Tag: Daniel Palestrant

(More) Madness in Massachusetts

Apr 22, 2010• 57

By DANIEL PALESTRANT, MD

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.

The Numbers Tell The Story

Mar 26, 2010• 12

By DANIEL PALESTRANT

Yesterday, athenahealth and Sermo released our Physician Sentiment Index℠ (PSI). With over 1,000 physicians polled, the national survey is thought to be the largest of its kind. While many of the findings will come as no surprise to physicians in practice, the messages are nevertheless alarming. Key findings include:

64% cited the current healthcare climate as somewhat or very detrimental to their delivery of quality care
Only 22% are optimistic about the ability of the American physician to practice independently or in small groups
59% are of the mind that the quality of medicine in America will decline in next five years; only 18% believe the quality of medicine will improve
The majority (54%) strongly disagree/disagree that more active government involvement in healthcare regulation can improve outcomes; less than a quarter feel otherwise
A shift from fee-for-service to pay-for-performance gives hope to almost half (49%) who think it will have a very/somewhat positive impact quality of care but;
- 53 percent believe pay-for-performance will have a negative/very negative impact on the effort required to get paid

View full PSI survey results (PDF)

Working with athenahealth and THCB, Sermo plans to publicize these findings to help the general public understand what is really happening in our healthcare system today and establish a sentiment indicator that can generate longitudinal trend data in this area. In the next phase of the athenahealth-Sermo relationship, we’ll be building off these findings to explore ways that physicians can run their practices more efficiently and level the playing field with insurers.

Daniel Palestrant, MD is the Founder & CEO of Sermo, Inc. A frequent contributor to THCB, his work also appears on the FtF blog at Sermo.com, where this piece first appeared.

Antitrust Warfare

Mar 2, 2010• 32

By Daniel Palestrant, MD

Not since the days of monopoly busting and Standard Oil has anti-trust been such a contentious topic in American politics. Today, Teddy Roosevelt has been replaced by Nancy Pelosi and the oil barons have been replaced by……doctors? The healthcare debate is quickly turning into a dog fight about monopolies and price controls, and in doing so, unveiling some of the dark truths about how the money really flows in this country’s largest industry.

Turns out antitrust law has become so contorted and subverted that it now serves the interests of those it was meant to regulate far more than those it was meant to protect. This past week, the FTC announced a consent decree with Roaring Fork IPA, a physician network in Colorado ( click here). Of course, this is less than a week after the Speaker of the House announced that she will pin her party’s hopes of resurrecting healthcare reform on repeal of the 1945 McCarran-Ferguson Act, a little known antitrust exemption that benefits the insurance industry ( click here).

So why has antitrust become all-the-rage-all-of-a-sudden? The Sherman Antitrust laws were originally intended to prevent monopoly behaviors, however, it has become a key tool in keeping physicians as indentured servants in our healthcare system. As Medicare continues to reduce payment rates, more and more providers are choosing to opt-out rather than contract to deliver services at a loss. Most notably, the Mayo Clinic chose to do this a few weeks back ( click here). What is fascinating, however, is that the FTC is claiming that the Roaring Fork’s decision (unlike Mayo’s) constitutes an anti-trust violation so egregious that it is worthy of an investigation and the consent decree. With 65 physicians, Roaring Fork represents well less than 1% of the physicians in Colorado, so why the anti-trust concern?

The answer lies in the cozy relationship between the insurance industry and the FTC. Insurers are determined to make sure that physicians are kept from having any leverage nor allowing market forces to create a balanced supply-demand between physicians and patients. The net goal of both is keeping physician payment artificially low, while maximizing insurance company profits. For physicians, Roaring Fork should be a wake up call to accelerate their efforts to decrease their dependence on third party payers and their adoption of technologies and services that can even the playing field.

Today we are witnessing a Kafka-esque sequence of events. Teddy Roosevelt, the original trust buster, would literally bust out laughing if he could see the incumbent political party pinning their hopes for their highest profile political effort on repeal of an anti-trust exemption, while the government chases after……..doctors, for ostensibly violating this same law. Only in America.

Daniel Palestrant is the CEO of Sermo, the social networking site for physicians. He is a regular contributor to THCB.

Can Social Media Save Healthcare Reform?

Oct 1, 2009• 2

By DANIEL PALESTRANT, MD

Daniel Palestrant is the Founder & CEO of Sermo, the largest online physician community, and a friend of THCB’s from the Health 2.0 world. Lately Dan has been seen on cable TV representing the 110K+ Sermo members in the health reform debate—including a very public break-up with Sermo’s former partners at the AMA, which has endorsed the House 3200 bill. I’ve been asking Dan, if his members’ don’t want the House bill, what do they want? This is the piece he sent me in reply—Matthew Holt

Speaking at Fortune’s Brainstorm Technology Conference last month, longtime healthcare reform advocate, Howard Dean pointed out that the “dirty secret” of social media is that it can put a whole lot of politicians out of business because it allows the truth to bubble up. For the sake of healthcare reform, let’s hope he is right.

True healthcare reform has no chance of occurring with the current political topography. As the general public tries to make sense of the 1,000+ page version of the bill and President Obama distances himself from Howard Dean’s raison d’etre, the public option, two things are becoming increasingly clear:

1. There is very little actual healthcare reform going on.

2 The insurance companies look like they will win, no matter what, especially if you believe the cover of the most recent Business Week “The Health Insurers Have Already Won”.

At Sermo.com we seem to be seeing Governor Dean’s prediction come true.