Medicare is not an auto dealer- it represents big government which unfortunately doesn’t play by the simple rules of supply and demand. We’ll agree on the above issue, which is why this year when my older partner retired, I’ve decided to stay solo, so as to pare down to the best paying patients and decrease my overall exposure to the socialized medicine plans that are coming down the road. This is the reason why I’m telling my son and those that I care about to NOT go into medicine.

When an entity (CMS/Medicare) cuts what it pays its providers and demands increased bureaucracy without paying for that effort, then this will restrict the capability of the system of providers from providing the needed services. In 10 years there will be a shortfall of some 150000 providers. Where is that going to come from? If things continue to progress in this manner, I feel that the shortage will be larger, and as seen in Massachusetts, the waiting lines will reach some 60 days or so just to see a PCP.

Al

Al, I don’t think the statistics bear that out.
The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the [WHO]report finds.

I’m not trying to get into a “pissing” match, just pointing out that when a larger purchaser of any product (cars, healthcare, etc.) wants deliverables a certain way, that’s what they’ll likely get. Look what happened in the auto industry. Suppliers who wanted to stay in the game, had to march to the Autos tune. You are a supplier. Medicare is a buyer of your services. That means they have a right to ask their suppliers to use certain tools, meet certain threshholds, etc. etc. You always have the right to provide or withhold the services you produce, but it may limit those who will buy from you. Just the facts.

There are many rumors, and the one that would really piss me off is if my state of Virginia goes the route of West Virginia and Massachusetts, both of who are contemplating forcing physicians to see these Medicare/Medicaid (M/M) patients as part of the licensure process. In 1985 the MA Med Society and the AMA lost a decision concerning balanced billing. It went all the way up to the Supreme Court, which refused to hear it. Now “anti-social acts” which in 1985 was specifically about balanced billing to what is being added on now- refusing to see the elderly or the poor, even if it puts physician offices out of business, is synonymous with “unfitness,” and can be added as a prerequisite to being licensed. The Massachusetts bill, which failed to be enacted, is about forcing participation and actually seeing a certain amount of M/M patients, s.a. 15% of one’s practice. This type of forced-servitude bill means that the physicians’ license to practice medicine is held in servitude to state-perceived medical needs. If it eventually does pass, these M/M patients would invariably be given exact 5-10 minute slots and be seen universally by PAs and NPs. They would be forced to wait for hours. It wouldn’t be a pretty sight. Slavery supposedly died 150 years ago- I’m surprised that it’s being resurrected again.

>>> it’s time ALL healthcare clinicians “get over it” and start using tools that benefit patient care.

The scientific method still is pertinent- show me a randomized, prospective study pitting the EHR vs a “basic EMR” and/or paper with the end point being not just “benefit patient care” but actually decreased errors, increased quality, decreased costs, and most importantly, an increased survival benefit and I’ll be the first to go on-board with the EHR concept. Many of the studies that I’ve read show either no statistical difference or a worsening of all of these parameters with the use of EHR.

RustBeltFan, we don’t need to “get there” just because vendors will benefit economically from physician usage of their products. We don’t need to have heavily lobbied politicians trying to force one industry (physicians) to capitulate to another (vendors) just because of a perceived future windfall for the latter. That’s not right and it’ll never work- docs will see right through it and not buy-in.

The fact remains that healthcare in the USA is the best in the world. Stop trying to fix something that’s not broken.

AL

While that is certainly the route some will choose, I doubt it will be en masse. This statement also presumes that HMOs and PPOs don’t jump on the bandwagon and require their providers to be meaningful users of EHR.
And from I’m hearing, that is NOT the direction Health Plans are going. Honestly, it’s time ALL healthcare clinicians “get over it” and start using tools that benefit patient care. I know they’re not perfect yet, but we are at least moving forward. The sooner we can all work together (that means vendors, providers, health plans, consultants, government, etc. etc.) the faster we’ll get there and the better off we’ll all be. We’re not working together yet. We’re still in our separate corners. We’re still mostly focused on What’s In It For Me.

I doubt that it’ll be the 50% that is expected by 2015. The way I see it, we’ll see physicians drop Medicaid/Medicare en masse and the MU uptake will be no more than 20%, and possibly it’ll be much less.

Currently, according to CDC’s report which came out on 12/2009, only 6.3% of physicians have an EHR and are using it in a meaningful way. All I see is an all-or-nothing HITECH Act set of rules that currently hover at an open-book 864 pages which will expand as it enters into the more onerous phase 2 then phase 3. It reimburses physicians not unlike that of computer parts venders that employ “rebates” which notoriously pay out at a 17% level, using 3rd parties. The past P4P Medicare experiments likewise paid out poorly, at a 20% level in one and at a 40% level in another but those that got paid in the latter one averaged only $600 for their troubles over the course of a whole year. Medicare will likewise rely on 3rd parties to administer their HITECH program.

It’s just much simpler to get rid of all of one’s Medicaid and Medicare patients and either go cash only or see younger HMO and PPO patients. If we’re not allowed to do that, many physicians that I know of will simply retire and go on into alternative careers. End of story…

Al