Survey: Pysicians reducing their hours/access

[Taco John]

Comprehensive Survey of 13,575 U.S. Physicians Points Toward Substantial Challenges

Research Commissioned by The Physicians Foundation Also Examines Physician Morale and Perspectives on Current / Future State of U.S. Healthcare System

Boston, MA, September 24, 2012— American patients are likely to experience significant and increasing challenges in accessing care if current physician practice patterns trends continue, according to a comprehensive new survey of practicing physicians. One of the largest physician surveys ever undertaken in the U.S., the research was commissioned by The Physicians Foundation, a nonprofit organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients.

Physicians are working fewer hours, seeing fewer patients and limiting access to their practices in light of significant changes to the medical practice environment, according to the research, titled “A Survey of America’s Physicians: Practice Patterns and Perspectives.” The research estimates that if these patterns continue, 44,250 full-time-equivalent (FTE) physicians will be lost from the workforce in the next four years. The survey also found that over the next one to three years, more than 50 percent of physicians will cut back on patients seen, work part-time, switch to concierge medicine, retire, or take other steps likely to reduce patient access. In addition, should 100,000 physicians transition from practice-owner to employed status over the next four years (such as working in a hospital setting), the survey indicates that this will lead to 91 million fewer patient encounters.

“It is clear that the introduction of nearly 30 million new patients into the U.S. healthcare system through healthcare reform, added to the already growing physician shortage, will have profound implications for patient access to medical care,” said Walker Ray, M.D., vice president of The Physicians Foundation and chair of its Research Committee. “The rate of private practice physicians leaving the medical field, as well as changes in practice patterns that reduce the number of hours spent seeing and treating patients, is alarming. When these lost hours are added up, we get a much fuller and more ominous picture of the kind of access crisis that patients may soon face.”

More than half of physicians (52 percent) have limited the access of Medicare patients to their practices or are planning to do so, while one out of four physicians (26 percent) have already closed their practices altogether to Medicaid patients, the survey shows. Physicians cited rising operating costs, time constraints and diminishing reimbursement as the primary reasons why they are unable to accept additional Medicare and Medicaid patients.

The survey, fielded online from late March to early June 2012 by Merritt Hawkins for The Physicians Foundation, is based on responses from 13,575 physicians across the U.S. The overall margin of error (MOE) for the entire survey is (μ ± 0.998 percent), which indicates a “low to very low” sampling error for a survey designed to draw opinions and beliefs from a large population. Generally, an overall MOE at 99 percent confidence is considered highly trustworthy at +/- 2 percent or less, and all questions within the survey met this criterion.


Physician Morale

An overwhelming 80 percent of physicians cited “patient relationships” as the No. 1 most satisfying part of their job. Yet the survey also found an overwhelming majority of physicians, 77 percent, are pessimistic about the future of medicine. Eighty-two percent believe they have little ability to change the healthcare system.

Multiple factors were cited as driving widespread feelings of discontent among the nation’s physicians. “Liability / defensive medicine pressures” (related to potential malpractice lawsuits) was cited first, followed by “Medicare / Medicaid / government regulations,” “reimbursement issues” and “uncertainty / changes of health reform.” These issues and others cited throughout the study tend to distract or interfere with the time physicians spend with their patients, according to survey respondents.

“The level of pessimism among America’s physicians is very troubling,” said Lou Goodman, Ph.D., president of The Physicians Foundation and CEO of the Texas Medical Association. “More than 84 percent of physicians feel that the medical profession is in decline and nearly 58 percent are reluctant to recommend medicine as a career to their children. That means we need to make significant changes to ensure that we preserve the patient-physician relationship and continue to have the brightest minds going into medicine.”

Healthcare Cost Drivers

When asked about the factors driving increases in healthcare costs, “defensive medicine” was cited as the No. 1 cause for 69 percent of physicians, followed by an “aging population” (65 percent). On average, older patients visit physicians three times as often compared to younger patients. Other factors ranked included “cost of pharmaceuticals,” “advances in technology / treatment” and “social conditions.”

Additional survey findings of note include:

• Close to 92 percent of physicians are unsure where the health system will be or how they will fit into it three to five years from now
• More than 62 percent of physicians said Accountable Care Organizations (ACOs) are either unlikely to increase healthcare quality and decrease costs, or that any quality / cost gains will not be worth the effort
• Physicians are divided on the efficacy of the “medical homes” concept, and many (37.9 percent) remain uncertain about their structure and purpose
• While close to 70 percent of physicians have implemented electronic medical records (EMR), 47.4 percent have significant concerns that EMR poses a risk to patient privacy

“The 13,000 plus physicians who participated in this landmark survey, which included nearly 8,000 open-ended responses, strongly demonstrates the overwhelming desire of America’s physicians to share their perspectives and concerns about the current state of medicine,” said Tim Norbeck, CEO of The Physicians Foundation. “The accuracy, rigor and sheer scope of this survey should make it an invaluable piece of research to policy makers, healthcare providers, media and other stakeholders that truly want to understand the challenges that face America’s healthcare system.”

http://www.physiciansfoundation.org/...al-challenges/

[King_Chief_Fan]

Originally Posted by La literatura

And others consider it sensible cost-control measures that are necessary for government-funded health care.

I am sure you wouldn't feel that way about your grandma.
Sorry granny, you had your turn in the hospital and you don't get another one.
On second thought you would prostitute yourself and your family

[La literatura]

Originally Posted by King_Chief_Fan

I am sure you wouldn't feel that way about your grandma.
Sorry granny, you had your turn in the hospital and you don't get another one.
On second thought you would prostitute yourself and your family

We just can't design a public-funded program based on what our wishes for our own grandma's healthcare are.

[patteeu]

Originally Posted by La literatura

Critics (mylonsd) now want to say that the ACA has started to implement death panels, using a term that Republican fear-mongers used in 2009 to attempt to derail the bill. (The proposal, as you may recall, involved end-of-life counseling). What am I doing that you find so objectionable?

Denying that they exist.

[patteeu]

Originally Posted by La literatura

Mylonsd and I were talking about medicare cost-cutting measures, but I'm open to expanding the discussion. Is it your argument that government bureaucrats are mandating that insurance companies cut certain benefits?

You brought "death panels" up by mentioning something you called ACA, which I take to mean "Affordable Care Act" which I further assume is what you're calling Obamacare.

[La literatura]

Originally Posted by patteeu

Denying that they exist.

Yes, I deny that death panels, as it was used in the Republican smear campaign's attempt to derail the ACA, exist. In fact, the provision that began the whole death panel smear (relating to end-of-life counseling) was taken out.

[La literatura]

Originally Posted by patteeu

You brought "death panels" up by mentioning something you called ACA, which I take to mean "Affordable Care Act" which I further assume is what you're calling Obamacare.

Okay. Go on.

[King_Chief_Fan]

Originally Posted by La literatura

We just can't design a public-funded program based on what our wishes for our own grandma's healthcare are.

I think your own grandma just flipped you off.
Funny that you can design one that excludes people.
So Palin was right? Call it what you want, but changing the name doesn't make it any better.

[patteeu]

Originally Posted by La literatura

Yes, I deny that death panels, as it was used in the Republican smear campaign's attempt to derail the ACA, exist. In fact, the provision that began the whole death panel smear (relating to end-of-life counseling) was taken out.

Nonetheless, they exist in the form mlyonsd mentioned and you chose to battle your strawman instead. And you apparently can't stop.

[La literatura]

Originally Posted by patteeu

Nonetheless, they exist in the form mlyonsd mentioned and you chose to battle your strawman instead. And you apparently can't stop.

No, death panels do not exist in any form. It's unreasonable to call a penalty issued to a hospital for 30-day returning medicare patients a death panel. It was unreasonable to call end-of-life counseling a death panel. A death panel, at the bare minimum, consists of a group of people who alone decide to effectively shut off aid to a person because they are deemed to be less valuable to society and okay to die.

I'm not going to agree that everything some critics dislike about the legislation is a death panel. Not everything short of a full healthcare buffet is a death panel. I don't consider insurance benefit limitations a death panel either, though, so maybe I'm the crazy one.

[La literatura]

Originally Posted by King_Chief_Fan

I think your own grandma just flipped you off.
Funny that you can design one that excludes people.
So Palin was right? Call it what you want, but changing the name doesn't make it any better.

No, Palin wasn't right. There are no death panels as a result of Obamacare. Also, there never was a proposal to have death panels.

Medicaid and medicare both exclude people who don't meet the eligibility criteria. I didn't design it.

[Velvet_Jones]

Originally Posted by Cephalic Trauma

I'm referring to the way physicians are compensated by third-party payers. It's relative. Cut medicare, third-party insurance companies cut compensation because they base their compensation on medicare.

You are incorrect on this. Most insurance companies pay at a contractual rate that has nothing to do with medicare. If the contractual rate is not available, Usual and Customary costs are used that are not based on Medicare either. It is the percentile representation of billed amount that is broken down by service and geographical area for NON-MEDICARE billing. Lastly, there is a relative value calculation that can be used to attempt to discount a claim. This is based on Medicare reimbursement schedules but you will routinely get told to **** off if you attempt to base some negotiation on relative value.

[patteeu]

Originally Posted by La literatura

No, death panels do not exist in any form. It's unreasonable to call a penalty issued to a hospital for 30-day returning medicare patients a death panel. It was unreasonable to call end-of-life counseling a death panel. A death panel, at the bare minimum, consists of a group of people who alone decide to effectively shut off aid to a person because they are deemed to be less valuable to society and okay to die.

I'm not going to agree that everything some critics dislike about the legislation is a death panel. Not everything short of a full healthcare buffet is a death panel. I don't consider insurance benefit limitations a death panel either, though, so maybe I'm the crazy one.

Yes, maybe you are.

[La literatura]

Originally Posted by patteeu

Yes, maybe you are.

I went to wikipedia to check the consensus of the "death panel" allegation. What does this tell you?

For 2009, "death panel" was named as PolitiFact's "Lie of the Year", one of FactCheck's "whoppers", and the most outrageous term by the American Dialect Society.

. . . .

Media
The Economist said the phrase was used as an "outrageous allegation" to confront politicians at town hall meetings during the August 2009 congressional recess.[56] The New York Times said the term became a standard slogan among many conservatives opposed to the Obama administration’s health care overhaul.[22] Former Newsweek editor Jon Meacham said it was "a lie crafted to foment opposition to the president's push for reform"[57] and Fox News analyst Juan Williams said "of course there is no such thing as any death panel."[58] The Christian Science Monitor reported that some Republicans used the term as a "jumping-off point" to discuss government rationing of health care services, while some liberal groups applied the term to private health insurance companies.[59] Journalist Paul Waldman of The American Prospect called the "death panel" charge a consequential policy lie, a falsehood about a policy that had definite effects on the policy, a type of lie that is not as condemned in the media as personal lies.[60]
The Daily Telegraph noted that some critics of the U.S. reform used the United Kingdom's National Institute for Health and Clinical Excellence (NICE)—"as an example of [doing] the sort of drug rationing that amounted to a 'death panel'". NICE, as one of its functions, uses cost-effectiveness analysis to determine whether new treatments and drugs should be available to those covered by Britain's National Health Service.[61] The Sunday Times wrote that Sarah Palin's use of the "death panels" term was a reference to NICE.[62]

Physicians
C. Porter Storey Jr. said the term represents fear that due to financial pressure "some mechanical, governmental method will be used to determine how much of our scarce health care resources will be applied to their situation."[63] Atul Gawande, a surgeon and writer, said that fear of missing out on an expensive life-extending treatment is behind the phrase, but he thought that framing the issue in this way was completely mistaken. "[T]he trouble is not whether we're going to offer a $100,000 drug to help someone get 3 or 4 months"; our big trouble is that patients receive a $100,000 drug that not only yields no benefit—it also causes major side effects that shortens their lives", he said.[64] Gawande said doctor's schedules of 20 minute appointments, a lack of payments and the emotional difficulty of conversations about mortality were barriers to the doctor-patient discussions about end-of-life care issues, which can take about an hour.[65]
Geriatric psychiatrist Paul Kettl said his experience in a geriatric unit showed end-of-life discussions and reimbursements were "desperately needed" as these hour long conversations are "ignored in the crush of medication and disease management."[66] In the Journal of the American Medical Association, Kettl wrote he was in favor of the "death panels that were originally proposed ... periodic discussions about advance directives that Medicare would pay for as medical visits."[66] Kettl noted that the attention-catching phrase "death panels" became "a lightning rod for objections to a series of ideas about health care besides" end-of-life discussions, and that somehow, "the concept of physicians being paid for time to talk with patients and their families about advance directives ... generated into the fear of decisions about life and death being controlled by the government."[66] Kettl also wrote that, "We can expect more good medical ideas to be destroyed by sound bytes and needless concerns that will be exaggerated. It makes for good television, but bad medicine."[66]
The American Society of Clinical Oncology (ASCO) published a statement in January 2011 advocating an individualized approach to treatment and supportive care for patients with advanced cancer. They said there was a
need to recognize the value of these conversations to both our patients and society and the effort such care requires in our reimbursement systems. Currently, our system highly incentivizes delivery of cancer-directed interventions (chemotherapy, targeted therapy, and so on) over conversations that are critical to establishing a patient’s goals and preferences and providing individualized care. Efforts to compensate oncologists and others for delivering this important aspect of cancer care were unfortunately politicized in the recent health care reform debates, but these efforts had at their core a critical patient-centered societal interest and should be revisited.[67]

Benjamin W. Corn, a cancer specialist, wrote in the New England Journal of Medicine that the "death panels" controversy showed Americans were uneasy discussing topics related to the dying process. Corn said the end-of-life care conversations can have an important positive effect on patients, although some patients may not ever welcome them. Corn also said that certain issues, such as whether experimental therapies should be reimbursed, the possible expansion of hospices, restoring dignity to the process of dying, and guidelines for physician assisted suicide, need to be addressed directly.[21] David Kibbe, a physician, and Brian Klepper, a health care analyst and consultant, wrote, "One of American politics' most disingenuous conceits is that health care must cost what we currently pay. Another is that the only way to make it cost less is to deny care. It has been in industry executives' financial interests to perpetuate these myths".[68]

Politicians
Sen. Lisa Murkowski (R-AK) stated that "death panels" were a baseless charge that unnecessarily incited fear and detracted from real problems in the proposed legislation. She said the proposed legislation was "bad enough that we don't need to be making things up."[69] Sen. Johnny Isakson (R-GA), thought there was illogical confusion over "death panels"; he said advance directives put "authority in the individual rather than the government."[70] In July 2010 Rep. Bob Inglis, (R-SC) said that he thought it was counterproductive for the conservative movement for some to promote misinformation about death panels when they do not exist.[71] Rep. Darrell Issa (R-CA) endorsed Rep. Charles Boustany's statement that "medical panels of people who care about what's best for their patients ... is good science and good medicine."[72] Speaking for himself, Issa said "Republicans have to step back from the words 'death panels'."[72] Michael F. Cannon, a former domestic policy analyst for the U.S. Senate Republican Policy Committee and a member of the Cato Institute, wrote that "[p]aying doctors to help seniors sort out their preferences for end-of-life care is consumer-directed rationing, not bureaucratic rationing."[73]
President Barack Obama cited the charge—along with the citizenship conspiracy theories and "job-killing" allegations—as demagogy against him.[74] In testimony before the United States Congress Joint Select Committee on Deficit Reduction, Erskine Bowles (D), co-chair of the National Commission on Fiscal Responsibility and Reform, called "death panels" "a kind of crazy stuff" and added that end-of-life care in the U.S. needed reform.[75] Rep. Earl Blumenauer (D-OR) called the references to "death panels" or euthanasia "mind-numbing" and "a terrible falsehood".[76] He thought that the news media contributed to the persistence of the myth by amplifying misinformation and extreme behavior.[77] When a regulation for reimbursing consultation payments was upcoming, Blumenauer cautioned supporters to keep things quiet, reasoning that Republican leaders would attempt to continue the myth.[13]

[patteeu]

Originally Posted by La literatura

I went to wikipedia to check the consensus of the "death panel" allegation. What does this tell you?

It tells me that you're clinging to your strawman for dear life.

[La literatura]

Originally Posted by patteeu

It tells me that you're clinging to your strawman for dear life.

Not my strawman, man.