Americans are so focused on the availability of health care provided by the Affordable Care Act that they completely overlook the quality of care they might receive. Government interference, intrusive mandates and cumbersome regulations are making it impossible to continue providing high-quality care.
Physicians across the nation have been planning for the worst, and an exodus of more than 100,000 doctors is expected by 2020. I will be closing the doors of my office in December after 32 years in surgical practice.
Patients will be lucky to see a physician because fewer will be available. The government does not recognize the term “physician” anymore. A fully trained doctor of medicine or doctor of osteopathic medicine who completed a residency and became board-certified will be rare because the lesser-trained licensed health care provider will be the norm.
Since the 1980s, my career has been riddled with regulations created by a government bent on controlling every aspect of patients’ lives. The coup de grace was delivered by the Affordable Care Act, but the blindfold was placed by President George W. Bush.
By executive order, Mr. Bush in 2004 created the position of national coordinator for health information technology. This allowed for the establishment of a health information technology storehouse. Funding for this came from President Obama’s American Recovery and Reinvestment Act of 2009.
To insure buy-in from all health care providers, the government had to create meaningful incentives, the first of these being marginal payback for compliance. What started out as voluntary soon became mandatory. While physicians may have received partial reimbursements from the government to equip their offices with the computer systems, these did not come close to meeting the costs of implementation.
Mandates meant as meaningful incentives are quickly turning into penalties. Physicians see deductions on already-lowered Medicare payments because of failure to use e-prescribing. They are threatened with further deductions if they do not have electronic medical records in place by 2014.
The practicing physician is buried in more mandates, more regulations and more penalties. As entry of patient data into the computer becomes more burdensome, it does not take long to discover that the system has been designed for auditing purposes, not for charting purposes.
Not only are health records no longer protected within the walls of a medical office, but physicians are complaining about the time consumption, computer errors and false sense of security created as a scheme rather than a service. One physician wrote on a blog, “It adds an hour of work to my day and makes my office notes sound like they were written by an imbecile.”
From the patient’s viewpoint, the physician has turned his attention to clicking computer keys with eyes glued to the screen. Data entry now takes priority over quality time.
The Affordable Care Act will finish driving the wedge between the doctor and the patient and put an end to a once-sacred relationship. Not only will the current mandates remain in place, but physicians will be inundated with the new insurance exchange identification numbers, authorizations, codes and denials.
My office staff puts the patient’s interest first and tries to follow Medicare guidelines, yet we have problems getting insurance carriers to cover routine procedures without writing letters and making myriad phone calls. With my upcoming retirement comes the relief of no longer screaming four-letter words into the phone at uneducated bureaucrats and medical directors committed to pigeonholing people and withholding care.
The health information technology storehouse gives the government more ammunition to track physicians, enforce new evidence-based standards and grade physicians accordingly. The grading, called “pay for performance,” will be another way for the government to cut costs under the guise of improving health care.
If the health care provider fails in a certain category such as infection rate or mortality rate, his reimbursement will be affected. With this type of incentive for physicians, high-risk patients will have difficulty finding access to quality care. The art of medicine is becoming the trade of medicine.
The health information technology storehouse and the Affordable Care will rip total control of patient care from the hands of physicians. Anyone who believes differently is as delusional as the congressional leaders who passed the legislation in the first place. Then again, no one bothered to read it.
Dr. Constance Uribe is a general surgeon and author of “The Health Care Provider’s Guide to Facing the Malpractice Deposition” (CRC Press, 1999).