What are the “scores of regulations” that are occupying his time, and which ones of them are due to the ACA, rather than other factors that would not be alleviated were the ACA to be repealed?
Elizabeth Rosenthal had a good article recently (out of her newly published book) about the complexities of medical billing. But notice that none of the complexities she talks about are due to Obamacare. Rather, they’re due to hospitals using the system to get the highest possible billing.
Some single payer advocates say that single payer would eliminate this ridiculous, expensive overhead. Some ACA opponents say that repealing the ACA would eliminate this nonsense. I don’t see how either of those could be right. As long as doctors and other clinicians are paid by procedure, they’re going to make sure they claim they did the most lucrative procedures, and there’s plenty of room for interpretation. One way to address this is to do more paying by diagnosis-- if all the care for an episode is aggregated, the providers have less opportunity to charge for every little thing.
I’ve read various doctors, and patients too, complaining about electronic medical records, but you don’t seriously think we should be going back to paper and pen in this day and age, do you?
From what I’ve heard, the regulations on EMR require doctors to supply information, check boxes etc. that the doctor doesn’t think is important but that some bureaucrat thought was important. And the doctor can’t move on to the next screen until this unimportant or redundant information is supplied.
I also wonder how vulnerable these electronic records are to hacking.
I think that even in our lifetime medicine will change drastically. Devices, implants or nano-thingies will monitor the patient’s condition including heart rate, BP, pain level or sugar. Some of the doctors visits will be done remotely using the same technology we now use for teleconferences + the feed from nano-thingies. Robotic surgery will replace much of that done manually. More of the things we are used to will go away.
I am no fan of the ACA, knowing many medical professionals, but I do think that single-payer medicine is the most efficient model.
Mistakes in EMR are there forever, whether they were cut and pasted incorrectly or entered that way. You can add a new note “correcting them,” but the original wrong stuff is still there cluttering things up. There are so many different electronic medical records and they do not necessarily communicate with one another, making it difficult as well.
I have access to some of my electronic records in some systems but not others and see errors transferred from former provider records to newer providers. It is frustrating watching the proliferation.
I feel the providers miss out on cues they would get if they were able to spend more time last joint at and examining patients rather than staring at the computer screen and keyboard during exams but understand why they do enter notes while seeing patients.
I know some form of electronic records is part of the answer but find the multiple competing electronic systems bewildering.
Mistakes in EMR may be there forever, but correct lab results and diagnoses are also there forever, which is of considerable value. Having searchable data is incredibly worthwhile.
Yes, the system has a ways to go. When my adult son was hospitalized two years ago, the nurse called me to see what psych meds he was on. Really?? Not reassuring.
Physician here. Was an anesthesiologist, H a cardiologist. Solo practice is not ideal because the overhead costs would be similar to those of a group- more expensive per physician. Small group practices se4em to be taken into large groups that are run like businesses. That happened decades ago with HMO’s, long before EMRs and the ACA.
I was able to have a solo practice because I only needed to use the common case scheduler and an accountant. Then the hospitals formed groups and no girls allowed (stayed for H’s practice). H had a wonderful small group that hen grew and after he retired got bought out by a hospital. After moving to FL I have experienced both the group and solo docs. Between my experience as a patient and the physician side I have seen many changes in many decades. Pros and cons.
Insurance coverage for more is a great thing- wish my family could have afforded more when I was a kid. The corporate/profit driven model is horrible. Somewhere along the line we let business take over. Having to run a business as well as the medical side was not good- a waste of medical knowledge spending time with the books or not doing them well. But- all of the managed care brought on by companies and their insurance plans has taken away so much from the doctor-patient relationship.
I like groups- knowing you could see another doctor when yours took vacations et al.
EMR’s have their limits. I really, really dislike some things such as “allergies”. Not all intolerances are true allergies, MA person reviewing the record… I also had trouble getting the person to find what was a simple to me procedure entered- what I put on an anesthesia record and filed with the accountant could not be found that day… Son worked for a major EMR player as a software developer just out of college. Hospitals and groups need to spend millions so making major software changes would involve so much time and money away from medical care. This means basic internal software programming changes don’t happen as often or as drastically as would be best. Reminds me of needing to retool a whole plant to change a car.
Overall I love having labs et al readily available. Information without having to read poor handwriting or physically get the chart.
When life is perfect call me. I’ll either be in heaven or hell as defined by somebody.
The ACA electronic health record requirements, known as Meaningful Use, ended in December 2016 but were replaced by MACRA (Medicare Access and CHIP Reauthorization Act of 2015) which aims to control Medicare spending by rewarding quality over quantity. The requirements are equally complex and I really can’t see how those in private practice can keep up unless they are part of a network or have a strong professional association who can assist. The message is that without something like MACRA, Medicare will be broke in about 10 years.
A few years ago, my husband’s PCP switched to practicing concierge medicine for cash only and no longer accepts any insurance. He has such a large and devoted following that there does not seem to be any impact.
@wis75 I’m with you on the allergy thing. I have “morphine” listed under “allergies” on my medical record even though I’m really not allergic to it. The last time it was given to me, I had extreme chest pains and I probably shouldn’t have it again… but it wasn’t an allergic reaction.
I don’t know any other way they can put that on my EMR though. And I’d rather have it under allergy than no where at all, especially if I’m not in a position to talk on my own behalf. (I also have it listed as an allergy on my med alert bracelet because, again, I don’t know how else to convey that information quickly.)
The imperfections of any system, sigh. btw- sometimes what patients consider important are not medically and so much time can be wasted if everything is put in a record. There may be a reason your physician cuts you off- need to get to things that matter. Imperfect world- some of those seemingly extraneous details could matter but would never get to where they do unless the focus is narrowed… Just a comment on records. Too much and you miss the important stuff, making things uniform makes it easier to follow…
Around here there are 2 main hospital systems, each affiliated with its own insurance, and they have been butting heads (one won’t accept patients with the other’s insurance, etc). My doctor group is still independent, so they take all insurance types. Many physicians belong to one or the other hospital systems. There are 4 doctors in the group, but I can usually see mine when I need to. There is a lot of staff to deal with the paperwork, referrals, etc.
I have read a few articles recently on concierge medicine, which looked surprisingly affordable but I haven’t checked the details.
A lot of Doctors were transitioning to EMR well before the ACA. I think some handle it better than others. I just saw my Opthalmologist who is transitioning to EMR. He has always had an assistant in the room who is record keeping while he interacts with me. He does it well, sits in a chair directly in front of me, looks me in the eye and spends time talking to me and answering questions. Prior to EMR the assistant was transcribing info in the chart as he talked to me, now it’s just the EMR instead of by hand. My S and D both used to see a dermatologist who transitioned to EMR before the ACA. He installed computers in his exam rooms in such a way that while the doctor or nurse was interacting with the patient they had their backs to them the whole time and were focused on the computer entering information. Just poor planning IMO. My Gyn doctor does it well also, I believe she enters the info in the computer after she leaves the room but she is focused on me while in the exam room.
I think doctors being frustrated in private practice and even practicing medicine in general predates the ACA. Sure there are problems with the ACA, but there are also benefits and going back to having a lot of people without access to any care outside of ERs is really not the way to go. There has been building frustration with the insurance industry among doctors for a very long time. Excess time being spent on the bureaucracy, red tape and paperwork. Frustration with the way insurance rewards performing procedures while not valuing time spent with the patient. And on and on. IMHO the best way forward is to look at where the ACA is not working and try to fix that rather than replace with something entirely new and try to build on what is working. Not likely to happen though.
My husband is a physician and he has a lot of frustrations with EMR, some of the things mentioned above like not being able to skip non pertinent sections but he has developed work arounds by having automated things that he can rotely enter when it doesn’t pertain to a particular patient. Having access to the EMR when he is on call at home is great.
It’s odd, I’ve read a lot about the perceived deficiencies of ACA, but this thread is the first place I’ve seen the complaint that the law has placed an insupportable regulatory burden on providers. I’ll have to delve deeper.
I can live without Marcus Welby. I don’t care a bit if a provider is looking at a screen instead of into my eyes, so long as my care is good. I know, for example, that my endocrinologist, who, like my internist and cardiologist, is part of a group affiliated with our hospital system, has full info about all my medical issues, my treatment history, my ER admissions, and my current prescriptions from other docs. She has the whole picture of me as a patient rather than me as a thyroid case. I do see one doc who is not affiliated with the group, and I feel burdened with the responsibility of keeping him-up-to-date on my health status, since I’m hardly an expert in the field. He once prescribed a medication and then left me a frantic message later in the day telling me not to fill the prescription because it didn’t play nice with another med I was taking. I had mentioned I was taking it, but who knows how clearly I had communicated or how effectively it had been recorded. I don’t think that would have happened if he had access to the same comprehensive data my other docs have.
I also appreciate the fact that the docs within my affiliated group know one another’s styles and personalities from years of cross-referrals and consultations. My primary care doc knows I’m a well-educated medical consumer who does a lot of research on my own and comes to an appointment well-prepared and with in-depth questions, so he sends me to specialists who he knows will be able to connect with me. Maybe Marcus knew all the docs in whatever small-town America he practiced in, but in my small city and surrounding towns there are many, many providers, and the long-standing connections among the docs in the group are a valuable asset.
My H quit medicine years before the ACA was established. He couldn’t take the endless paperwork trying to get insurance approvals for his patients, coupled with the horrendous conditions they lived in, in low SES areas, overlooked by the rest of us. He would have stayed, I believe, if we had Canadian style coverage. Ridiculous paperwork predates the ACA by many years. He took care of kids in homeless shelters, housing projects, etc, in Newark. He probably made a tiny fraction of what the present day complainers are making.
Medicine’s loss was education’s gain–he’s a fine teacher now.
“this thread is the first place I’ve seen the complaint that the law has placed an insupportable regulatory burden on providers”
Probably because the complaint is ill-founded. As several people here with direct experience as physicians or married to physicians state, it was a problem long before ACA came along.
one of obamcares long term goals is to force doctors into large hospital groups(and force hospitals to merge and merge again)smaller rural hospitals in many cases were/are simply shut for good and a ban was placed on " creation and expansion of physician-owned hospitals".all getting ready for the grand prize down the road . I am sorry your husband and many other doctors,small hospitals and specialty hospitals as well as we the patients are victims of this agenda. it is a process that will take years to bring to fruition…slow by design and I do not see the brakes being put in motion. 25-30 years from now unless change actually occurs…not just talk. it will be a nightmare unless you only have a simple medical issue to deal with. (and even that maybe a large feat to get taken care of)
Like any profession, all of this evolves over time. My late MIL’s dad was a physician decades ago. He was born in the late 18O0’s. He got rations for gas during WWII so he could visit patients, poorer people gave him things like food (and chickens!) in appreciation of his services. Those days are gone. My Grandmother was an RN from a hospital program in Pittsburgh. Now most nurses go to college! It all adds up. Other professions also have more requirements/ licensing these days.