Wednesday, July 18, 2012

Patients, Doctors in Best Position to Mold Future of Medicine

Letter from McLennan County Medical Society President, Charles H. Stern, MD to his colleagues about last month's Supreme Court decision on the Patient Protection and Affordable Care Act (PPACA).

Two and half years ago, my Scott & White peers and I were charged by our University of Texas Executive MBA faculty to engage in a shared read of the Patient Protection and Affordable Care Act (PPACA). Parts of which were authored by Republicans and Democrats over the past 20 years. We had already spent weeks reviewing the status of US medical economics and factors that influence rising health care costs. Prior to reading the bill we were asked to consider the impact that such legislation would have on patients, physicians, medical education, business, insurance companies, and government entities.

Upon completion of this assignment, we spent several days presenting key aspects and highlights of the PPACA. Despite the differing political backgrounds in the class, we all felt philosophically that many of the ideas in the bill were worth consideration. We also agreed that the bill had some flaws and did not address other pertinent issues (e.g. tort reform, broken Medicare physician payment system, etc.). The biggest question we were left pondering was how would the more sensible elements be implemented with minimal bureaucracy and paid for in the most cost effective manner.

The Supreme Court decision regarding the PPACA generated a wide array of reactions ranging from anger and disappointment to satisfaction and elation. As a result the health care reform debate has accelerated.


Michael Speer, MD, Texas Medical Association President, stated, “Since day one that we need to find what's missing, keep what works, and fix what's broken in the new law. We absolutely must reduce the law's red tape and bureaucracy that interfere with patient care. Today's health care system is riddled with hundreds of regulations imposed by federal health law that do little to improve patient care, but instead divert our time and energy away from our patients."

The TMA and its member physicians recommend Congress and the Texas Legislature:
  • Protect important consumer insurance protections, such as insurance product labeling and protections for patients with preexisting conditions;
  • Immediately fix the broken Medicare physician payment formula;
  • Enact Texas-style liability reforms for the rest of the nation;
  • Allow Medicare patients to contract directly with their physicians for any covered service;
  • Scrap the Independent Payment Advisory Board;
  • Lift restrictions on physician hospital ownership;
  • Help fund the huge need for more physicians to care for America's growing elderly population; and
  • Rebuild the Medicaid physician network by enacting competitive Medicaid and Children's Health Insurance Program (CHIP) physician payments.

David Brooks of the New York Times remarks that, “People in both camps seem to agree: We’ve had a big argument about health care over the past several years, yet we haven’t tackled big issues like end-of–life issues, the medical malpractice system, and antiquated administrative systems.” “Crucially, we haven’t addressed the structural perversities that are driving the health care system into bankruptcy. Obamacare or no Obamacare, American health care is still distorted by a fee-for-service system that rewards quantity over quality and creates a gigantic incentive for inefficiency”.

No matter how one feels about the PPACA, health care reform is not going to go away. The unsustainable rise in health care costs and its impact on all factions of our society will dictate that. Never before in modern medical history has our medical profession been faced with such challenges. Soon, we must have open collaborative discussions and try to reach a reasonable consensus as to the path we will take in the future. We must explore, create and foster models of accessible health care delivery that are patient centric, improve the health of our population, and promote value and cost-effectiveness. We cannot afford to be passive. Physicians and patients are in the best position to mold the future of medicine. Now more than ever, I encourage you to become active in your medical society and organized medicine.

Charles H. Stern, MD
McLennan County Medical Society President
Quality & Safety Director – S&W Department of Family Medicine


2 comments :

  1. Doctors, what can you say? Love ‘em and hate ‘em. The trouble I have is that unless it is something that they can figure out on a test fairly easy, they don’t really want to have anything to do with you after a while. Someone once said that doctors do become frustrated when they can’t help a patient and actually do want them to look somewhere else. Fine, but at least find a decent way to give patients a heads-up on that vs. rolling their eyes, or sighing repeatedly, or saying things like, “I’m not impressed with your symptoms,” etc. Something like that could really backfire. I’ve had a lot of problems with complicated or sensory migraines for years, with nothing really showing up on any scans. I managed to avoid the ER room for quite a while, but finally after one bad bought that involved aphasia only on my left side and pain in my left thigh, I finally went to the ER. Wound up being nothing major, but when I followed up with my primary physician, she acted like I was a nut-case, and even stated “she wasn’t impressed.” (I didn’t want another scan; I wanted something for the pain.) This was after seeing this physician for ten years. Definitely time to find another doctor. Sad.

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  2. Can you say "irrelevant" to the discussion...?

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