Thursday, September 13, 2012

Governance….is it in the Right Place?


There seems to be a similar problem with government and healthcare.

It comes down to governance. Congress and the executive branch seem to be inept at the least, incompetent, or at times malicious.

It is time to take back not only the United States, but healthcare as well. Our leaders despite their best attempts have failed and continue to fail.

I read a blog by a respected family physician yesterday, who has decided to leave the practice that he started almost 20 years ago. He is the type of physician who has always been an innovator, beginning with his use of EMR over 15 years ago. He is known for speaking at national meetings about the benefits of health IT long before there was an ONCHIT, or RHIOs and the ARRA and HITECH. You can read his story. He  articulates very well his consternation with his group practice which took on a life of it’s own and clearly sets his new goals with firm guidelines as to how it will operate.

Rob Lamberts MD has been a dedicated physician who has worked within a difficult system. ….he is making a healthy move for himself and his family. We cannot expect providers to operate in a health system for the betterment of their patients in a constant state of frustration which evolves into what I call a “traumatic stress disorder” We cannot expect more physicians to fall on their sword to overcome the enormity of what government has done to us all (in the name of balancing budgets, preventing fraud, proper coding, treatment paradigms and more. When I read of Dr. Lamberts decision I was ‘blown away’. He is not the type to make a compulsive move.  He has acted responsibly and given more than 90 days notice to his partners and patients, alike.

I cannot speak for Dr. Lamberts, it would be far easier to throw up one’s hands and go with the flow. He knows, he already had started a successful medical practice, investing hundreds of thousands of dollars, or more likely millions of dollars in his medical practice, adding new physicians, equipment, and facilities.  Anyone who has started a medical enterprise knows the pitfalls of taking on new associates. Contrary to popular opinion group practices can be more inefficient than small closely held or solo organizations.  Eliminating insurance will eliminate much overhead, and rightly give back that responsibility to those who buy it…the patient.  This one feature will engage and empower patients in their health care costs.

Before I digress further, let me close and stay on topic.

Good luck Rob Lamberts, M.D.  You are far from alone. I only hope that most on a new path will succeed. The next step is to leave medicine altogether, some get an MBA then become health care executives (at least they have choices then). Some will become ‘entrepreneurs”, some will become disabled, or retire early.

Health Care is much too important to allow politicians to control and make decisions which have repeatedly gone sour.  They ignore good advice, take direction from the wrong directions, from powerful self-interest groups, foundations, non profit organizations, academia, pharmacy and insurance conglomerates. 

Sometimes we wish for something and when we get it we realize what a mistake it is or was.  Perhaps now is that time to reassess what health reform should be, not what it is turning out to be.  As we step through meaningful use stage I, stage II and eventually stage III it becomes apparent how flawed PPACA has become. It was all there, but no competent people read it before it was passed by a highly partisan congress.  Each side was out for it’s own selfish motives, righteousness and truly unconcerned about the burdens and extent of PPACA.

Yes, it is time to retrieve our responsibilities as physicians to govern. Most of us were intensively trained in decision making.  As regulations increase bureaucracy increases exponentially, with increasing cost, complexity, and diminished accountability.

Numerous new forms of physicians practice have appeared, concierge practices, direct practices, and cash retainer practices.  All do away with the physician being responsible for processing insurance claims. 

The present situation evolved shortly after Medicare developed mandatory assignment with direct payment to the provider. Then it progressively became worse, fueling medical inflation.  Following the curve I expect the same will occur with Obama care….Although I want health care for all and affordability.  Obama care is wrong for our patients.


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