Scherz of Docs4PatientCare asks a good question: "Obamacare may be around, but will your doctor?"

In particular, he notes that ObamaCare will increasingly reward doctors for cutting costs and skimping on care to patients.

Under IPAB, ACOs, "bundled payments", and the other new regulations, doctors will be encouraged to not practice medicine, rather than to practice medicine.  For instance:
Obamacare creates a template which will result in the elimination of the private practice of healthcare. This will occur through Accountable Care Organizations (ACOs) which are large hospital systems employing physicians, ostensibly to facilitate the integration of care and to control costs.
Sadly, ACOs are akin to the HMOs of the 1990s, only much worse. The payment for an episode of care comes into the ACO as a single bundled payment and the institution determines how the money is divided. The patient no longer is the first priority of the doctors, but rather, it is satisfying the needs of their boss- the ACO. Doctors will be incentivized to save money- doing less, not more for their patients. Currently, less than 50% of doctors are self-employed and this number will drop sharply under Obamacare.
Under these pressures, many doctors will quit or retire early.  Others will just ramp down their efforts, working fewer hours.  We'll see fewer doctors willing to put in the extra effort staying late in the medical library consulting a journal to nail a difficult diagnosis or fine tune a patient's treatment protocol.

Instead, more and more doctors will develop a clock-puncher mentality, like we see at the local DMV office.  After all, why should they make that extra effort for you, the patient, when their bosses don't want them to?

If you don't want that kind of doctor taking care of you in a few years, the time to speak up is now.

(Read the full text of "Obamacare may be around, but will your doctor?")