Friday, January 08, 2010

Delusional (statements by) doctors

Lest I be accused of libel, note that I believe the following statements are delusional, not the actual physicians themselves. First, see this article. One of the Mayo Clinics in AZ will no longer be accepting Medicare patients. What is disturbing, however, is a statement by Robert Berenson, a fellow at the Urban Institute and proclaimed expert in Medicare. Apparently, when you are out of practice for some time (I did a limited search and had trouble finding out the last time he actually took care of patients but I bet it's been a while), it gets easier to make such blanket statements about the everyday doctor. From the article:

Robert Berenson, a fellow at the Urban Institute’s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care.

“Some primary care doctors don’t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.

This is some twisted, convoluted logic. Why does he think there aren't enough providers going into primary care? There are many reasons but one is certainly because they get paid less than specialists, which includes reimbursement from Medicare and other insurers. So, Dr. Berenson thinks that Medicare doesn't really underpay, it just looks like it does because other insurers pay more? That gets into the question of how much he thinks physicians should be compensated. What is the fair market value of a physician? Oh wait, he doesn't really believe in the market when it comes to the medical profession. After these ridiculous comments I did a little research and came across the following from a letter in the Journal of the American Medical Association, May 27, 2009 (subscription required; in response to original article January 21, 2009):

We did not express opposition to health care competition per se, but rather to a specific form of competition core to the "consumer-driven" approach that encourages patients to shop for discrete health services to find the best match of quality and costs.

Anytime someone says they don't agree with something per se, yeah, that means they don't agree with it but they're afraid to admit it outright in case others might think they're crazy. Then in the letter, they (includes Dr. Cassel, more on her later) use direct-to-consumer advertising of drugs with its evils as an example of why competition among physicians is concerning. Talk about a non sequitur. How are these even related? As mentioned before, they still completely ignore other areas of competition such as LASIK and cosmetic plastic surgery which has improved care while lowering rates with little insurance penetration (until lately).

I love how Berenson later quotes his own article to bolster his claim: "See, read this article from another smart man; what I'm saying is true."

The other part of the "they" is Christine Cassel, current president of the American Board of Internal Medicine which certifies most internists in this country, including me. Scary.

Berenson's comment on the "unlimited demand" for primary care MD's is equally bewildering. If there is such an unlimited demand for something, how is it that people are moving AWAY from it? Oh yeah, it's because you're trying to cut their pay. Completely opposite of free market but apparently this type of thinking is common. Note this comment by Senator Conrad recently:

And let me say, if I can, on this question of reducing Medicare, there are $500 billion of savings to Medicare. Most of those savings have been negotiated with the providers. They're going to get less than they were anticipating. They've agreed to those savings because they know they're going to get 30 million more customers. That is a dramatic increase in business for them, and they are sharing some of the savings so that we can pay for this bill. There's not unreasonable.

This kind of comment highlights how clueless non-physician legislators are about physician practices. As if physicians are just sitting around twiddling their thumbs and so excited about all these new patients that will be filling their offices. No, physician offices are typically busy. Why? Because of this unlimited demand? No, because they have to cram 40 patients a day into 15 minute slots in order to make a buck. And why do they have to do that? Because of overhead, administrative and insurance junk they have to deal with that take up so much time and money. Add to this complex patients, late patients, more insurance problems and a whole bunch of other junk and there you have your overflowing waiting room. No wonder why many doctors aren't taking insurance anymore. They can spend more time with patients, treat them properly and still break even. Here's one example.

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