ACOs Threaten Quality Medical Care

The PPACA is "nudging" doctors out of independent practice and into working as employees of large practice groups or hospitals. This move is occurring because of the bundled payment structure of Accountable Care Organizations (ACOs) which favors "vertical integration" of doctors, hospitals and health plans.

The only problem is that bundled payments are simply capitation rewritten, and employee physicians face divided loyalties between the needs of their employers and the desires/needs of their patients.

This arrangement is especially insidious when coupled with the ethics of "social justice" which gives a physician the moral OK to sacrifice his patients to the "greater good" of society. What is good medicine for the masses is often at direct odds with what is good for the individual patient--and thus, quality medical care suffers.

Resources:

For more on the PPACA effects on private practices see "Killing Marcus Welby: How ObamaCare stifles private practices" by Scott Gottlieb, MD, NY Post 10/18/100

For more on problems with the underlying assumptions for ACO's see "On Being Politically Incorrect and Realistically Correct about ACOs" by Richard Reece, MD at Medinnovation, 10/7/10

For more on the destructive effects of the concept of "Social Justice" on the availability of quality medical care, see Dr. Rich Fogoros at The Covert Rationing Blog.(multiple posts)

See also:'"Deconstructing ACOs" by John Goodman at John Goodman's Health Policy Blog, 8/18/10

In Defense of Physician Autonomy

Dr. Saul Greenfield, pediatric urologist and professor of medicine, wrote in the Sept. 7, 2010 WSJ:

In recent political debates, the autonomous physician has been portrayed as a problem to be solved, an out-of-control actor motivated by greed---and a major cause of rising health-care costs...

Physician autonomy is a major defense against those who comfortably sit in remote offices and make calculations based ont concerns other than an individual patient's welfare. Uniformity of practice is a nonsensical goal that fails to allow for differing expression of disease states.

this is not to say that critical research, randomized controlled trials, literature meta-analysis an guidelines are not necessary and useful. They are all essential...But we must recognize that many physicians will often make decisions that deliberately do not conform to "community standards"---and that patients will be better for it.

Dr. Greenfield correctly points out that quality medical care consists of physicians applying their independent assessments to the unique circumstances of each individual patient. Without autonomy, this goal can not be achieved.

Read the rest of what he writes "In Defense of Physician Autonomy."

Physician Debate at Stanford

The Federal Government or Free Market: Which Can Offer the Most Compassionate and Effective Health-Care Plan for America?

Four physicians will debate health care policy. I am thrilled to see compassion as the center of the debate. Proponents of greater government involvement in health care argue that it is necessary and right on the basis of caring for the disadvantaged. These arguments completely evade the facts that coercion is not compassionate, and central planning is not effective. This should be a lively and interesting debate.

More information.

Register on-line.

The Benjamin Rush Society presents this debate at

Stanford University School of Medicine
May 20, 2010, 6pm
Location: James H Clark Center Auditorium
318 Campus Dr
Stanford, CA 94304

Co-sponsored by:
Stanford Federalist Society (Stanford Law School)
Stanford Chapter of the American Medical Students’ Association (Stanford Med School)
The Latino Medical Students’ Association (Stanford Med School)
Stanford Emergency Medicine Interest Group (Stanford Medical School)
Stanford Health Care Club (Stanford Business School)

Paperwork vs. Patient Care

As the health care bureaucracy grows, so does the paperwork.

Paperwork, or documentation, takes up as much as a third of a physician’s workday; and for many practicing doctors, these administrative tasks have become increasingly intolerable, a source of deteriorating professional morale. Having become physicians in order to work with patients, doctors instead find themselves facing piles of charts and encounter and billing forms. –NYT 4/8/10

Paperwork is also taking more and more time away from patient contact and direct patient care during medical training-as much as 6 hours a day! This trend will only worsen with the recent massive increase in health care laws and regulation.

In 1965, when Congress created Medicare and Medicaid, the bill was 137 pages long… Thirty years later [the Mayo clinic] found 130,000 pages of rules they must comply with. –G-M Turner, 4/16/10

This time we are starting with a law over 2000 pages long which will create over 100 new federal agencies. Instead of spending time advancing medical expertise, how much time will physicians have to spend learning all the new regulations? (Especially now that coding errors are more likely to be interpreted as fraud and subject to felony changes. [2010HR 3590, Sec. 6402(f)(2)]

Medical training used to emphasize how to think in essentials and document only the information directly pertinent to the medical condition and care of the patient. This simplified future information retrieval–by oneself as well as medical colleagues. Now the essentials are buried in a morass of details required for payment and as protection against malpractice suits.

The switch to electronic records are no panacea as studies are showing they do not decrease administrative costs, only ”might modestly improve” quality of care provided, and may actually slow doctors down. In addition, electronic records combined with reporting requirements put patient privacy seriously at risk.

Doctors can spend time focusing on patients and their medical needs, or they can spend time being sure their paper trail is properly covered. More time on paper work means less time for patients.

Just one more way that the new laws are putting the government in between patients and their doctors.

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