Anybody Can Do That! by Pat Conrad MD


Imagine one day you notice a small blurring in one part of your field of vision, a distortion that no amount of staring, coffee, or eye rubbing will fix. What do you do?

The Obama Administration is proceeding with its long-term efforts to transform Medicare by moving large chunks of its fee-for-service payments to more malleable standards of pay based on “quality.”

A Bloomberg article tells us that “U.S. health secretary, Sylvia Mathews Burwell, announced Jan. 26 that she wants at least 30 percent of Medicare’s $362 billion in fee-for-service payments moved, by 2017, into new programs that demand accountability from doctors and hospitals and in some cases penalize them if their care doesn’t meet quality and efficiency standards. The fraction would rise to 50 percent by 2019.”

This article projects that specialists, most of whom get paid by the procedure, will get the short end of the stick while primary care docs will be paid “for work they haven’t historically been paid for doing, such as monitoring their patients’ health between office visits.”

This piece touts “thousands of primary-care physicians” joining programs created by the ACA that reward them for coordinating care, and encouraging them to remain in private practice, “even loaning money to small doctors’ offices for computer systems and staff to keep up with record-keeping.”

“This is a bless-your-heart day,” Doug Henley, the executive director of the American Academy of Family Physicians, said …Good primary care requires doctors to keep in touch with chronically ill patients … making sure they are taking medications, watching their diet, exercising and monitoring indicators of their health, Henley said.

“A fee-for-service system only incentivizes that face-to-face visit,” Henley said in a phone interview. “It doesn’t pay for any of that other stuff.””

I don’t know whether to curse a two-paragraph stream of profane invective, or just laugh bitterly. This is garbage on a collective scale, crap for a blind and stupid society. This is a bait and switch. This is a lie. These cost-shifting accounting gimmicks are a way to take money away from physicians, the same ones blasted by respondents to a column here several days ago as filthy rich predators. NO one is suggesting we decrease the number of administrators, Medicare/’Caid auditors, JCHAO inspections, or EHR requirements. In blogs a decade ago I was comparing organized family medicine to Vichy France, defeated cheerleaders for whatever was fed to them at gunpoint, just to survive. I have been proven right, and then some. The primary care docs who are dumb enough to think they are getting ahead will still have their own pay cut, and won’t have the specialists they counted on for their complex patients. The government – Bush, then Obama, it doesn’t matter – is pushed by a fearful society it created to provide for unlimited demand by restraining supply. Of course it can’t work, but in the short term it requires pitting generalists against specialists, and the minority loses…until everyone does.

And what about that blurry spot? It can be evaluated by a trained ophthalmologist of over forty years’ experience, my dad in fact, who is one of those evil specialists targeted in the last few years for cost savings. He invested in a specialized ultrasound that can take digitally compressed readings of the back of the eyeball and render 3-D images. That blurry spot, read as an adhesion stemming from chronic inflammatory disease, can be treated by the proper retinal specialist who can MANUALLY excise it, and restore total vision.

The photo above is of one such adhesion, taken by the old man. I’m a trained family doc and I think, a pretty damned good ER doc. On my best day, I’d be lucky to know how to even turn this machine on. I certainly could not interpret the results, nor do anything about them. The physicians that can are the ones we’ve decided to short, for the time being.

64570cookie-checkAnybody Can Do That! by Pat Conrad MD