The Ten Questions Walter Cronkite Would Have Asked About Health Care Reform by Kenneth A. Fisher, M.D. - HTML preview

Introduction

Since the inception of Medicare/Medicaid we have developed a unique medical culture. We now practice an exceptionally expensive style of medicine. In many cases we reluctantly provide non-beneficial inappropriate care. The new health care law, The Patient Protection and Affordable Care Act is in effect a health insurance law aimed at nearly universal coverage. It is financed in large part by decreases in Medicare funding, targeting mostly physicians and hospitals.

Unfortunately this law was not predicated at understanding the reasons why we spend so much per patient and did not make real attempts to address this. The savings could then have been used for funding universal coverage.

This survey is meant to help practicing physicians express their views about our medical societies’ role in health care reform, define the fundamentals of why we spend so much/patient and suggest the tools we would need to practice excellent cost-effective medicine.

In response to The Patient Protection and Affordable Care Act, I asked physicians and medical students to complete this survey. It should not be considered professionally done; it is informal and suggestive only.

With enough physician participation I am hoping our voice will be heard by the public and in the halls of Congress.

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Highlights from the National Survey, To Date:

1. Three quarters responding did not think medical societies did a good job in representing physician interests.

2. The three reasons why our medical care is so expensive chosen by three quarters or more by the respondents were:

a. The public practices bad health habits

b. There is a lack of coordinated care for many patients with chronic disease

c. There is a fear of adverse legal action

3. The three reforms thought by a significant majority that would help physicians practice a more efficient style of medicine are: a. A single national computerized medical record with appropriate privacy safeguards. This was chosen by over eighty percent and is extremely significant. Instead of every office, group and hospital having their own computer system at great cost to the government this opinion is for a central national system that would allow for review from anywhere in the country. This type of system could be paid for by modest user fees and thus would be at no cost to the government.

b. A payment schedule that would allow primary care doctors to spend at least one half hour in the office with each patient and at least a few visits when their patients are hospitalized. This idea received a two thirds majority.

c. Sixty percent were in favor of a physician & nurse committee serving as timely consultants to help insure that we deliver only beneficial care and protect physicians from the threat of legal action.

4. So far exactly two thirds of physicians stated that if Medicare decreased payments they would see fewer of those patients. This is especially relevant since over five hundred billion dollars over the next ten years is to be taken from Medicare to pay for about half of the costs of the new health reform law.

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5. Over two thirds of respondents were in favor of having each generation pay for its own benefits and not depend on succeeding generations. The same percentage were in favor of this being accomplished by having health saving accounts for out-patient medicine and commercial or government insurance (Medicare/Medicaid) for more costly items and inpatient care.

6. Three quarters of those participating in the survey agreed that drug and device funded research should go through a third party (i.e. The National Institutes of Health) to insure adequate experimental design and reliability of results.

7. Three quarters of those participating in the survey agreed that drug and device funded research should go through a third party (i.e. The National Institutes of Health) to insure adequate experimental design and reliability of results.

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The Survey

1. In what State do you practice?

2. How long in practice

• Still in training (medical school, residency, fellowship)

• Less than 5 years

• 5-20 years

• More than 20 years

3. Type of practice

• Hospital based

• Hospital owned practice

• Small independent practice, < 6 members

• Medium to large independent practice, > 6 members Your Views 4. Do you think physician interests were well represented by our medical societies during the deliberations in Congress as they created the PPACA?

o Yes

o No

5. In your opinion some of the reasons why our medical care is so expensive include (check all that apply):

• The public practices bad health habits

• The public has unrealistic expectations about what medicine can accomplish and the finality of the human life span

• The advent of medical advertising to the public leads to inappropriate demands and increases costs

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• The intense commercial lobbying of Congress causes the Medicare reimbursement system to encourage the overuse of lucrative procedures, technology and drugs

• There is a lack of coordinated care for many patients with chronic disease

• There is the fear of adverse legal action

• There is the delivery of a great deal of non-beneficial costly care

• There is confusion about the limits of patient autonomy

• other reasons

6. In your opinion, some of the tools and conditions that would facilitate physicians dealing with these issues would include (check all that apply):

• A single national computerized medical record with appropriate privacy safeguards

• An amendment to the Patient Self Determination Act which created advance directives to include the phrase, “within the bounds of good medical practice”, to help deal with unrealistic expectations

• A new advanced directive created at each hospital admission with the aid of the medical team to secure agreement and rationality

• A physician and nurse committee, serving as timely consultants, to help insure that we deliver only beneficial care and protect physicians from the threat of legal action

• The creation of a quasi-independent entity similar to the Federal Reserve Bank, thereby Removing Congress from the direct control of Medicare/Medicaid

• A payment schedule that would allow primary care physicians to spend one half hour in the office with each patient and at least a few visits when their patients are hospitalized

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• other tools

7. If indeed Medicare further decreases physicians’ payments would this cause you to see fewer Medicare patients?

o Yes

o No

8. Are you aware that there is cost shifting paid by those with private insurance to help subsidize Medicare and Medicaid?

o Yes

o No

9. In this era of changing demographics, would you support the concept that every generation should save for its own benefits and not depend on succeeding generations for support, i.e. the accumulation of funds in special tax free accounts?

o Yes

o No

10. Would you support health savings accounts for out-patient medicine and commercial or government insurance (Medicare/Medicaid) for more costly items and inpatient care?

o Yes

o No

11. Do you believe that drug & device funded research should go through a third party (i.e. The National Institutes of Health) to insure excellent experimental design and reliability of results?

o Yes

o No

Any thoughts or comments

Physician survey about the new health care reform law, The Patient Protection and Affordable Care Act (PPACA), the actual survey can be viewed at http://www.surveymonkey.com/s/makeyouropinioncount 135