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Archive for the ‘Message from the President’ Category

By Definition, Obamacare Fails as Health Care Insurance

Wednesday, March 1st, 2017

As we move into ACA “Repeal and Replace” discussions and action, consider Obamacare’s fundamental philosophical and economic paradoxes.

On one hand the ACA law is a boon to establishing government-insurance company cartels taking federal and state government money to “cover” US citizens who are not enrolled in Medicare, Medicaid, and the VA. Also, of course, the large ACA Medicaid expansion in Minnesota is administered through HMOs in cartel-TPA arrangements with our state government.

But what is the fundamental definition of Heath Care Insurance? The ACA flatly negates the principles of individual patient insurance risk underwriting by requiring “guaranteed issue” and removing all “pre-existing conditions” as coverage exclusions. So now, health care insurance companies must enroll all applicants based not on the likelihood of them incurring projected health care expenses but rather by the criteria of their economic status as defined by government-income classifications and thresholds. Therefore, it’s no surprise that insurance companies have dropped out of Mnsure and the MN individual insurance market. We’ll need to continue to pay off the insurance companies unless there is a proper definitions of health care insurance which is distinct from social health care entitlements.

2017? This year the Minnesota legislature decided to subsidize insurance companies who cover Minnesotans faced with huge increases in their health care premiums. There are current proposals to re-establish a Minnesota high risk pool to be administered internally within Minnesota insurance companies. This will allow them to unload expensive cases to taxpayers.

I’m thinking we should bring back a patient-centered high risk health care insurance pool in Minnesota modeled after the 1976 Minnesota Comprehensive Health Association plan http://mchamn.com/ which was phased out in 2013 because the ACA was supposed to be a refuge and safety net for patients and families with expensive medical conditions.

Causes of The Epidemic of Physician Burnout

Thursday, January 5th, 2017

Causes of The Epidemic of Physician Burnout
Thursday, January 5th, 2017
https://www.stepsforward.org/modules/physician-burnout

At the Jan. 3, 2017 Minnesota Academy of Medicine meeting, Dr. Mark Linzer gave an informative presentation on the work of his team at HCMC to mitigate physician burnout.

It is estimated that significant physician burnout now affects half of US physicians, and it is getting worse. Dr. Linzer cited a recent Mayo study: http://newsnetwork.mayoclinic.org/discussion/physicians-and-burnout-its-getting-worse/

Despite a nationwide shortage of physicians, burnout is both a symptom and cause of the critical problem facing organizations wanting to retain and recruit physician employees as “providers” in health care organizations. There are narrowing employment options for doctors outside of such large clinic systems because independent medical practices continue to be bought up at a record pace by hospital-clinic organizations http://www.forbes.com/sites/scottgottlieb/2013/03/15/hospitals-are-going-on-a-doctor-buying-binge-and-it-is-likely-to-end-badly/#296758694f72

Mark offered a “demand-control model” for physician burnout in which generic physician stress (pressures on doctors) is counter-balanced by the doctors’ ability to have control of their work environments and the quality of supports which are in place to reduce stress. The model’s reference: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.71.7.694

From surveying the doctors at HCMC, two identified reasons for increasing burnout stand out:

1. Time pressure during patient encounters. Not enough quality clinical time with patients, nor the flexibility to adjust their efforts to the patient’s needs.

2. Inputting electronic health records (EHR) now dominates physicians’ outpatient and many inpatient clinical encounters and distract from doing quality patient care.

Dr. Linzer’s recommendations included:
Bringing scribes into the examining room whenever possible. The doctor is then free too interact with the patient while the scribe silently types away (in the background).
Expand the (allowable) 20 minute doctor care visit to 30 minutes.
Add (support) perks like a doctor’s lounge, quiet room, child care services and a 7 hours on, 7 off schedule, rather than one of 12 on 12 off. More time off.
Formal listening sessions sponsored by the organization to hear the gripes and complaints of the doctors.

When asked during the Q and A about the financial drivers of physician burnout?, Dr. Linzer said his he’s convinced his recommendations (in progress) save money for the organization — essentially by improving physician productivity and job satisfaction.

A number of audience members commented on the negative consequences to physicians when they are viewed by their organizations as “providers” (health care workers) rather than physicians (professionals). He agreed that this is a real problem.

Not examined or discussed during this fine talk was the elephant in the examining room, a connection between HCMC’s financial incentives and the mounting stresses experienced by its employed doctors. Many people, including policymakers, are not aware that HCMC as our public safety net hospital-clinic organization is now an Accountable Care Organization (ACO) called Hennepin Health http://content.healthaffairs.org/content/33/11/1975.abstract So as with other ACO’s, the organization’s financial incentives must be to reward physicians for spending less money on patient care. How does this square with “increasing physician productivity”?

Also, as a psychiatrist by training, I am very concerned about patients’ medical care data privacy and confidentiality. If an EHR is mandatory in the HCMC system, how can patients be assured of privacy and confidentiality in mental health and substance use interviews and encounters? And, if scribes are seen as the answer to reducing documentation stress for most doctors, what is the effect of having another person in the examining room room during one’s doctor-patient visits?