Reforming the Government Physician Reimbursement System Is Good Medicine
As a presidential candidate, Senator Obama argued that you can’t “solve homelessness by mandating everybody buy a house.” Unfortunately, he took a different approach with the ACA. The common sense strategy of addressing the flaws in the current system and producing solutions that target them should serve as the foundation of the Trump administration’s efforts to lower costs and expand patient access. One perverse incentive that needs the scalpel is the government’s physician reimbursement system.
During the health care debate, proponents of the ACA spoke glowingly of the government’s reimbursement system. Yet, as a physician, I know Medicare’s and Medicaid’s reimbursement system are not these programs’ greatest strengths, but actually one of their greatest weaknesses.
Government payers reimburse providers based on price controls. Generally speaking, Medicare and Medicaid typically reimburse physicians at lower fees than private insurers. Often these reimbursements for care are less than the cost to deliver it. In 2014 their combined underpayment was $51 billion.
This reimbursement system along with the high operating costs of medical practice creates a dangerous lack of time and resources in the trenches. This compels physicians to see more patients in a day and can interfere with the ability of patients to get the time they may want or their medical issues may dictate.
In other industries, through payment, a seller and buyer come together to give the client the time he or she needs. If a customer requires a half hour, there is a half hour meeting. If a purchaser needs an hour, he gets an hour.
In medicine under the current reimbursement system, if a patient’s complex medical needs require a half hour of physician time, the patient generally gets a 15 or 20-minute appointment. If the patient needs an hour, the patient generally gets a 15 or 20-minute appointment.
I am sure many know the feeling of having a doctor visit with the physician at least figuratively, having one foot in the exam room and one foot out. This is frustrating for both doctors and patients. These time constraints can lead to patients not having the time to understand their diagnosis and treatment course. It can prevent patients from getting their questions and concerns addressed and hurt the patient-doctor relationship. This can leave patients unnecessarily confused, worried, and anxious.
By impacting the ability of doctors to connect, engage, support, and counsel their patients, time pressures hinder the ability of physicians to heal. They can foster poor compliance with treatment and compromise medical care. Insufficient time can also lead to medical errors and ordering more medical tests. While these inefficiencies stem from the government’s desire to save money, the unintended consequences they hasten ironically can be quite costly for society in both health and dollars. They are also drivers of physician dissatisfaction and burnout.
Research published in the American Journal of Public Health highlights these problems. According to the authors, it would take a primary care physician (PCP), 7.4 hours per working day to perform all the US Preventive Services Task Force A and B recommendations for a panel of patients. Keep in mind prevention is only one part of a PCP’s responsibilities. The research suggests an insurmountable task. Ultimately, it is the sickest, complicated patients who are hurt the most.
In repealing and replacing the ACA, the Trump administration should work to create a simpler government physician reimbursement system that better aligns scarce resources with demand. The new administration should also conduct a review of federal health care regulations to scale them back to lower costs, expand access, and fuel innovation. This will allow providers to dedicate more time to patient care and less time to government mandates. It would also allow hospitals and health systems to dedicate more resources to medical practice and less to administration, which should further give doctors more time and resources to help their patients.
If a patient’s complex medical illnesses require an hour of physician time, then the health care system and its reimbursement structure should give the patient an hour of time. Giving them anything less is anything but efficiency.