Issues: Health Care – Regulations strangling the medical profession
by James Veltmeyer, MD | June 29, 2017
When I chose to commit over a decade of my life and incur hundreds of thousands of dollars of medical school debt to achieve my lifelong dream of becoming a doctor, I believed that my training and studies would permit me to heal the sick and save lives. I still want to believe that.
However, as any physician today can confirm, much of my time is now occupied with complying with rules, regulations and red tape imposed by government bureaucrats. It also entails begging for the approval of medically-necessary treatment from faceless insurance company operatives who force me to listen to Muzak when I should be attending to my patients.
One study in the American Journal of Emergency Medicine found that emergency room doctors spend 43 percent of their time entering electronic records, but only 28 percent with patients. Most doctors I know say they spend 70 to 80 percent of their time entering clinical data and documentation. The Direct Primary Care Coalition estimates that 40 percent of all primary care revenue goes to claims processing and profit for insurance companies.
The problem has become so serious that thousands of doctors are leaving or considering leaving the profession. This has worsened since the arrival of Obamacare with its mandated Electronic Health Records requirement. With a pricetag of $27 billion, the EHR mandate has resulted in many small medical practices closing up and physicians either taking early retirements or selling out to corporate medical or hospital groups in order to afford the cost of converting to electronic records. Doctors are literally extorted to go “paperless” by having their Medicare payments cut if they do not.
That’s just one example.
Let’s take a look at the coding monstrosity. In the 1980s, Medicare imposed price controls (i.e., socialism) on doctors who treated the elderly. The controls forced us to use complicated coding classifications to submit our claims to the government. The codes were tied to a fee schedule. Hospitals were required to submit to a similar coding system. This process has not only forced doctors to try to fit round pegs into square holes, consuming vast amounts of time that could be better spent with patients, but it incentivized hospitals to submit as many diagnostic codes as possible to the government in order to increase the “Medicare payday.”
Private insurers soon followed the Medicare example and imposed coding regulations on physicians. By making their income dependent on how much they could bill the insurance companies, many doctors began spending more and more time focusing on navigating codes to generate revenue for their practice than spending time with their patients. Many medical practices actually employ coding specialists and maximizing profits from codes, which has become something of a cottage industry in some places.
Next, we had the rise of HMOs, PPOs and various sorts of networks which the insurance companies designed to ration care. Physicians, their staffs and patients spend endless hours trying to figure out if a certain doctor or hospital is “within the network” or not, often receiving contradictory information from the insurance company and the medical provider. Often, a patient will be assured that a doctor is “in network” only to find out later that wasn’t the case when a big unexpected bill arrives in the mail.
The current course in health care is unsustainable. It doesn’t work for patients or doctors. It does work for government MediCrats, insurance companies and giant hospitals.
The answer can be found in the direct-payer health care reform known as the Medical Association Membership which frees doctors to treat their patients as their training, judgment and circumstances dictate, and gives patients the power to choose who provides their care and what it costs, not Washington, Sacramento or the highly-paid CEO of Anthem Blue Cross.
Dr. James Veltmeyer is a prominent La Jolla physician voted “Top Doctor” in San Diego County in 2012, 2014, 2016 and 2017. Dr. Veltmeyer can be reached at email@example.com
Dr. James Veltmeyer is Chief of the Department of Family Medicine at Sharp Grossmont Hospital in La Mesa, California. His views are his own and do not necessarily reflect the views of Sharp Grossmont Hospital or its staff. Dr. Veltmeyer can be reached at firstname.lastname@example.org