One of
Obamacare’s causes and effects has been the consolidation of physicians into
hospital groups, which decreases competition and most likely will result in
less access to rural and under-served areas
Recent attempts
to “fix” certain aspects of the Affordable Care Act have done little to address
the fundamental underly flaws of the massive “reform” law. Many of the reforms
that were approved over the summer by House and Senate leaders are likely to be
advanced in the new Congress when it meets in January, but they largely adopt
many of the Medicare payment reforms that are already in the Obamacare law,
according to Dr. Scott Gottlieb, M.D., of the American Enterprise Institute.
Leaders of both
chambers – who are lawyers, mostly, not doctors – back the consolidation of
physicians who previously operated their own independent clinics into salaried
positions within larger hospital groups and institutions, which in effect ends
those independent medical practices.
In other words,
one of the most under-served communities around the country – America’s
small towns and rural counties – will be affected most by this consolidation,
meaning people living in those areas will have even less access to medical care
than they do now – and this, at the same time that a provision of Obamacare
serves to forgive up to $50,000 in school loans for physician assistants and
advanced practice nurses who work in underserved areas for two years.
“Republicans
must embrace a different vision to this forced reorganization of how medicine
is practiced in America if they want to offer an alternative to Obamacare,”
Gottlieb writes in The Wall Street Journal. “The law’s defenders view this consolidation as a
necessary step to enable payment provisions that shift the financial risk of
delivering medical care onto providers and away from government programs like
Medicare. The law’s architects believe that doctors, to better bear financial
risk, need to be part of larger, and presumably better-capitalized
institutions. Indeed, the law has already gone a long way in achieving that
outcome.”
He goes onto
note that a recent Physicians Foundation survey of nearly 20,000 doctors found
that 35 percent described themselves as independent – a figure that is down
from 49 percent just a few years ago (2012), and 62 percent in 2008, before the
Obamacare mess. Gottlieb observes that once most doctors become
consolidated and affiliated, “the continued advance of the Obamacare agenda
will become virtually unstoppable.”
It’s hard to
imagine that the masterminds who wrote the Affordable Care Act legislation did
not consider this potentiality, but even if they did not, the cause-and-effect
nature of forcing more onerous regulation on this very large sector of the
economy matters little in the great scheme of things because the transformation
will have taken place nonetheless; once consolidated, as Gottlieb opines, it
will be nearly impossible for a physician to become non-aligned.
“Local
competition between providers, who vie to contract with health plans, is
largely eliminated by these consolidated health systems,” he writes. “Since all
health care is local, the lack of competition will soon make it much harder to
implement a market-based alternative to Obamacare. The resulting medical
monopolies will make more regulation the most obvious solution to the inevitable
cost and quality problems.”
Keeping
physicians much more independent would actually serve patients – and
taxpayers – much better because it would preserve local competition between
doctors, and provide patients with more choice (choice in abortion, yes, but
choice in healthcare, no, say the progressives).
Obamacare-related
consolidation all part of trying to stay financially viable. Physicians and
hospitals increasingly relied on some form of government payment to stay
afloat; Obamacare puts that reliance on steroids by exploding Medicaid rolls
(and remember, between Medicaid, Medicare and the VA, the federal government
was already the nation’s largest purchaser of healthcare services).
A better
solution, Gottlieb observes, would consist primarily of getting Uncle Sam out
of the business of healthcare purchasing (but that, of course, is anathema to
authoritarian progressives).
“First,” he
writes, “Congress should remove the pervasive biases in Obamacare that favor
hospital ownership of medical practices. Payment reforms that create incentives
for the coordinated delivery of medical care (like Accountable Care
Organizations and payment “bundles”) all turn on arrangements where a single
institution owns the doctors. They’re biased against less centralized engagements
where independent doctors enter into contractual relationships among
themselves.”
Such “bundles,”
are a sort of “back to the future” adaptation of 1990s health care policy (a
transformation which, again, was triggered by federal rules). The current
Obamacare payment reforms mimic 1990s-style health maintenance organizations
(HMOs), in which institutions like hospitals would receive a lump-sum payment
from Medicare (now Obamacare) for their acceptance of the risk of caring
for a large pool of patients. However, now these payment schemes, Gottlieb
observes, are much tilted in favor of having hospitals pool the risk, not a
looser network of physicians.
“For one thing,
providers who want to participate in the ‘reformed’ physician payment plan must
control their own IT infrastructure to comply, as opposed to collaborating
freely across space rented in the cloud,” he writes. In other words, there are
“incentives” in Obamacare to force private practices to adopt electronic
medical records (to enhance payment), but such systems are expensive.
“This practical
need can require IT infrastructure that costs millions of dollars. It makes
participation absurdly expensive for anyone but a hospital that already has its
own server hub,” says Gottlieb.
He further
notes:
Also,
waivers of certain anti-kickback provisions (that prevent doctors from forming
needed business partnerships) only apply when providers qualify as an
Accountable Care Organization. Not surprisingly, ACO qualification is largely
dependent on requirements that create the same need for physical infrastructure
and bureaucratic overhead that is hard to replicate outside the hospital
setting.
Real reforms,
he went onto say, would come in the form of enhancing – not discouraging –
private independent practice, something that rural areas and small towns
desperately need.
“To implement
real reform, Congress must give independent, private-practice doctors an equal
footing. One legislative proposal would let a new class of ‘independent risk
managers’ act as third parties to help individual doctors analyze and share the
risk of caring for these patient pools,” says Gottlieb. “This would make it
possible for independent medical offices to band together and bid against
hospitals for a pool of patients. Private companies specializing in analyzing
and pricing medical risk could serve as brokers and help the doctors know what
they’re getting into. But Obamacare deliberately crowds out this sort of market
innovation in favor of hospitals and their existing networks.”
Gottlieb says
that when he talks to colleagues, whether they are Republicans or Democrats,
they say the strains on their profession would be the same with or without
Obamacare. That is a reasonable assertion, given the federal government’s
historic, overly bureaucratic micromanagement of the healthcare industry
(scrutiny and rule making which does not similarly hamper the legal
industry). But he says that isn’t the case at all, because Obamacare has not
only accelerated some of the worst regulatory trends in health care, but has
introduced new ones as well.
Do YOU believe the GOP-led Congress will seriously move to mitigate
some of Obamacare’s worst provisions? Do you think minority Democrats – most of
whom voted for the law to begin with – will feel the heat from
constituents to side with Republicans? What do think President Obama will do –
go along with, or veto, any changes? INFORM THE DEBATE below!
Source:http://absoluterights.com/is-obamacare-eliminating-your-small-town-doctor/
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