Physicians

(More) Madness in Massachusetts

Lately I have been watching with complete horror the events playing out in my home state of Massachusetts. A bill currently under review by the state legislature will make participation in the state and federal Medicare/Medicaid programs a condition of medical licensure, effectively making physicians employees of the state.

This is particularly alarming because Massachusetts is essentially a leading indicator of what will happen in the rest of the country. Several years ago the state passed a series of laws mandating health coverage. Like the recently passed national health reform bill, the Massachusetts law did not address any of the well known causes of runaway costs, including tort reform, drug costs, or insurance regulation.

Although the state now has one of the highest percentages of its population insured, it is grappling with exploding healthcare costs. In response, it is imposing capitation schedules, reductions in payment rates and now mandatory participation in the health programs by physicians. What most people don’t understand is that the private insurers are also free to lower their physician payments, based on the Medicare/Medicaid benchmarks. This is all the more concerning given the fact that the Federal reimbursement rate is now scheduled to be reduced 21% on April 15.

We will no doubt see the same sequence of events play out across the country as the current versions of healthcare reform are implemented. The net effect of these laws is that it will make it close to impossible for physicians to stay in private practice. Patient access to physicians will suffer as more and more physicians retire and/or move to different states. For our academic colleagues who think this turn of events can only “help” them because they won’t have to compete with physicians in private practice, just wait. 28 states are now imposing “comparability” laws that allow nurse practitioners and other allied healthcare professionals to work without the supervision of a physicians with equal pay. Few academic departments can avoid hiring “physician extenders” if they want to stay competitive. As this gains momentum, physician payments will be pushed downwards. As the “going rate” goes lower, academic salaries will also get pushed downwards. I knew this reform effort would be bad for the practice of medicine and even worse for patient care. I just had no idea things would deteriorate this fast.

Daniel Palestrant, MD, is the CEO of Sermo.

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REAL DOCGerber Lifecoach suitcaseshealthExhaustedMD Recent comment authors
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REAL DOC
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REAL DOC

Note about NPs: Observe carefully the fact that “Dr.” Linda, the NP, feels compelled to put no less than SIX (6) titles and credentials after her name. How incredibly insecure. How blatantly absurd. All the titles after your name DO NOT make you a REAL doctor, “Dr.” Linda! To be a real doctor who sees patients, go to MEDICAL SCHOOL and pass REAL licensing exams for a REAL medical license- the USMLE, or even the COMLEX. ALL THE PARTS, LINDA. NOT just the easiest part, Linda. This is for all the revolting NPs out there trying to glom onto and… Read more »

Gerber Life
Guest

I couldn’t agree more. Why wasn’t the point about Massachusetts being an indicator brought about with more emphasis when this national health care bill was being hammered out. Massachusetts is certainly not having a walk in the park with their in state health care industry. They have some of the highest insurance premiums in the nation. Why is this being done? If the providers do not want this type of legislation and the insurance companies do not want this type of legislation then who? I can only see one thing: power grab by the federal government…plus this federal government can… Read more »

coach suitcases
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Wow,great content and your blog design is just gorgeous. keep up your work, i’m sure many people would agree with me!

health
Guest

Thanks for the early validation, Ms GA! You just don’t get it, because you are not a provider and your personal welfare is not at risk, at least not just yet, because your blind faith is just that, it blinds you!

health
Guest

Primary care doctors need to become more assertive in defining their evolving roles.

Vikram C
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Vikram C

rbar- liked your comment on market forces. I am also very supportive of letting competition manage prices. However we need to understand that this market cannot be completely behave like market for consumers goods. One for the reason that consumer is highly scared and completely unsure about his/her judgement. Second is that seller doesn’t like to talk about price unless it gets below a threshold when the complaining starts. Do provider groups of insurance companies do good job of negotiating rates? My take around pricing has been that it doesn’t matter if competition forces you to cut price or the… Read more »

Vikram C
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Vikram C

Interesting reference to flattening of world by Margarit. I looked at US deficit and spending and it was pretty obvious that current spending is untenable. So far the equilibrium was maintained by cutting off uninsured, rescinding and reducing benefits by sly. As a proponent of global care aka medical tourism its been my argument that caring in remote place is still humane compared to not caring at all and leaving them to elements. My deep psychological studies of consumer behavior 🙂 has led me to understand that there is huge fear and sloth factor. We never do research seeking good… Read more »

rbar
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rbar

From your rec. WSJ article: “In fact, the real choice with medical care, as with any good or service, is between rationing via politics and bureaucratic lines or via a competitive market and prices.” Exhausted, looking at hospitals in your area with advertising for robotic prostatic surgery, cyber knife and possibly valet parking, do you think that market forces in the insurance system have any effect on prices? You probably could design a price driven competitive system, but then the whole system has to change a LOT more than the changes coming with Obamacare, and most Americans would like it… Read more »

ExhaustedMD
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ExhaustedMD

why don’t all you supportive pundits of Obama-nation read the link below, in today’s Wall street Journal, and spin your webs of denial, rationalizations, and deflections to dismiss it away. And you objectors and dissenters like me, read it to see what this monstrosity is in fact!
http://online.wsj.com/article/SB10001424052748704133804575198322718759844.html#printMode

MD as HELL
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MD as HELL

Dr. Linda M. MPH,MSN,ND,RN,CNC,CTN Clearly you illustrate my problems with NPs. Most can’t make a decision and stick to it. As for taking Medicaid, it is a political program and as such participating in it is a political decision, not a humanitarian decision or even an ethical decision. If a patient comes to the ED they are seen with no coverage. They are seen at my urgentcare, but they pay for it. At the urgent care we do not accept medicaid as payment, because it is an unnacceptable political program. If someone really needs something, I will give it to… Read more »

Margalit Gur-Arie
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MD as HELL, whether flattening the world is a good thing or not is a completely different question. I have my own misgivings there. The fact is that it is happening and the currently wealthy countries will have to tighten the belt significantly. It is going to affect us all, with exception of Presidents and tycoons who are really international in nature. As to healthcare, anyway you look at it, whether we pay less for each service, or use less services, physicians incomes will decline. My only hope here is that the decline is not blindly across the board. Primary… Read more »

ExhaustedMD
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ExhaustedMD

You know what is both fascinating and perverse? Watching another profession, with lesser training and competency, come in and demand access to services and claim levels of skill equal to those of precedence, like the Nursing Practitioner issue discussed above. And then this cheaper substitute drives out the higher skilled provider, because, hey, why pay the higher fee for service when someone cheaper is available, says the insurer. And then, once the substitute provider is entrenched, and providing what becomes less efficient services, then they have the audacity to demand a higher pay scale! And physicians should be happy with… Read more »

Nate
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Nate

“given the high relative wages of physicians, it is rather unlikely that modest income cuts will result in a massive exodus from the field of medicine to the field of plumbing.”
True but don’t you think there could be a mass exodus of older docs to retirement?

Dr. Linda M. MPH,MSN,ND,RN,CNC,CTN
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Dr. Linda M. MPH,MSN,ND,RN,CNC,CTN

I find it interesting that the first thing doctors do when they feel threatened is to take a cheap shot at nursing. The Physician Assistant was the answer to the growing threat and competence of Nurse Practitioners (NP). And why are NPs growing at an alarming rate? Because the NP serves a growing problem of physician vacanies in the rural communities, reservations, and other needed areas where physicians won’t go because they can’t get reimbursed for what they believe is fair medicine. It started in the early 70’s with the demise of “traditional fee-for-service,” doctors were no longer able to… Read more »

MD as HELL
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MD as HELL

Margalit,
You assume that getting through this is a good thing. What makes “flattening the world” a desirable thng? The President and his family are in the mountains of North Carolina on vacation as I write this. He is not in the flatlands. Nor did he get here by overland transportation. He flew.
Spending more resourses on healthcare is a losing proposition, flat or not. It will not add one thing to the future of our country or our economy.
We need to spend much less overall on all aspects of healthcare.