Daniel F. Craviotto: A Doctor’s Declaration of Independence – WSJ.com.
Common sense, a rare commodity. Regarding “Big Data”:
Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?
Duh… no. And guess what? It’s getting harder to make a living…
Meanwhile, our Medicare and Medicaid reimbursements have significantly declined, let alone kept up with inflation. In orthopedic surgery, for example, Medicare reimbursement for a total knee replacement decreased by about 68% between 1992 and 2010, based on the value of 1992 dollars. How can this be? Don’t doctors have control over what they charge for their services? For the most part, no. Our medical documentation is pored over and insurers and government then determine the appropriate level of reimbursement.
I suppose it’s possible Dr. Craviotto is being paid too much to start with…. but I doubt it. Which leads us to his proposed solution…
I don’t know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.
We could change the paradigm. We could as a group elect not to take any insurance, not to accept Medicare—many doctors are already taking these steps—and not to roll over time and time again. We have let nearly everyone trespass on the practice of medicine. Are we better for it? Has it improved quality? Do we have more of a voice at the table or less? Are we as physicians happier or more disgruntled then two years ago? Five years ago? Ten years ago?
Both hands clapping Dr .Craviatto. Let’s examine his questions:
- We have let nearly everyone trespass on the practice of medicine. Are we better for it?
Most likely not. Keep in mind the people pulling the strings are busy justifying their jobs.
- Has it improved quality?
Don’t know. Hospital’s are being penalized for re-admissions. If they can lower re-admissions will quality have been improved? Although the answer may well be yes, I don’t believe the case is nearly as straightforward as it appears.
- Do we have more of a voice at the table or less?
Don’t know but it’s certainly easy enough to believe the answer is a resounding LESS.
- Are we as physicians happier or more disgruntled then two years ago? Five years ago? Ten years ago?
Obviously I’m not a physician but the answer is self evident. A local case in point is that Boulder Community Hospital has pruchased a large number of small private practices as Obamacare has been implemented. I don’t think that’s the end game that many of these practices imagined. Also, I can’t imagine a scenario where the cost to the patient is going to be reduced by these purchases.
Dr. Craviotto recommends that physicians stop taking insurance. This is easier for doctors who see patients requiring low cost services. Think PCP docs. For an orthoped, can most people afford his services without insurance? Most likely not.
One things for certain, the future is murkey and the government will look for ways to punish those who don’t plan on playing along.
