22.4.14

THE PHYSICIAN'S HAMSTER WHEEL.

Brought to you by the Medicare monopsony.
Patients — and physicians — say they feel the time crunch as never before as doctors rush through appointments as if on roller skates to see more patients and perform more procedures to make up for flat or declining reimbursements.

It's not unusual for primary care doctors' appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they've been asked to see patients every 11 minutes.

And the problem may worsen as millions of consumers who gained health coverage through the Affordable Care Act begin to seek care — some of whom may have seen doctors rarely, if at all, and have a slew of untreated problems.

"Doctors have one eye on the patient, and one eye on the clock," said David Rothman, who studies the history of medicine at Columbia University's College of Physicians and Surgeons.

By all accounts, short visits take a toll on the doctor-patient relationship, which is considered a key ingredient of good care, and may represent a missed opportunity for getting patients more actively involved in their own health. There is less of a dialogue between patient and doctor, studies show, increasing the odds patients will leave the office frustrated.
So help me out, dear reader.  Wal-Mart bends the cost curve by squeezing its vendors and having the help do work off the clock, and it's a bad thing.  Congress authorizes the Secretary of Health and Human Services to issue regulations to squeeze vendors and have the help do work off the clock, and it's in the public interest.
No one knows exactly why 15 minutes became the norm, but many experts trace the time crunch back to Medicare's 1992 adoption of a byzantine formula that relies on "relative value units," or RVUs, to calculate doctors' fees.

That was a switch for Medicare, which had previously paid physicians based on prevailing or so-called usual and customary fees. But runaway inflation and widespread inequities dictated a change. RVUs were supposed to take into account the physician's effort and cost of running a practice, not necessarily how much time he or she spent with patients.

The typical office visit for a primary care patient was pegged at 1.3 RVUs, and the American Medical Association coding guidelines for that type of visit suggested a 15-minute consult.

Private insurers, in turn, piggybacked on Medicare's fee schedule, said Princeton health economist Uwe Reinhardt. Then, in the 1990s, he said, "managed care came in and hit doctors with brutal force."

Doctors who participated in managed care networks had to give insurers discounts on their rates; in exchange, the insurers promised to steer ever more patients their way. To avoid income cuts, Reinhardt said, "doctors had to see more patients — instead of doing three an hour, they did four."
Typical quantitative nonsense. It's easier to measure patients seen or patients per physician hour than it is to measure additional years of healthy life.  It's the error, though, of measuring inputs, not outputs.

Give an assist to  Craig Newmark, who anticipates that full implementation of Obama "Care" will require ever more aggressive efforts to end mutually beneficial trades between physicians fed up with the Obamanopsony and patients who will self-insure and pay the tax.  As it must, because in the eyes of the Anointed, universally lousy health care is preferable to any regime in which some citizens receive better care than others.

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