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At a recent presentation – ‘Physician Whither Thou Goest’ – Dr. Howard Krauss says the physician-patient relationship must prevail over the provider-enrollee encounter.
The world has witnessed many remarkable and hard-to-foresee changes since the Hippocratic Oath. However, the principle that “with regard to healing the sick (...) I will take care that they suffer no hurt or damage” remains at the core of caring medicine.
Whether that physician-patient relationship prevails depends largely on how doctors respond to today’s intensifying pressures.
This was the thesis of the presentation Dr. Howard Krauss delivered at The St. John’s Physicians Alumni Association on October 15, 2015.
“We face a tsunami of issues,” Dr. Krauss noted, “ranging from the Patient Protection Affordable Care Act and Pay-for-Performance to for-profit mega health plans, but if we and our professional organizations do not protect our patients, then we do not deserve to be protected.”
“The physician has been and must continue to be, first and foremost, the chief advocate for the well-being of his or her patient,” Dr. Krauss urged. “It’s our duty to maintain personal excellence and to promote adherence to standards of medical care as established by a physician community which is dedicated to the well-being of patients.”
Medicare and other third party payer payment differentials – in association with ever increasingly expensive compliance with evolving regulations – are driving solo practice doctors and small groups into large healthcare systems. As Dr. Krauss put it, “This risks drastically increasing the costs of service and reigning in physician autonomy.”
While there are powerful pressures from all sides now, physicians are the ones who know what excellent health care is. The physician and the physician community must hold the high ground and insist that the need for a healthy corporate balance sheet cannot outweigh the health needs of their patients, Dr. Krauss insists.
“Government, administrators, and payors need to trust that we will sensibly stand up against anything that might sacrifice the well-being of a patient,” said Dr. Krauss. “If we fail in that duty, we may do harm in the name of ‘costcontainment’ or ‘shareholder profit.’“
What’s more, the future of medicine is not something that can be taken for granted.
“What will happen,” asked Dr. Krauss, “if there are no more doctors, but only ‘providers’?”
Dr. Krauss continued with a deliberately faniciful, tongue-in-cheek tale. “Imagine walking into a facility in pain and being greeted by someone saying, ‘Hello, my name is Larry. I’ll be your healthcare provider today… Would you like to hear about our specials?’ And then, before you can answer, an announcement comes over the PA: ‘Attention shoppers, for the next two hours only, there is a blue light special on aisle 9 – have your colonoscopy today and receive a coupon for 50 percent off any routine preventative healthcare procedure for you or a loved one, good for one year from date of issue!’ “
Dr. Krauss’ story was told with his usual disarming sense of humor, but make no mistake: His underlying message is a serious one. Medicare and other third-party payer payment differentials -- in association with ever increasingly expensive compliance with evolving regulations -- are driving solo practice doctors and small groups into large healthcare systems. As Dr. Krauss put it, “This risks drastically increasing the costs of service and reigning in physician autonomy.”
And there are still more looming questions. “Will the IPAB (Independent Payment Advisory Board) be constituted? Will ‘data’ analysis of ICD-10, CPT-coded encounters, and ‘outcomes’ lead to government or third-party payer mandated protocols of care?” Dr. Krauss asked the group. “Are ‘quality indicators’ already being designed and utilized by government and third-party payers as tools of coercion of physician behavior?”
As with all endeavors in 2015, medicine is also profoundly impacted by new technologies and new applications of existing technologies. The evolving roles of mHealth and telehealth are still being defined. Last year saw the launch of IBM Watson Health, and its $700 million dollar acquisition of Merge Healthcare is, as The Wall Street Journal noted, “a crucial step in its plan to put artificial intelligence to use in medicine.”
Yet with all these changes – and in many ways, because of these changes, physicians have to take more care than ever to ensure that they keep their patients’ care foremost in their minds.
The pressures are real, but so are the responsibilities.
Dr. Krauss closed his presentation with these inspiring words, “My dear colleagues: It’s up to you. Will you fight for excellence? Will you create the future of health care, or will you fall victim to it?”