Hospital officials discuss 2013 ‘significant impacts’

story by Michael Tilley

Officials with three large hospital operations in Fort Smith and Northwest Arkansas don’t dispute a report on 2013 “significant impacts” on doctors and patients that includes erosion of “physician autonomy” as an issue.

The Physicians Foundation issued in December a top five list of issues that leaders of the nonprofit say “are likely to have a significant impact on patients and physicians in 2013.”

Topping the list is “uncertainty” over the ongoing rollout of the Patient Protection and Affordable Care Act, aka, the new federal healthcare law.

“Much of the law has yet to be fully defined and a number of key areas within PPACA – including accountable care organizations (ACOs), health insurance exchanges, Medicare physician fee schedule and the independent payment advisory board – remain nebulous,” noted the report.

A 2012 survey conducted by the Foundation found that 77% of doctors are pessimistic about the future of medicine because of unknowns surrounding the law.

Second on the list is consolidation among hospital and medical groups. The Foundation is concerned that “increased consolidation may potentially lead to monopolistic concerns, raise cost of care, and reduce the viability and competitiveness of solo / private practice.”

The top five list rounds out with the following issues.
• Another 30 million new patients are likely to enter the health care system beginning in 2014.

“As the 12-month countdown to 30 million continues across 2013, physicians and policy makers will need to identify measures to help ensure a sufficient number of doctors are available to treat these millions of new patients – while also ensuring the quality of care provided to all patients is in no way compromised.”

• The Foundation predicts a reduced ability of a doctor to “exercise independent medical judgment.

“Many of the factors contributing to a loss of physician autonomy include problematic and decreasing reimbursements, liability / defensive medicine pressures and an increasingly burdensome regulatory environment.”

• Growing administrative burdens may also negatively impact physicians and patients in 2013.

“Excessive ‘red tape’ regulations are forcing many physicians to decrease their time spent with patients in order to deal with non-clinical paper work and other administrative burdens.

Martine Downs Pollard, executive director of communications at Mercy Northwest Arkansas, said the Foundation list is representative of the complex issues facing the industry.

“The watch list of issues from The Physician’s Foundations is an accurate reflection of the stresses of a changing industry for physicians, hospitals and all of health care. There is no question that the road ahead will be more complex,” Pollard said.

But she added that such challenges forces many hospital groups to seek “constant improvements” so patient care doesn’t suffer.

“Despite the hurdles of the changing economic and regulatory conditions, we are motivated and energized because we have more tools and resources to deliver quality and cost effective care than ever before,” Pollard explained.

Donna Bragg, spokeswoman for Sparks Health System in Fort Smith, said the Foundation report represented “valid concerns.” Sparks is owned by Naples, Fla.-based Health Management Associates, one of the largest hospital holding companies in the U.S.

“With so much legislative uncertainty regarding health care, it is difficult to know how to plan. Then throw in uncertainty from changing insurance reimbursement and the increasing cost of providing care for the uninsured,” Bragg said in an e-mail response.

But like Pollard at Mercy NWA, Bragg said hospitals must remain focused on quality care.

“Bottom line: Regardless of what new legislation is enacted or how the details are interpreted, we will continue doing our best to provide the best medical care possible for our patients,” Bragg noted.

The Mercy system in Fort Smith said the “primary mission” of the hospital opened more than 100 years ago remains to “make health care available for all, especially the poor and underserved.”

“Many of the changes we face today are about the financial structure of health service delivery. More than a decade ago, Mercy saw the need for reform in this area and began the process of transforming the delivery of health care,” Ryan Gehrig, president of Mercy Hospital Fort Smith, said in a statement.


Gehrig’s statement included the following detailed list of changes the hospital has made to anticipate possible changes in health care patient care and payment rules.
• Installation of electronic health records to streamline the care process by making medical records available instantly.
• Improving access to specialists through telemedicine.
• Leveraging technology and adopting evidence-based practices to decrease variation in order to improve outcomes and reduce costs.
• Development of Mercy Clinic, a partner organization to the hospital, structured specifically to be physician-led and professionally managed to successfully integrate doctors and clinics without loss of the physician’s autonomy to make independent medical judgements.
• Using advanced practitioners to expand access to health care.
• Improving efficiency through improved supply chain management.

Advanced planning may not be enough if concerns by the Physicians Foundation about too many regulations become reality. Their report noted: “In 2013, physicians and policy makers will need to work closely together to determine steps that will effectively reduce gratuitous regulations that negatively affect physician–patient relationships.”

Other points in the Physicians Foundation report include:
• More than 47,000 full-time-equivalent (FTE) physicians will be lost from the workforce in the next four years.

• 52% of physicians have limited the access of Medicare patients to their practices or are planning to do so.

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Am I reading things right?

I read somewhere else with Obamacare you can go to any doctor. Now I am reading here with Medicare you can't. Which is worse physicians who do this, or a government that lets them?

A physician is not required

A physician is not required to take medicare, or any other insurance. It is within their rights to accept any form of payment for their services that they deem appropriate, from cash to chickens, just like every other business person

Yes, you are reading things right.

In Fort Smith and most likely in other communities, if you don't already have a primary care physician in place before you have Medicare, good luck finding a doctor who will accept you as a patient. I was in a medical clinic waiting room last week and a lady came in for her first appointment to establish care. The receptionist realized that the lady had Medicare, rather than the insurance that was listed when the appointment was made, and they said they were sorry but she would have to find another doctor because they didn't take new patients with Medicare. This clinic has six physicians and not one of them would accept a new patient with Medicare. The Patient Protection and Affordable Care Act (ObamaCare) should actually specify that you can go to any physician, as long as you DO NOT have Medicare.

Physician Rights

I am a primary care physician. Medicare and Medicaid patients are almost always more complex and have multiple medical problems to deal with during their visits. Medicare and Medicaid are also the two worst paying insurances. Doctors have to strike a balance and limit how many of these patients we can see. If you start to get much more than 40 or 50% of these patients in your practice, it becomes increasingly difficult to manage all their needs in a competent manner and still make enough profit at the end of the day to justify the grueling demands of practicing in America. The only solution to this problem, like it or not, is going to be a single-source payer system.

Learn to trust the tzar I guess.

Making it worse is just a normal step in the process of making things better. We will now add the 'billing police' to the scenario and also pay them based primarily on how much they save upon finding any errors made traversing this maze by your comparatively far less experienced person until you finally send that part of the job to India like the government has. Included somewhere in all this is the 'mother of all errors' where then they split what would have been your money. If you want government money at all though my guess is you'll have to take 100% of the Obamacare ones or else, so you will simply ditch more or who knows all on medicare.