Wintery Knight

…integrating Christian faith and knowledge in the public square

White House review of VA finds “corrosive culture” to blame for poor patient care

The Wall Street Journal reports.

Excerpt:

A White House review of the VA health system points to a culture that has degraded the timely delivery of care and requires a restructuring to improve transparency and accountability.

Acting Secretary of Veterans Affairs Sloan Gibson and Rob Nabors, White House deputy chief of staff, told President Barack Obama on Friday that significant further action was needed to address systemic problems.

Six weeks after the president dispatched Mr. Nabors to assess problems within the VA, the president’s aide outlined a long list of issues affecting access to timely care at VA medical facilities.

Mr. Nabors’s work is the latest in a series of reviews and reports issued in the past two months, including those from the VA’s independent inspector general, the Office of the Special Counsel and the VA itself. The new report found what Mr. Nabors described as a “corrosive culture” that affects employee performance and patient care. He added that the Veterans Health Administration structure has “impeded appropriate management, supervision and oversight.”

The review also found that the VA’s goal for scheduling many medical appointments within 14 days is “arbitrary, ill-defined and misunderstood.” That goal had been set in 2011. The VA recently eliminated that 14-day target.

Mr. Gibson praised the report. “We know that unacceptable, systemic problems and cultural issues within our health system prevent veterans from receiving timely care,” he said in a statement.

The White House has scrambled to respond to evidence of widespread mismanagement within the VA and to fill a growing number of vacancies in top posts. An internal assessment also revealed improper appointment-scheduling procedures and efforts to hide long wait times across the VA health system.

Another interim report from the VA inspector general confirms that:

The VA’s independent inspector general office has said it would likely issue in August its full report on its sweeping review of the department. An interim report, issued just days before Mr. Shinseki’s resignation, showed problems throughout the VA. They included employees tinkering with official patient appointment wait times to make them seem much shorter than the actual times veterans were having to wait.

In case you were wondering why this is all happening in the VA health care system and not in the private health care system, it’s because the VA is 100% pure government-run health care, as health care expert Avik Roy explains in Forbes magazine. The VA is not scandal is not some sort of aberration from government-run health care. Long wait times and patient deaths are essential to government run health care, in practice.

Filed under: News, , , , , , , , , , ,

How do doctors feel about the federal government’s regulation of their profession?

In the Wall Street Journal, a doctor speaks out about government control of health care.

Excerpt:

In my 23 years as a practicing physician, I’ve learned that the only thing that matters is the doctor-patient relationship. How we interact and treat our patients is the practice of medicine. I acknowledge that there is a problem with the rising cost of health care, but there is also a problem when the individual physician in the trenches does not have a voice in the debate and is being told what to do and how to do it.

[...]The Centers for Medicare and Medicaid Services dictates that we must use an electronic health record (EHR) or be penalized with lower reimbursements in the future. There are “meaningful use” criteria whereby the Centers for Medicare and Medicaid Services tells us as physicians what we need to include in the electronic health record or we will not be subsidized the cost of converting to the electronic system and we will be penalized by lower reimbursements. Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist?

This is not a unique complaint. A study commissioned by the American Medical Association last year and conducted by the RAND Corp. found that “Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction.”

In addition to the burden of mandated electronic-record entry, doctors also face board recertification in the various medical specialties that has become time-consuming, expensive, imposing and a convenient method for our specialty societies and boards to make money.

Meanwhile, our Medicare and Medicaid reimbursements have significantly declined, let alone kept up with inflation. In orthopedic surgery, for example, Medicare reimbursement for a total knee replacement decreased by about 68% between 1992 and 2010, based on the value of 1992 dollars. How can this be? Don’t doctors have control over what they charge for their services? For the most part, no. Our medical documentation is pored over and insurers and government then determine the appropriate level of reimbursement.

I don’t know about other physicians but I am tired—tired of the mandates, tired of outside interference, tired of anything that unnecessarily interferes with the way I practice medicine. No other profession would put up with this kind of scrutiny and coercion from outside forces. The legal profession would not. The labor unions would not. We as physicians continue to plod along and take care of our patients while those on the outside continue to intrude and interfere with the practice of medicine.

We could change the paradigm. We could as a group elect not to take any insurance, not to accept Medicare—many doctors are already taking these steps—and not to roll over time and time again. We have let nearly everyone trespass on the practice of medicine. Are we better for it? Has it improved quality? Do we have more of a voice at the table or less? Are we as physicians happier or more disgruntled then two years ago? Five years ago? Ten years ago?

Doctors certainly provide a lot more value to me than unions, lawyers and government workers of all sorts. I wish we had more doctors, and fewer unions, lawyers and government workers. Anything that doctors can do to push back against their tormentors would be welcome in my opinion.

 

Filed under: News, , ,

Doctor shortage: how Obamacare makes it harder to find a doctor

Remember how Obama promised that if you liked your doctor, then you could keep your doctor? It turns out that there is more to making policies than just saying what you’d like to do in a scripted campaign speech. The truth is that some health care policies will make you lose your doctor, regardless of what the President reads off of a teleprompter. Is Obamacare one of these policies? Let’s see.

Avik Roy writes about it in Forbes magazine.

Excerpt:

On Saturday, the Wall Street Journal reported that, due to Obamacare’s cuts to Medicare Advantage, among other factors, UnitedHealth expects its network of physicians “to be 85 percent to 90 percent of its current size by the end of 2014.” The result? Some retirees enrolled in Medicare Advantage will need to find new doctors. And it’s a trend that could accelerate in future years.

[...]Over the next ten years, Obamacare was designed to spend around $1.9 trillion on expanding health coverage to the uninsured. The law pays for this new spending with $1.2 trillion in new taxes, and $716 billion in cuts to Medicare, relative to prior law.

[...]The private insurers who supply Medicare Advantage plans, like UnitedHealth and Humana, have been responding to the cuts by squeezing out inefficiencies in the way they deliver care. One obvious way to do that is to pay doctors and hospitals less—or kick out the providers who refuse to accept lower reimbursement rates. And that’s what United has done, according to the WSJ report from Melinda Beck.

“Doctors in at least 10 states have received termination letters, some citing ‘significant changes and pressures in the health-care environment,’” writes Beck.

Another one of my favorite health care policy experts is the ex-Canadian Sally C. Pipes, who knows all about the horrors of single-payer health care. It killed her mother! Here’s what she had to say about the doctors shortage in a Forbes magazine article from earlier this year.

The first problem is that we have an aging doctor population and since we do such a poor job of educating our children (public school indoctrination centers) we aren’t making any new ones:

Right now, the United States is short some 20,000 doctors, according to the Association of American Medical Colleges. The shortage could quintuple over the next decade, thanks to the aging of the American population — and the aging and consequent retirement of many physicians. Nearly half of the 800,000-plus doctors in the United States are over the age of 50.

The second problem is that adding more regulations and burdensome paperwork makes a lot of people not want to be doctors any more:

Obamacare is further thinning the doctor corps. A Physicians Foundation survey of 13,000 doctors found that 60 percent of doctors would retire today if they could, up from 45 percent before the law passed.

The third problem is that the government isn’t reimbursing doctors as much as private insurance companies do, and it makes them refuse to take government-funded patients:

They’ve long limited the number of Medicaid patients they’ll treat, thanks to the program’s low reimbursement rates. According to a study published in Health Affairs, only 69 percent of doctors accepted new Medicaid patients in 2011. In Florida, just 59 percent do so. And a survey by the Texas Medical Association of doctors in the Lone Star State found that 68 percent either limit or refuse to take new Medicaid patients.

Medicaid pays about 60 percent as much as private insurance. For many doctors, the costs of treating someone on Medicaid are higher than what the government will pay them.

These underpayments have grown worse over time, as cash-strapped states have tried to rein in spending on Medicaid. Ohio hasn’t increased payments to doctors in three years; Kentucky hasn’t raised them in two decades. Colorado, Nebraska, South Carolina, Arizona, Oregon, and Arizona all cut payments in 2011.

By throwing nine million more people into the program without fixing this fatal flaw, Obamacare will make it even harder for Medicaid patients to find doctors.

It’s not just Medicaid that’s the problem, either. It’s the government-controlled exchanges.

Healthcare providers are signaling that they may turn away patients who purchase insurance through the exchanges, too.

In California, for example, folks covered by Blue Shield’s exchange plan will have access to about a third of its physician network. The UCLA Medical Center and its doctors are available to customers of just one plan for sale through the state exchange, Covered California. And the prestigious Cedars-Sinai Medical Center is not taking anyone with exchange insurance.

Now I know what you’re thinking – why not just force doctors to work for lower wages, like a good socialist country might? Well, that actually makes the shortage worse, because people don’t like to learn hard things and then work hard for little pay. And doctors work VERY hard – it’s not an easy profession to get into. That will just make all the doctors leave the country for other countries where they can be paid fairly for the work they do.

And in fact that is exactly what happened in a 100% socialized health care system in Venezuela, according to this report from the left-leaning Associated Press.

Excerpt:

Half the public health system’s doctors quit under Chavez, and half of those moved abroad, Natera said.

Now, support staff is leaving, too, victim of a wage crunch as wages across the economy fail to keep up with inflation.

At the Caracas blood bank, Lopez said 62 nurses have quit so far this year along with half the lab staff. It now can take donations only on weekday mornings.

I recommend reading that entire article for a glimpse of where the Democrats are trying to take us. There is not a dime’s worth of difference on policy between the Democrat party and the socialist party of Venezuela, except that the socialists have been in control in Venezuela for longer, and so they are further along the road to serfdom.

In other news, the Washington D.C. insurance commissioner was fired after raising concerns about the “fix” proposed by Obama in his speech last week. That’s also something that you might expect to see in a country like Venezuela. That’s what happens in authoritarian socialist countries. Whistleblowers and critics just disappear.

Filed under: News, , , , , , , , , , , , , , , , , , , , , , , , ,

Duke U. researcher: 129 million people will lose health insurance under Obamacare

From the Daily Caller.

Excerpt:

If Obamacare is fully implemented, 68 percent of Americans with private health insurance will not be able to keep their plan, according to health care economist Christopher Conover.

Conover is a research scholar in the Center for Health Policy & Inequalities Research at Duke University and an adjunct scholar at the American Enterprise Institute. In an interview with The Daily Caller, he laid out what he estimates the consequences of Obamacare’s implementation will ultimately be.

“Bottom line: of the 189 million Americans with private health insurance coverage, I estimate that if Obamacare is fully implemented, at least 129 million (68 percent) will not be able to keep their previous health care plan either because they already have lost or will lose that coverage by the end of 2014,” he said in an email. ”But of these, ‘only’ the 18 to 50 million will literally lose coverage, i.e., have their plans entirely taken away. This includes 9.2-15.4 million in the non-group market and 9-35 million in the employer-based market. The rest will retain their old plans but have to pay higher rates for Obamacare-mandated bells and whistles.”

Conover also says it is hard to imagine President Obama didn’t know these statistics when he was flacking for his health care bill by promising Americans they could keep their health insurance if they liked it.

“If President Obama himself believed this the first time he said it, he was poorly advised,” Conover said.

“The problem is that he said it at least 24 times, most of which occurred after his own rule-writers had estimated that 49-80 percent of small employer plans would have lost their grandfather status by 2013, along with 34-64 percent of large employer plans. The same rule estimated that each year 40 to 67 percent of non-group plans not already grandfathered would lose their grandfather status. Given how extensively presidential statements — especially to a joint session of Congress — are vetted and fact-checked, it is pretty inconceivable that President Obama was not aware that he was engaged in some degree of truth-twisting.”

Surprise! It looks like what the Democrats wanted was to destroy private health insurance, after all. The nice thing about this is that finally the low-information voters who elected Obama are getting to see why it might be a good idea to get their political news from somewhere other than the Comedy Channel.

Filed under: News, , , , , , ,

Doctor shortage: how Obamacare makes Americans lose their doctors

Mysterious Tim sent me this article from the Wall Street Journal.

Excerpt:

Everyone now is clamoring about Affordable Care Act winners and losers. I am one of the losers.

My grievance is not political; all my energies are directed to enjoying life and staying alive, and I have no time for politics. For almost seven years I have fought and survived stage-4 gallbladder cancer, with a five-year survival rate of less than 2% after diagnosis. I am a determined fighter and extremely lucky. But this luck may have just run out: My affordable, lifesaving medical insurance policy has been canceled effective Dec. 31.

My choice is to get coverage through the government health exchange and lose access to my cancer doctors, or pay much more for insurance outside the exchange (the quotes average 40% to 50% more) for the privilege of starting over with an unfamiliar insurance company and impaired benefits.

Countless hours searching for non-exchange plans have uncovered nothing that compares well with my existing coverage. But the greatest source of frustration is Covered California, the state’s Affordable Care Act health-insurance exchange and, by some reports, one of the best such exchanges in the country. After four weeks of researching plans on the website, talking directly to government exchange counselors, insurance companies and medical providers, my insurance broker and I are as confused as ever. Time is running out and we still don’t have a clue how to best proceed.

Here previous private health insurance plan was doing a good job of honoring her policy:

Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.

I think that this is what Obama was talking about when he cautioned people about insurance companies that “screw you”. Yeah, private companies always screw people, Obama, never the government. What does this man know about how anything actually works in the real world, anyway?

More:

What happened to the president’s promise, “You can keep your health plan”? Or to the promise that “You can keep your doctor”? Thanks to the law, I have been forced to give up a world-class health plan. The exchange would force me to give up a world-class physician.

For a cancer patient, medical coverage is a matter of life and death. Take away people’s ability to control their medical-coverage choices and they may die. I guess that’s a highly effective way to control medical costs. Perhaps that’s the point.

Another factor that is going to make this situation worse is the widespread decline in the number of doctors caused by Obamacare.

Investors Business Daily reports on a recent poll of doctors by Deloitte.

Excerpt:

When our polling showed four years ago that doctors planned to leave the profession if the Democrats’ interpretation of health care reform became law, we were ridiculed mercilessly. But, as a new poll shows, we were right.

In 2009, our IBD/TIPP Poll asked 1,376 randomly chosen practicing physicians from across the country what they thought about the health care “reform” being considered at that time.

It found that 45% of doctors “would consider leaving their practice or taking an early retirement” if Congress passed the plan the White House and the Democratic majority in Congress had in mind.

[...]But almost a year later, we were vindicated. An August 2010 Merritt Hawkins survey of 2,379 doctors conducted for the Physicians Foundation revealed that 40% of doctors said they would “retire, seek a nonclinical job in health care, or seek a job or business unrelated to health care” over the next three years as the overhaul was phased in.

Those three years are up, the country has found out what’s in ObamaCare, and the story remains the same.

The Deloitte 2013 Survey of U.S. Physicians found that six in 10 doctors say “it is likely that many physicians will retire earlier than planned in the next one to three years” — that is, in the age of ObamaCare — “while more than half believe that physicians will retire (62%) or scale back practice hours (55%) based on how the future of medicine is changing.”

The problem is that when government controls health care, they spend the money on things that will buy them more votes. People who need expensive care like this definitely do not get treated. In government-run health care, government takes control of the money being spent by individuals on actual health care in the private sector. They then redirect that money into public sector spending on “health-related” services. Instead of helping people who are really sick, government-run systems cut lose those sick people and concentrate on buying perfectly healthy people things like condoms, abortions, IVF and sex changes. They spread the money around to more people in order to buy more votes. The main goal is to get the majority of people dependent on government so that they continue to vote for bigger government. The few people who need expensive health care? They can just go die in a ditch.

The really sick thing is when a person works their entire lives, paying into a government-run health care system, and then when it is their turn at the end to finally get some treatment, they find out that they are denied treatment, and their money has all been spent on elective treatments for favored (liberal) minority groups. I’m sorry, but you can’t have treatment for prostate cancer, because we used the money we got from you to provide IVF to a professor of women’s studies who spent her fertile years advocating for abortion and against marriage. We should never be letting government control health care. Never.

Filed under: Commentary, , , , , , ,

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