Physicians, Shouldering the Brunt, Carry On

By George W. Chapman, MBA

I have worked with physicians, as an administrator or consultant, in every type of healthcare setting including: primary care, specialty care, community and regional hospitals, health centers, clinics, for profit, not for profit, urban and rural for my entire career. At no time have I been more impressed by their professionalism, fortitude, resiliency, adaptability and yes, sanity, as I am now.

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U.S. Pacific Fleet via Compfight

Unbeknownst to most people, your physician has managed to carry on and provide you with excellent care while shouldering the brunt of the most radical and comprehensive (but well intentioned) changes in their industry since Medicare. Despite the virtual healthcare war being waged in congress and all the uncertainty in the industry it creates, your physician continues to provide excellent care and remains your best advocate.      

The Patient Protection and Affordable Care Act of 2010, or ACA, set into motion dramatic, pervasive and unproven changes in how healthcare will be organized, delivered and reimbursed. It will impact all of us, regardless of age or insurance. But most consumers would never know that because the press and politicians have focused almost exclusively on the exchanges.

The exchanges are a relatively small component of the entire Act. Of the 20 million people who receive their insurance because of the ACA, 7 million are on expanded Medicaid which leaves only 13 million out of 320 million of us (4%) purchasing individual insurance from a commercial insurance company on the exchange. The obsession with the premiums and carriers offering insurance on the exchanges has totally overshadowed the rest of the ACA which impacts us ALL. There is much more at stake for physicians, hospitals, payers and all 320 million of us than just the exchanges.  Some background is in order.

Prior to the ACA, there was general consensus among the “players” (physicians, hospitals, insurers, government, employers) that our fragmented and super expensive US healthcare system had to change. Healthcare costs us over $3.2 trillion annually or about $10,000 per person which is more than double the per capita costs in Germany, Sweden, Canada, France, Australia and Japan. The ACA was developed with input from all the players. But because everyone had vested interests to protect, what we got was compromise, not a perfect solution, and we all know how hard it is to keep everyone happy. So what happened?

The ACA became a political football and critics quickly dubbed it “ObamaCare”. When Medicare was passed into law in 1965, it wasn’t dubbed “JohnsonCare”. We all know the more political anything becomes, the more irrational, divisive, emotional and uncivil the discourse. Facts are twisted or spun if not totally ignored and the search for blame and the development of straw man arguments begin. There is far more to the ACA, and its impact on physicians in particular, than meets the public eye.    

Hundreds of billions have been invested by the players in preparation for the changes, agreed upon in principle, to improve affordability, access and quality. “Triple Aim” is the mantra of system reform: improve overall health, enhance the experience of receiving care and lower costs. Six years into the ACA, just about every horse is out of the barn.

Repealing and replacing the ACA would be like canceling an important experiment before the results were in. The ACA has been rolled out in phases and will continue to be rolled out until 2022. We are half way. Because of all that has been invested so far, none of the critical players in healthcare (physicians, hospitals, insurers), is actively lobbying Congress to kill the ACA. Too much money has been invested in complying with the ACA, especially by physicians and hospitals. Our healthcare system will take time to “fix” and starting over or introducing new legislation half way through the 12 year ACA experiment makes no sense.

As politicians, pundits and analysts pontificate, and government agencies regulate, and “big insurance” and “big pharma” bloviate about decreased profits, physicians have quietly scrambled to comply with the myriad of mandates and changes, all the while managing to take care of us. In order to get paid, or not be penalized, physicians have had to (for better or worse): master one or more electronic medical records systems; morph into “population managers”; transition from fee for service reimbursement to fee for quality or outcome; learn new and ever changing procedural and diagnostic coding; adhere to quality metrics and incentives that differ by third party payer; forfeit their autonomy by working with “care management teams”; affiliate with the alphabet soup of “health systems” out there such as ACOs (Accountable Care Organizations) and CINs (Clinically Integrated Networks); compete with retail clinics; incorporate telemedicine and on line access; and much more.

Factor in declining revenue and increasing expenses on top of all this and you can appreciate what physicians have had to deal with over the past few years. While physicians aren’t happy with every aspect of the ACA, most agree things had to change.

Despite all the regulations, mandates, confusion, and even uncertainty as to how they will eventually be paid, physicians do remarkably well according to their patients. A Harris poll from about a year ago revealed that 88% of those surveyed report they were “satisfied” with their most recent doctor visit. The aspects of a visit to the doctor’s office considered to be “very important” are: doctor’s training and expertise: 83%; doctor’s ability to access overall medical history: 65%; time spent with doctor: 58%; ease of making an appointment: 49%; efficient and simple billing process: 45%; ability to communicate with the doctor by phone or email: 44%; time spent waiting: 43%; convenience of office location: 40%; minimized paperwork 32%; office appearance: 31%.

To my knowledge, no other profession has had to endure more changes or more attacks on their autonomy than that of physician. Yet, they are exhibiting an uncanny ability to block all the “distractions” around them and focus on us in the exam room.

Physicians are a tough breed. They aren’t looking for our sympathy. Physicians are looking for us to be compliant and to take responsibility for our health. They want us to be active partners in our healthcare. Their success will depend on our success in the new reimbursement system.

Finally, I think a little understanding and appreciation are in order. Hopefully, you now have a little better idea of the conditions under which they are working. So… if your physician is running a bit behind or seems to rarely look up from his/her lap top, cut him/her some slack. Consider how they must carry on while shouldering the brunt of change.

Assumptions Good And Bad

I always hear about the horrors of assuming things. Everyone has heard the phrase about assuming makes an ass out of you and me. In general, I can’t disagree with that statement because we should always be as sure as possible about things in our lives.