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Exodus from Private Practice

For doctors to focus solely on patient in post-ACA era, collective bargaining is needed

It’s reasonable to say the outlook for physician providers is grim.

As pressure keeps mounting on physicians, some will seek early retirement, administrative positions or similar non-patient care employment, or change careers. Already, many physicians in private practices are being acquired by hospitals as employees. Their hopes are to avoid a reduction in pay and administrative burdens brought by Meaningful Use (MU) mandates. Most hospital-employed physicians now realize they cannot escape either problem.

As the physician shortage worsens, the gap is being filled by the growing employment of allied health extenders. The cost of medical education is quite high, and post-graduate medical education requires years of residency and fellowship training – a huge time and financial commitment in higher medical education that may not yield a return on investment.

Two solutions may help solve this dilemma:

1. Physicians need to be represented by a group that addresses the following non-medical issues: restrictions imposed by regulations, insurance plan interference with care, and unfair compensation that’s out of line with the commitment of medical education. The Association of Independent Doctors could represent these issues on behalf of physicians.

2. Physicians may accomplish the same goal by tapping into the already existing American Medical Association (AMA) via local, state, and national branches. By having thousands of solo physicians as members, the shared discontent with heavy-handed regulations and dwindling fees may be expressed to garner a more favorable outcome.

Membership would demand expediting these pressing issues to the forefront of the legislative agenda in Washington, DC. This would redirect the AMA to deal with real obstacles facing local physicians. By joining forces, a momentum would be created by the physician manpower in this country – and also capture attention at the local, state, and federal level.

By lobbying on Capitol Hill, physician voices may be heard in unison. The control over how to treat patients would shift from insurance plans back to providers, where it belongs. Payment should be proportionate with the medical service provided – not with what CMS or private insurance plans deem appropriate. The focus should shift from MU measures to a true and simple meaningful healthcare relationship between two people: the physician and the patient.

Actions the AMA could take to grab the attention of the politicians in Washington, DC:

Request that members collectively become non-participants in the Medicare/ Medicaid program. Certain specialties are already non-participants.

Call for members collectively to not accept Medicare HMOs or private insurance contracts unless the reimbursement is higher than 100 percent of the local geographic Medicare fee schedule.

Recommend implementing an administrative service fee for processing or obtaining authorizations on insurance claims, and also charging insurance plans a set fee for unnecessary denials that cost a practice time and money. This may stop the game of denials played by the insurance industry to avoid or delay reimbursement for services.

After all, at the heart of the matter is the physician-patient relationship. The patient and the provider may disagree with what the payer may deem quality care. The quality of care exists when the doctor provides safe and effective care for the patient, and the patient is satisfied with the care rendered by the doctor. It’s not quality care when the doctor cannot control when or how to treat a patient, or when the provider has to play by the payer’s rules to receive a payment on behalf of the patient.

Personalization and the professional relationship between a physician and patient is a quality that cannot always be captured by mandates.

J.B. Bitar, MD, FACC, and his wife, Susan Bitar, MSN, RN, practice at Cardiology Care Center in Lake Mary.

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