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Delray Beach, FL, Westport, MA, United States
Undergraduate degree, Colby College; MA in teaching, Columbia Teacher's College; former high school English teacher in three states; former owner of interior design co. with advanced degree from R.I. School of Design. Published first book in 2009 titled, MINOR LEAGUE MOM: A MOTHER'S JOURNEY THROUGH THE RED SOX FARM TEAMS. Her humorous manuscript titled ELDERLY PARENTS WITH ALL THEIR MARBLES: A SURVIVAL GUIDE FOR THE KIDS was published in June, 2014. In 2015 A SURVIVAL GUIDE won a gold medal in the self-help category at the Florida Authors & Publishers Association conference. See website By CLICKING HERE.

Wednesday, January 14, 2015

The Physician's "Squeeze"

As a person outside the medical community, I want to mention a couple of scenarios I've read about that are emerging in this country affecting physicians.  Much of this information is based on a report by Dr. Sandeep Jauhar (author of Intern: A Doctor's Initiation, 2009) in SaturdayEveningPost.com (Jan.-Feb.'15, pgs. 34-38, 78).

Let's start with where the U.S. ranks in life expectancy among developed nations - #45 - according to a report by The Commonwealth Fund, a healthcare research group.

If you live in Miami, Medicare will spend $8414/person/year versus $3341/person/year in Minneapolis. Why?  A large supply of doctors in Miami means more per capita utilization of services and testing, hospitalizations, and intensive care stays.

Doctors in this country are reimbursed for whatever they bill.  They're paid separately by insurers for patient visits.  As long as their patients are in the hospital, doctors can bill and be paid for each visit. In our healthcare system, "if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur."
(SaturdayEveningPost.com, Jan.-Feb., '15, p. 36).

Volume counts.  Fear of lawsuits creates volume in terms of services (some unnecessary) and referrals.  Better-informed patients might be the most potent restraint for over-utilization.

Here's the other side of the coin.  According to Dr. Jauhar, he was under pressure
at Long Island Jewish Medical Center to reduce the length of stay of patients
hospitalized with heart failure.  The shorter the patient's stay, the more the hospital's costs were reduced (associated with less use of hospital resources during a shorter stay).

It's a physician's squeeze.

The result?

Doctors are trying to sell their practices; uncompensated care is growing; admissions and elective procedures (money makers) are declining; and hospitals are cutting costs, staff, and services.

Dr. Jauhar suggests several options:
          - Hire doctors as employees and put them on salary, removing incentives to
          - Use bundled payments for packages (an entire hospitalization, for example),
            rather than discrete services
          - Move to an "accountable care organization" in which teams of doctors would
             be responsible (and paid) for patients' clinical outcomes.  Most doctors have
             performed poorly in such situations. (pg. 38)

A recent Time magazine article by Steven Brill  (Jan. 19, 2015) suggests another option:
          - The University of Pittsburgh Medical Center's model (Brill also cites the
            Cleveland Clinic's model, a 75-facility enterprise)
             in which hospitals, doctors, clinics, AND INSURANCE COMPANY would be
             under one roof.  Tight regulations for these conglomerates, mostly through
             use of
             federal anti-trust laws and state regulatory authority, would ensure their
             accountability.  The in-house insurance company
             would have the incentive to control the doctors' and hospitals' costs
             AS WELL AS the means to do so. There would be less incentive to
             inflate costs or overtreat, because the in-house "boss" would get the bill
             through the insurance company.



  1. Thanks for sharing tis information, Pam. Would that the health care consumer knew more of this information. Until we address end of life decisions and tort reform, I believe the cost of care through the well-intentioned Obama mandates, will go through the roof. And the burden of paying... why the tax dollars of companies and the US citizens of course. Watch out!
    Oh one other thought... all local and federal workers should be in the Obamacare system!

  2. Thanks for your comments, Dr. Ed! Always enlightening to hear from someone in the health care community.