By Paul Goldfinger, MD, Editor @Blogfinger. Originally posted in 2014 non Blogfinger.net
About two years ago a large and prestigious cardiology group in Morristown, an independent organization which had been in existence for 50 years, was bought out by Atlantic Health, a mega-medical system akin to Meridian. The doctors in that group, all graduates of the finest training programs in the country, became hospital employees. They did that because they were forced to, not because they wanted to.
A cardiologist in that group told me that the Medicare reimbursements for office procedures and patient visits had been cut significantly and were much lower than the fees for such services provided at the hospital. So, because of the financial stresses, the group had to give up and sell out.
Their practice was destroyed by a roaring ill wind that has been rapidly blowing apart the private practice of medicine throughout the country, and that ill wind was created by the government (Obamacare) through Medicare payment reforms which force doctors out of private practice and favor the growth of corporate healthcare organizations such as Atlantic Health.
At Blogfinger we have been writing about this theme for the last three years: What will happen to the quality of healthcare and, more specifically, the doctor-patient relationship, as a result of the new government-driven system called Obamacare (aka Affordable Care Act–ACA ?) For awhile there were no answers, but now the truth is forcing itself out into the open. Instead of what they say, we are beginning to see what they do.
A decline in quality is already happening, and many of you have experienced either the loss of your regular doctor due to insurance limitations, or the reduced availability of care, or worrisome changes in how care is delivered. Some doctors have left or are planning to leave the profession.
In the Wall Street Journal on Dec. 7, an op-ed article by Scott Gottlieb, MD, an expert on health policy, appeared called “Obamacare’s Threat to Private Practice” *
A survey of 20,000 physicians found that only 35% were in independent practices compared to 62% in 2008. This shows how quickly the private practice of medicine is being dismantled.
Dr. Gottlieb says, “Right now, Medicare is paying much more for many procedures when performed in a hospital outpatient clinic rather than an independently owned medical office. Things as common as heart scans ($749 versus $503), colonoscopies ($876 versus $402) and even a 15-minute doctor visit ($124 versus $70) all pay more when done by a hospital-based doctor than a privately owned medical office. Obama officials know that hospitals are buying doctor practices to take advantage of this difference. But they favor hospital ownership of doctors and see it as a small cost to pay to drive that migration.”
He also says that Congress should remove the pervasive “biases in ObamaCare” that favor hospital ownership of medical practices.
Perhaps you are thinking, “Well, so what if doctors make less money and lose control of their practices?” There are a number of responses, but I would say that most doctors are, by nature, devoted to providing quality care and placing the welfare of their patients above all concerns. When they become employees, they lose much of the control over quality and they are disconnected from the feelings of responsibility that doctors in private practice typically have towards their patients. Most doctors would agree that medicine run by bottom-line oriented hospital corporations will result in reduced quality.
Wait and see what is coming in the future unless this trend is reversed.
Nov. 10, 2016 note: The situation has worsened since this piece was written in 2014. Medicare, which has been influenced heavily by Obamacare, is now in serious financial trouble, and ACA premiums are due to rise sharply.
The comments section from 2014 is quite good and can be added to now; especially in view of the sudden U turn about to happen in Washington. —-PG
2025 update. Blogfinger. net Obamacare provided access to health insurance under the name of the “Affordable Care Act.” but now the cost of insurance under this government program has risen dramatically due to a breakdown of government premium cost controls, and many patients will lose their coverage now.
As I predicted 10 years ago, quality care will decline for a variety of reasons which most of us have now experienced first hand.
Part of the situation includes shortages in all avenues of care including physicians and nurses; and failed management in the delivery of care both inpatient and out. And there is the massive increase in the number of covered individuals and families.
Also, the accelerated use of “mid-levels” being used as if they were as competent as doctors has proven that use to be a failure as seen through the eyes of professionals like me and patients/families with common sense.
And finally there are shortcomings currently revealed by modern communication methods including electronic medical records, AI medical analysis and reports, and the takeover of the whole system of private care by huge medical conglomerates which are run by businessmen who are clueless about how to do smart patient care. I heard of one company in the mid-west which controls over 100 hospitals.
One of the casualties of all this is the breakdown of the doctor-patient relationship; try and get your doctor to call you back or speak to you when you call. Instead you might get a PA or NP who will take a sloppy history over the phone, make a diagnosis, and then call in a prescription without telling your doctor what is going on.
As far as I am concerned, this is practicing medicine without a license. Starting with college, then medical school, then postgraduate training, I spend 13 years not counting military service developing knowledge and judgement that far exceeds what a NP on the phone has to offer.