Dr. Mark Sklar is an endocrinologist in solo practice in Washington D.C., in addition to serving as an assistant professor of medicine at Georgetown University Medical Center. So the man knows his stuff, and what he's experienced in recent years - as the federal government has increasingly inserted its clutches into both the delivery and the finance mechanisms of health care - has been nothing good.
Writing in this morning's Wall Street Journal, Dr. Sklar tells us that he now has to spend so much time on data entry and other menial work required to satisfy federal regulations, he is forced to choose between giving up all his personal time or severely curtailing the time he can spend really caring for patients. And ObamaCare is taking things to an absurd new level:
To prevent physicians from prescribing more costly medications and tests on patients, insurers are increasingly requiring physicians to obtain pre-authorizations. This involves calling a telephone number, often being rerouted several times and then waiting on hold for a representative. The process is demeaning and can take 30-45 minutes. Rather than having physicians pre-authorize expensive medications, the outrageous costs of many non-generic medications must be addressed. I understand that pharmaceutical companies need to make profits to cover investments in drug development. However, they should have some compassion for their customers.
To avoid Medicare penalties, I also must participate in the Physician Quality Reporting System program. Initially, this involved choosing three codes during the patient visit to reflect quality of care, such as blood pressure or blood-sugar control, and reporting them to Medicare. In 2015, the requirement will increase to nine codes.
Coming down the pike, but thankfully postponed from the October 2014 deadline, is something called ICD-10. This is a newer system that will contain about 70,000 medical diagnostic codes used for billing insurance. The present ICD-9 system has about 15,000 codes. The Physician Quality Reporting System and ICD-10 requirements are intended to benefit population research, but the effect is to turn physicians into adjuncts of the Census Bureau who spend time searching for codes—and to further decrease the amount of direct contact with patients.
The practice of medicine in the current environment is unsustainable. The multiple bureaucratic distractions in my day consume so much time that I have to give up what little personal time I have in the morning, evening and on weekends if I want to continue to provide excellent care during office hours.
Dr. Sklar also touches on a theme I've voiced often - that as much as possible without subjecting patients to unmanagable risks, we need get third-party payers out of health care. It's entirely doable, too. If most people who now have employer-provided health care realized how much of their paychecks was diverted into health insurance premiums, they would quickly realize they could divert most of it into health savings accounts from which they could simply pay for most of their basic care out of pocket - without having to involve insurance company bureaucracies, let alone the government kind.
The delivery of most basic health care would become dramatically less expensive if doctors and patients could simply make decisions without having to submit bills for approval from some other party (which of course has to get paid). There should still be insurance against catastrophic risk, but that should have little or nothing to do with basic day-to-day care.
As the experience of Dr. Sklar and so many others shows, however, we're going in exactly the opposite direction under ObamaCare. The government is making the delivery of health care and the process of paying for it more complicated, more costly and more burdensome for everyone involved - all in the name of making it "affordable."
I realize some will offer nothing but crocodile tears for well-compensated physicians who complain about having to work late and do data entry, but those who see it that way should understand something. Doctors are human beings. They did not go to medical school to spend all their time doing make-work nonsense like this. And if this is the type of experience politicians and bureaucrats are determined to impose on doctors, guess what: We're going to have a lot fewer doctors. Why go into a profession if meddling outsiders are going to ruin the experience for you? Some will anyway, but if it keeps going in this direction, we will lose enough physicians that we will likely face a supply crisis in medical care.
Oh, by the way, you know what happens to prices when a service is in limited supply? There is nothing affordable about that scenario.
