September 3, 2013

Is The Practice of Medicine Affected By ObamaCare?

Yes, the practice of medicine is being affected by the Patient Protection and Affordable Care Act, aka ObamaCare. In my reading, Kathleen Sebelius says anything good is because of the new healthcare reform. But when reporters ask about something not going right, she generally blames others.

I don't know how she will react to these figures, but they are not pretty by any stretch of the imagination. The source is The Apothecary/Congressional Research Service. This reports that the Obama administration compliance with the ACA statutory deadlines during the first three years of implementation. Deadlines completed on time or early 32 deadlines. Deadlines completed late counted 17; those not completed as of May 31, 2013 counted 24, and not completed due to lack of Congressional appropriations numbered 9.

I knew this would not please secretary Sebelius and I was right. Congress took the brunt of the blame for not authorizing funds for the personnel to complete the deadlines.

Most of the things the administration wanted will not happen, but the unintended things are happening. Some are good while others are bad. On the one side, consumer health care has been given an impetus and products are being produced that are unrelated to the accountable care model the administration is pushing. On the other side, hospitals are merging and acquiring doctors and this is making the market less competitive. This is causing gaming of third-party payment formulas and other things that are causing our health insurance premiums and taxes to become higher than they would have been.

The clearest explanation of the Obama administration desires for health reform comes from the Harvard Medical School and Professor Atul Gawande. He thinks that medicine should be more like engineering with all doctors following the same transcript and not exercising their individual judgments. This means the medical profession can no longer be individualistic, but like engineers building a mechanism whose parts actually fit together. These workings are to be more finely tuned and tweaked for better performance in providing aid and comfort to human beings.

With more doctors working for hospitals and other institutions, rather than in private practice, hospitals are using their doctors to obtain more money from Medicare. Although MedPac (Medicare Payment Advisory Commission) is finally taking notice, the practice may not be easy to stop. Yes, hospitals can charge more for the same services that the doctors can charge if they bill Medicare as independent practitioners.
Read the article in the New York Times about the fee schedules.

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