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.