A window into the (near) future! Where's Your Doctor?
- From: Tick <oltick@xxxxxxx>
- Date: Tue, 21 Sep 2010 12:32:36 -0700 (PDT)
This is a supior read for those in the US wondering how much control
they will have over their own MS related decisions in the future.
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http://www.basilandspice.com/healthcare-issues/obamacare-2010-wheres-your-doctor.html
Obamacare 2010: Where's Your Doctor?
Sep 20, 2010
Jeffrey B. English, M.D.--
A window into the (near) future!
For over 3 years, candidate and President Obama promised the American
people that under his health care reform, people could keep their
doctors if they so chose. He didn’t say “most” people, he didn’t say
“some” people, he said “everyone” would be able to keep the doctor of
their choice. A few months before he signed the new law, he admitted
that this part of reform was somehow left out. Oops, I guess in all
the back room deals and closed meetings for over a year with Senator
Reid and Speaker Pelosi, they must have somehow misunderstood the
President’s promise. The President must be really mad now. He gave
direct orders to the Pelosi/Reid team to draft a law that allowed one
of his most important promises to the American people and apparently
they simply didn’t listen. In my office, an intentional mistake of
this proportion would most certainly lead to a few people losing their
jobs. (Maybe that will be the case on November 2nd for Nancy Pelosi
and Harry Reid.)
I “wear a few hats” in my career. I am a member of a private practice
group. My group has been serving patients from Kaiser Permanente in
Georgia for 20 years. These patients constitute about 15% of our
general neurology practice. I am also employed by a multiple
sclerosis center, a separate non-profit organization. Multiple
sclerosis (MS) is a chronic, potentially disabling condition of the
brain and spinal cord. About 50% of patients if left untreated, or if
partially treated, will develop progressive symptoms within 10 years.
We have effective medications to slow the disease. Most patients also
have many other symptoms that need continual management or they will
have severe impact on their lives. Because it is such a complex
chronic medical illness, there are about 150 neurologists nationally
that treat the majority of patients with multiple sclerosis.
Due to health care reform, Kaiser has decided to “internalize”
neurology (meaning they are hiring their own neurologists to take care
of patients with neurological diseases). I have a great deal of
respect for Kaiser in Georgia. Their hospital doctors are among the
best I have worked with and the philosophy of their healthcare model
is one of the best in the world. However, in the outpatient setting
their problem is the frequent migration of physicians. Over the
years, this has been the case with their neurologists. Many have come
and gone, which has lead many patients to be unhappy with their care.
The Kaiser patients have always rated their experience with our group
extremely high. I will never tell you that we are smarter than other
doctors, but I promise you that our work ethic and energy is second to
none. Patients greatly appreciate our efficiency and care. As of
November 1st, 2010, none of that history or patient satisfaction
matters. It doesn’t matter that many of them have severe, disabling
conditions that I have been managing for 10 years. The relationship
we established, the life threatening experiences I have shared with
them, the many emotional family meetings we have had together, do not
matter as “they do not get to choose their doctor if they want.”
This is a story you will hear a million times over once Obamacare is
implemented. Patients will have no choice whatsoever about who will
take care of them, no matter how complex their disease. The White
House health care team has explicitly told physicians that they will
be working as employees for “health homes.” These health homes
(called ACO’s or accountable care organizations) will be owned
predominantly by hospitals. Patients will have to assign themselves
to an ACO or one will be appointed for them depending on their
location. It won’t matter if you have a chronic, highly specialized
condition and the best physician may be employed in another ACO. You
will have no choice. All of your care will be dictated by the first
line medical professional at the ACO like (to quote the White House
team), “a nurse practitioner, physician assistant, care coordinator,
or dietician.” It is likely that your doctors in the ACO will move to
other jobs on a frequent basis, just like in the Kaiser system. Why?
Because they will be employees, not business owners, and they will
have nothing tying them down to an ACO like they do to their privately
owned practice.
The ACO idea is not a bad one and was not invented by President Obama
or the politicians. In essence, like in Kaiser, groups of physicians
of all specialties would work together to provide the best care at the
most affordable price. This would greatly reduce costs by reducing
over utilization of services, would open communication between
physicians, and limit unnecessary tests. I don’t know a single
physician who would not promote such a system. Why has this idea not
blossomed already? Because of the Government and the obstacles they
have placed to prohibit coordinated care for the last 30 years.
That’s right, the Government that is now asking us to trust them in
fixing the problems has been the major obstacle and source of
escalating health care costs for years. Do you trust them? How’s
that “get to keep your doctor” working out for you so far?
Even Kaiser realizes that a restrictive ACO model will not work for
them. They are allowing patients with multiple sclerosis to continue
to come to our MS Center. They realize that our Center is focused on
an expensive and disabling disease in a manner that cannot be
replicated internally. (I suspect it might also have something to do
with the fact that we take care of many of their employees and family
members who have MS.) Kaiser plans to allow a general neurology
appointment with my group if the time to see a Kaiser neurologist is
too long or if we have more expertise in the condition. This is not
likely to happen under Obamacare if it follows the path of many
socialized medical systems, like Great Britain. In Obamacare, our MS
center will have to fold under an ACO run by a hospital which will
represent only a fraction of patients in Georgia. Patients from
outside our system will not get the care they need and some will
likely become disabled sooner. (We have patients, by the way, that
understand the importance of care at our Center who come from almost
all 50 States.)
Nancy Pelosi and Harry Reid could have delivered the President’s
promise and still allowed an ACO idea to flourish. The Government
could have removed many of the anti-trust laws, allowed medical
systems to coordinate care, and set up standards for care and cost.
Standards have been developed already by most physician
organizations. These standards focus on tests, medications, and
care. There is no reason why physician organizations could not have
been required to develop standards across the board. Under this
system, coordinated efforts between doctors and hospitals would have
competed with one another to improve outcome and reduce costs.
Different models would have been developed and we could have learned
from the better ones. Patients would have had the power to choose
their ACO based on need, expertise, and cost. Many private ACO’s
would have been able to develop relationships with specialty centers,
like our MS Center, as it would be far more costs effective than
trying to duplicate such a service.
Why did this not happen? Because, the politicians who drafted
Obamacare did not want “different models.” Different models would
have meant choices for the people. Different, private, and
independent models would have meant the private market would have
prevailed and the Government takeover of the industry would not have
been possible. Government takeover of patient’s choices, health care
dollars, and lives would not have been possible. The reform of the
system would have been so easy with just a few simple laws if they
really wanted to improve the system and reduce costs. Do you think
the “get to keep your doctor” error was the only one
.
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