Sunday, July 29, 2012

"So What Do You Think About Obamacare?"

....Is the question I am asked all the time....usually as we are walking out of the exam room after the visit. The answer is so complicated, I wish I was asked "What is the meaning of life". I do have a clear vision of what health care will be like in the future but don't expect a sound bite answer. My vision is created by considering many aspects of care as well as unintended consequences. Over time I will elaborate and extrapolate in a Charles Dickens-like way. We will keep politics out of the equation because political thinking is short-lived and incapable of long term problem solving. Forces that will drive the direction of health care will include technology, economics, strategic planning, and last but not least, patient efforts to take responsibility for their own health. I will tell you this. Health care will not be anything like what we are used to. But of course that depends on your age and what you're use to.

In Response to Professional Courtesy Article

Professional courtesy is not obsolete in my practice.  It is a token of respect for a colleague or allied professional that has spent countless hours away from his or her family to ease the suffering of others. But I do agree with the author that it will be obsolete.

Extending professional courtesy usually means waiving copayments.  Medicare can fine physicians for fraud because they assume the the total fee is inflated to compensate for lack of copayment.  An analogy can be make with an auto body shop that waives a deductible. The auto insurance company will certainly investigate.  Years ago, I made house calls in a local convent.  I was treated with the respect usually given to priests as they were gratefull for my visit.  I had to demonstrate a reasonable effort to bill the convent even though I felt my visits were a courtesy.

Also, these days clinicians are increasingly removed from billing practices.  Most just want to document what was done and leave the billing to others. "Just take the ticket and bring it to the cash register" will be the prevailing sentiment.  No room to wiggle there. Maybe rightfully so.