Reform Will Lead to Work Avoidance by Doctors

TUCSON, Ariz., May 31, 2011 /PRNewswire-USNewswire/ — On May 26, three physicians, including Congressman Michael Burgess (R-TX), briefed Congressional staffers on the effects of the Affordable Care Act (ACA), sometimes called ObamaCare, on the patient-physician relationship and patient care.

Patients and physicians are the people you don’t find on the complex organizational charts describing ObamaCare, stated Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons which sponsored the briefing.

Americans were promised that the ACA would save money and reduce the federal deficit. Dr. Burgess warned, however, that “entitlements are a raging fire, and the ACA is a gasoline tanker fixing to dump its contents on the fire.”

The cost explosion will not be translated into more patient care, the doctors explained. ACA may create much higher demand by increasing the number of insured patients, and mandates to cover “preventive” services for the healthy, but who will do the work of caring for the sick?

The new “accountable care organizations” (ACOs), like the managed care organizations they resemble, are supposed to contain costs by changing the incentives. Instead of fee for service (more pay for more work), doctors will be paid more for treating by the numbers, and keeping numbers like blood pressure within a certain range. From personal experience, Dr. Burgess described the pressures that managed care and government agencies put on physicians to limit care.

The costly, onerous regulations in the ACA will also drive more and more physicians out of independent practice and into salaried positions. Dr. Amerling predicts that once physicians become salaried hospital employees, they will revert to the nearly universal work-avoidance behavior of physicians in training, who receive the same meager salary no matter how many patients they see. The most obvious manifestation is “turfing”—attempting to have a new admission or difficult patient directed to someone else’s service.

“Fee for service has been wrongly blamed for runaway health spending,” Dr. Amerling said, “when the real culprit is the third party system, unrestrained by meaningful co-pays or deductibles.” Fee for service is necessary to ensure that patients are treated promptly.

The U.S. single payer system called the VA also discourages hard work. “Doctors can often provide the best care for their patients only by violating the rules,” Dr. Orient said.

To protect quality and access to care, the patient-physician relationship must be protected—and ObamaCare repealed—the panel concluded.