That might be the longest title in 10 years. Bob Doherty has written a “spot on” blog – Needed: Less macro, more micro health policy
What does his title mean?
1. Will anyone do anything about the oppressive burden of paperwork and red tape?
2. Will the candidates’ “macro” proposals for reforming healthcare and entitlements result in more or less paperwork and red tape?
3. I already don’t have enough time to spend with patients but now I am expected to counsel them on preventive care, lifestyle choices, and the effectiveness of different treatments? How is this possible?
4. Electronic health records, great concept, but they don’t really streamline the process as advertised, if anything, they just make things more difficult, and besides, they still don’t communicate with other systems.
5. Everyone wants to measure me, but the measures don’t agree with other, they measure the wrong things and they are difficult to report on. And who is measuring the value and effectiveness of the measures themselves?
6. Okay, I am supposed to practice cost conscious care, but who is going to stop a lawyer from suing me if I don’t give a patient the test they asked for?
7. Why is my cognitive care paid so little while procedures and drugs are paid exorbitant rates?
8. Payers and government keep imposing more penalties, for not e-prescribing, for not converting to ICD-10, for not meaningfully using my electronic health record, for not complying with their pay for performance schemes. By the time they get done fining me for noncompliance, I will have had to shut my office. Then who will take care of my patients?
9. And who has the time to keep track of all of these mandates, incentives, rules, and penalties? I would have to hire a full-time person keep on top of everything. Who is going to pay for that?
10. So I am supposed to transform my practice? Well, we all want to do our part, but who is going to pay for that? Besides, my patients seem to think my practice is just fine as it is
Bob has hit the proverbial nail on the head. Without addressing these issues, we will never provide enough primary care to our population.
Most wonks miss these issues. They think on a macro level. Bob has made clear in this post that most macro solutions disadvantage the very physicians we need the most. These “details” are essential.
Over the next two days I will participate in ACP’s two large policy committees. We will work on these issues. As Bob points out, no big idea will work unless we fix the details for the dedicated outpatient physicians, especially internists and family physicians. Our patients deserve and even require that we succeed.
