Physicians

Docs get mad, 2.0 style, at Sermo

SermoOf course, it’s not just cornering a Senator at July 4th picnic that changes policy.
These days there are online communities doing it too. And with increased grumpiness among many doctors, and now the almost-here-rather-than-looming-on-the-horizon cuts in Medicare, you can expect a response online. And here it is: Fed up Sermo docs draft manifesto. Yup, those docs hanging out on Sermo are not just discussing clinical cases, they’re on the verge of getting politically active. As you might expect, they’re pissed off with insurers, the government and lawyers. And who could disagree? (I know, I know it’s more complex than that….)

Never one to miss a trick, Sermo has allowed itself to be used as a vehicle for the open letter that’s going to get much more publicity (and yup, as a doc you have to sign up for Sermo to sign the letter, to verify that you are a doc!). Here’s the site called Doctors Unite.

Every other form of political activism has moved online, so don’t be surprised to see more like this. Of course, if the details get specific, it’s tricky to know whether the coalition of pissed off docs will hang together, and also whether Sermo will become type-cast as representing a particular flavor of doctor (see: Medical Association, American) which may somewhere down the road limit its business initiatives. But for now, it’s fun to see online organization get serious in health care.

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8 replies »

  1. I believe some in Congress had the idea to begin paying medical oncologists more for talking to and listening to patients and less for very expensive, very aggressive treatments.
    The Medicare Modernization Act (MMA) of 2003 changed how the CMS paid for medical oncologists’ services. It called for rewarding medical oncologists to communicate with patients and to spend more time dealing with patients’ chronic health conditions caused by infusional therapy.
    Medical oncologists would be reimbursed for providing evaluation and management services, making referrals for diagnostic testing, radiation therapy, surgery and other procedures as necessary, and offer any other support needed to reduce patient morbidity and extend patient survival. In other words, being paid to think rather than just dispense drugs.
    Before, medical oncologists received no reimbursement for providing oral-dose therapy to patients. This had been the principal barrier to the availability of oral-dose protocol. The advent of oral agents ultimately meant that medical oncology had to change its identity, prior to the Chemotherapy Concession.
    The MMA bill offered patients benefits they did not have before, mainly coverage for oral chemotherapy drugs. More might have been achieved if the American Society of Clinical Oncology (ASCO) and other fraternal groups had lobbied as much for the oral chemotherapy drug issue as they did for office-practice expense reimbursement. They fought long and hard to retain the Chemotherapy Concession.
    The MMA bill tried to remove the profit incentive from the choice of cancer treatments, which were financial incentives for infusion-therapy over oral-therapy or non-chemotherapy, and financial incentives for choosing some drugs over others. Patients should receive what is best for them and not what is best for their oncologists.
    While the MMA bill was trying to pay medical oncologists for being doctors again, instead of being in the retail pharmacy business, the private payors still go along with the Chemotherapy Concession.

  2. Yes! Existing physician organizations have failed to represent their interests and those of their patients. You need to take back control to restore the doctor-patient relationship and your ability to provide appropriate care without the intrusion of special interests. That includes tort-deform legislation. The insurance industry gave you guys/gals a bone, and when you took it, they took the bone away with continued escalating medical malpractice insurance premiums. Have that real and active dialogue with the public who are being cheated by insurance companies.
    It’s time for Congress to examine whether the extra payments to Medicare Advantage plans are the best use of tax-payers dollars for the beneficiaries the program is designed to serve. MedPAC found that we’re not getting good value for the dollar. These payments could be used to provide better benefits, like filling in the doughnut hole and reduce out-of-pocket costs for seniors and the disabled, as well as to create a viable alternative to the ineffective sustainable growth rate mechanism currently used to determine the physician payment update.
    Traditional Medicare needs to be able to compete on a level playing field with private plans, which requires the elimination of these extra payments. Pay medical oncologists and other specialists more for talking to and listening to patients, and less for very expensive drugs and procedures.

  3. Alas, we live in such an imperfect world. Increasing patients on one side, a growing money gap on the other – and in the middle, a health care industry (physicians included) resistant to substantive change. Clearly there’s no attractive outcome in sight.
    Do we ration care, increase productivity, both? Neither approach will make for a happy place for physicians. They have to make investments and gut wrenching – okay, maybe just “uncomfortable” – changes to how they practice, or share the pain of rationing through reduced income and working conditions.
    Health care is certainly not going to change on its own, even while watching the coming train wreck.
    Hey, I know! Let’s slowly cut their reimbursement, forcing them do the right things out of financial necessity. While we’re at it we can pay based on quality. At least this way, physicians get to decide how best to improve outcomes and productivity. Somehow I doubt they’d rather surrender their practices to the government and let them make all those decisions.
    Short of a magic wand, what else is there?

  4. As the physician who proposed the idea of writing the manifesto (i.e. the open letter), I must say that I’m very encouraged to see the large number of signatures that we’ve been able to get in such a short period of time. This is just the beginning of our efforts. We are bringing together physicians, patients, and policy experts in an unprecedented manner. The next wave of healthcare reform should be bottom up, with physicians leading the way. History tells us that no one else has the best interests of our patients in mind. We need to start having real and active dialogue with the public who are currently been cheated by insurance companies and even the government, as the proposed Medicare cuts have shown.
    We are not interested in doing politics as usual. I believe that all existing physician organizations have largely failed to represent our interests and those of our patients. We need to take back control to restore the doctor-patient relationship and our ability to provide appropriate care without the intrusion of special interests. Our strength comes from our unity and our commitment to inject sensibility into our fragmented and distorted healthcare system. Our efforts are grassroots, decentralized, tech-enabled, and transparent.
    To a better tomorrow for all physicians and the patients that we serve,
    SK

  5. “As you might expect, they’re pissed off with insurers, the government and lawyers.”
    Welcome to the real world the rest of us live in. I could add; insurers, government, lawyers AND doctors.
    Under a single pay system they could at least eliminate insurers and then negotiate with government on equitable compensation. In Ontario Canada under their “communist” healthcare system the government even pays 1/2 their malpractice premiums. If they want more pay would they then allow nurse practitioners to do much of the work they do to help save us all money?

  6. America Speaks, since I consider your response to be highly uneducated, I might ask, exactly how much an hour do you believe a primary care doc makes these days?
    As for making more than teachers, yes, I feel entitled to making more than teachers. I think you would find most teachers would agree with me. As for not working for money, what exactly should I be working for? I work for money. I assume you do to. But if you don’t, how do you get paid?

  7. I love the way doc’s are so quick to point the finger! How about we reduce doc compensation, so that instead of getting million dollar houses and Mercedes – they live a little more like the rest of the US population? Why should one profession that serves the public interest be so much (read exponentially) more entitled than another (take Teachers for example)??
    All those docs who aren’t ready to signup for a pay-cut now, please step forward so we can weed out those who are in it for the money. Want to address rising healthcare costs, start here PLEASE!

  8. Au contraire, Sermo represents the kind of doc who is p.o.’ed at the AMA (not entirely, of course, but largely.)
    Why else would they be doing this, if the AMA were doing it for them??!! Full disclosure, I have signed the letter.

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