How We Can Adapt To The Inherent Challenges In Healthcare Reform

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John H. McCord, DPM

The Apollo 13 crew detected a problem, acknowledged their peril, adapted, changed and survived. We are traveling in the spaceship called medical care and we have a problem.

   I recently attended a symposium of hospital leaders. This included physicians, administrators and hospital board members. The purpose of this gathering was to inform us of the changing paradigm and how to negotiate the winding road of healthcare reform.

   Admittedly, I have traditionally viewed these symposiums as a snooze fest. I have been in hospital leadership positions for the past 25 years and attended these seminars once or twice yearly. The usual experts in charcoal gray suits go to the podium, screw around for ten minutes with their PowerPoint and then start lecturing in a foreign language they learn in their MBA classes. An hour later, nobody in the room knows what they said.

   We fill out the class evaluation, trying to not show how confused we were and head for the coffee pot.

   The seminar I attended was different. The message was clear. Healthcare reform is here. We need to adapt. There is no chance of returning to the fee-for-service model that rewarded hospitals and doctors who played the numbers game.

   The “cash cow” procedure oriented physicians are now seen as liabilities to the system. The physicians and clinics that employ creative coders in their billing departments are considered liabilities.

   We have to get comfortable with a bunch of new buzzwords and acronyms such as accountable care organization (ACO), bundled payments and value-based payment. The list continues to grow.

   The traditional relationship of the independent physician and the hospital is beginning to blur as increasing numbers of physicians become employees of the hospital. The ACO model rewards hospitals for efficiency rather than volume. Employed physicians may get a few of the extra crumbs that fall off the table and independent physicians will be challenged to survive.

   This stuff is here. It was inevitable because our traditional fee-for-service model was unsustainable. Obamacare, insurance companies and malpractice have been the usual whipping boys but the change was coming anyway. Electing a Republican in 2016 and getting rid of insurance companies and tort reform will not change the reality that our traditional concept of healthcare delivery is a goner.

   One old medical professor summed it up by saying, “Things could be worse. I could be younger.”

   As the new paradigm evolves, physicians need to be educated, adaptable, innovative and willing to learn the new language that surrounds the new system of healthcare delivery. The “do nothing” approach is a huge risk. According to Earl Steinberg, MD, MPP, of Geisinger Health System and XG Health Solutions, Medicare and commercial payers have signaled a strong intention to move to bundles and population management, particularly in urban areas across the United States. The Centers for Medicare and Medicaid Services (CMS) has spent the past several years consolidating fiscal intermediaries so all providers in a region are on a single intermediary for Part A and Part B billings, thereby enabling CMS to make a single prospective bundled payment.

   This would have all been easier for podiatrists if we hadn’t have been so eager for parity in the 1970s and 1980s. Podiatrists wanted to be treated as equals to all other physicians. This was good for a while until managed care came to visit in the early 1990s.

   Dentists and optometrists have stayed somewhat independent and will likely not suffer much from the new model.

   When I started practice in 1975, many of the payers did not include podiatry so I basically ran a cash business. One receptionist did everything. I worked four days a week and usually had one or two surgical cases each week. Surgery paid well and insurance companies usually covered it. The surgical work covered my entire practice overhead. I shared an office space with a general surgeon. My half of the rent was $125 per month.

   Those were nice days. I had no student loan payments and we led a modest lifestyle. I took every Thursday off and went fishing in the summer and cross-country skiing in the winter.

   Podiatry evolved in a way that was good for the profession. I am glad of that but reflect fondly on the simplicity that I enjoyed in the beginning.

   Now we must prepare for the new model of what is now referred to as “population health.” Educate yourself by attending seminars that focus on the changing model of healthcare delivery. Analyze healthcare in your community to determine which innovative changes you need to make as a podiatrist to fit into the new healthcare environment.

   Hunker down with your personal finances and be ready for some difficult times while the country works this out.

   We will survive. We always have.

   Dr. McCord retired in December 2008 from practice at the Centralia Medical Center in Centralia, Wash.

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