DJP Update 3-10-2011 Important paper on practice of medicine
See tweets below. Go to link and read paper prepared by The Physicians Foundation (20 medical associations comprise this foundation – see start of paper)
DJP Comment: Now is the time for leadership to prevent the destruction of ethical science-based medicine. Let’s put the patient in charge and the physician as trusted advisor. How many alerts do we need!
Excerpt from paper’s executive summary:
The Patient Protection and Affordable Care Act (PPACA) and its potential effects on physician practice are wide ranging, fluid topics subject to a variety of interpretations and analyses.
Some of the conclusions (these are from the Executive Summary):
1) Health reform is comprised of two elements: “Informal reform,” (i.e., societal andeconomic trends exerting pressure on the current healthcare system independent of the
Patient Protection and Affordable Care Act), and “formal reform,” (i.e., the provisions contained in the Act itself).
2) The current iteration of health reform, both formal and informal, will have a transformative effect on the healthcare system. This time, reform will not be a “false dawn” analogous to the health reform movement of the 1990s, but will usher in substantive and lasting changes.
3) The independent, private physician practice model will be largely, though not uniformly, replaced.
4) Most physicians will be compelled to consolidate with other practitioners, become hospital employees, or align with large hospitals and health systems for capital, administrative and technical resources.
5) Emerging practice models will vary by region—one size will not fit all. Large, Accountable Care Organizations (ACOs), private practice medical homes, large independent groups, large aligned groups, community health centers (CHCs), concierge practices, and small aligned groups will proliferate.
6) Reform will drastically increase physician legal compliance obligations and potential liability under federal fraud and abuse statutes. Enhanced funding for enforcement, additional latitude for “whistleblowers” and the suspension of the government’s need to prove “intent” will create a compliance environment many physicians will find problematic.
7) Reform will exacerbate physician shortages, creating access issues for many patients. Primary care shortages and physician maldistribution will not be resolved. Physicians will need to redefine their roles and rethink delivery models in order to meet rising demand.
8) The imperative to care for more patients, to provide higher perceived quality, at less cost, with increased reporting and tracking demands, in an environment of high potential liability and problematic reimbursement, will put additional stress on physicians, particularly those in private practice. Some physicians will respond by opting out of private practice or by abandoning medicine altogether, contributing to the physician shortage.
9) The omission in reform of a “fix” to the Sustainable Growth Rate (SGR) formula and of liability reform will further disengage doctors from medicine and limit patient access. SGR is unlikely to be resolved by Congress and probably will be folded into new payment mechanisms sometime within the next five years.
10) Health reform was necessary and inevitable. The impetus of informal reform would likely have spurred many of the changes above, independent of formal reform. Net gains in coverage, quality and costs are to be hoped for, but the transition will be challenging to all physicians and onerous to many.
These and other conclusions are examined in more detail in this paper.
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THE IMPORTANCE OF TWITTER to learn of new happenings. Don’t rely on the talking heads on TV or pundits on radio.
I learned about this paper from a tweet by my son, the Exec Director/EVP of Medical Association of Georgia (MAG). His tweet is below and I retweeted. Get a free twitter account and follow those you agree with and those you don’t to get the news ahead of those who rely on newspapers and TV and radio.
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Impt! RT @DPalmisanoMAG: Great white paper.. #hcr & ..private practice physician prepared by.. Physicians’ Foundation http://bit.ly/fMYMFS
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DPalmisanoMAG Donald Palmisano Jr.
Great white paper on health care reform and the private practice physician prepared by the Physicians’ Foundation. http://bit.ly/fMYMFS
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Here is another link to the white paper: http://www.mag.org/pdfs/mha_foundation_whitepaper_1010.pdf
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Stay well,
Donald
P.S. Tomorrow is my trip to the operating room as a patient! Another great adventure! Glad this is national patient safety week.
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Donald J. Palmisano, MD, JD
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