The Dumbing down of our profession

Thirty years ago our patients paid directly for our services. Those with health insurance sent in claims to their insurance for reimbursement. Health insurance at that time was true insurance. Reimbursement was for expensive medical bills, not for routine care. It covered large and catastrophic medical expenses. It is different today. People are enrolled in health plans that pay for routine medical care and expect that care to be paid for by these plans for a small cost. When physicians willingly contracted with these plans, so began the dumbing down of our noble profession.

Twenty years ago we were called physicians and the people we treated we referred to as our patients, family, friends and neighbors. What are they referred to as today?

· Covered lives
· Health Care Consumer
· Capitated life
· “Name the Insurer” patient
· HMO patient
· PPO patient

With our entry into managed care we gave up the management rights of our profession and handed it over to corporate CEO’s of the health insurance industry. These corporate CEO’s have managed to increase year to year revenues and profits on the backs of physicians, hospitals, patients, and employers. Profits of the health insurance industry is in the billions year to year and continues to increase while payments to those that provide the medical care decreases.

How much money is spent on the insurance infrastructure that does not go into patient care?

If we were to take half of these profits and unneeded infrastructure out of the equation, could we put it towards better use?

Lets see some of what this insurance infrastructure has created by looking at an entire new medical vocabulary.

· Provider
· In-network provider
· Out-of-network provider
· PCP – (primary care provider)
· Physician extenders
· Prescriber
· PBM’s – (Pharmacy Benefit Managers)
· Formularies
· Tier 1, 2 or 3 medications
· Generic equivalent
· Managed Care
· Capitation
· Copay
· Precertification
· Preauthorization
· Insurance referral
· Utilization review
· Quality Assurance
· Incentivize
· Pay for performance
· Third party payer
· Contractual adjustment
· Assignment
· Claims
· Payers
· DRG’s
· Universal Healthcare
· HIPPA

Did any of these words appear in any medical dictionary prior to managed care?

Do you evaluate any patients in your office without using one of the words listed above?

My father was a family doctor prior to managed care. Had he been alive today, but in a twenty year time bubble, he would not understand the mess we have gotten ourselves into. He would say, “Just treat your patient’s well and to the best of your ability, and you will have a good career, a good business and a good reputation in your community.”

How many of our medical offices today are run with my fathers thoughts in mind?

Instead we have reacted to this insurance system quagmire in many ways.

· We try to see more and more patients each day.
· We hire more clerical and billing staff to handle intrusive rules and regulations.
· We go to seminars that attempt to teach us cost-effective healthcare.
· We hire physician extenders.

Does any of the above help with patient care?

Can we really evaluate and treat our patients in the 8-10 minutes we give ourselves?

So we hire medical assistants, billing managers, office managers and health care consultants to help run our practice.

They all help in the day to day operations of our practice, but how much of their time is actually spent with patients, and how much time is spent pushing papers, or on the phone with an insurer, etc?

We go to seminars that tell us to use electronic billing, to buy an electronic medical record, to organize our office to comply with all the insurers and governments rules and regulations. Does any of this help in our evaluations of our patients?

They tell us how to see more patients per day, and how if we only stay open every weekend and five nights a week, that our practices will thrive. But I for one, enjoy my work, but I work to live, not live to work!

Nurse practitioners and physicians assistants are hired to medically evaluate our overflow of patients. Is this a good for our profession? Are we allowing physician extenders to become commonplace in our healthcare system? If we hire them, are we not giving our blessing that they can do our jobs as well as we can? In essence we are hiring our own replacements.

Big business has also reacted to high healthcare costs. Walk in clinics staffed by nurse practitioners and physician assistants are growing quickly. Walmart clinics, and Minute Clinics are in direct competition with family practitioners. They are treating the bread and butter illnesses of our patients, which accounts for a nice percentage of most offices revenues. Do we accept these clinics as inevitable, or do we devise a strategy to compete?

Can we compete?

Do we have the will to save ourselves?

Can we enlist any group to help?

Who will understand the most?

Who needs us the most?

Who is closest to us?

· Lawyers?
· Insurance industry?
· Politicians?
· Hospitals?
· Universities?
· Media?
· Congress?
· President?
· Governor?
· Democratic or Republican party?

Can you find ONE in the list that has any interest in helping our profession get out of this mess and make a better system?

Our patients are the one group that we must get on our side. This will not happen if all we do is complain, without offering solutions for high quality and affordable healthcare. We can abandon all third party payers but we must not abandon our patients. We can and must reform our healthcare system by returning the pricing power to the physician, cutting out the middleman, and return to the primacy/centrality of the doctor-patient relationship. It is a trend we as a profession must set by example.

With the presidential election approaching, and the candidates all proposing fixes to healthcare, setting an example with a unified front must not be a dream, but a reality. All of these have factored into the dumbing down of our profession in our eyes, our patients eyes and the government eyes. If we are to survive as a profession, we need to take control back. We must act to set the rules before we lose control of our profession forever.

Steven Horvitz, D.O.
Founder of The Institute for Medical Wellness