The Disturbing Changes in Medical Care Delivery That Fails Patients, Doctors
Opinion Advocates for ideas and draws conclusions based on the author/producer’s interpretation of facts and data.
By Dr. John L. Costa
I am a retired pediatrician who had a solo practice in Bedford Hills for 25 years and joined the Mount Kisco Medical Group for my last six years of practice.
I write this article because I am dismayed, angry and concerned at the major changes made in the delivery of today’s care. I was exposed to medicine at a very early age, since my father had a home-based pediatric practice. As a teenager I worked at Northern Westchester Hospital caring for patients, then in the Radiology Department and finally rode an ambulance. I experienced how medicine was delivered with care, compassion and kindness.
I, and many of my colleagues, had very active practices rendering excellent care with integrity. With the 1990s advent of Managed Care Organizations (MCOs), whose main goal was to contain costs and manage the delivery of care, private insurances for our patients were becoming obsolete. Their employers put them into MCOs.
As physicians we had to join to maintain a practice. They lowered our customary fees and imposed rules, regulations and guidelines. They even made a list of drugs that we had to use. Otherwise, patients would be responsible for the costs. Hence, many of us joined large medical groups since they had leverage to negotiate with insurance companies’ terms and fees that were not possible for a solo practice or small groups.
This was the beginning of the end of medical care that both physicians and patients were accustomed to. The physician was losing his or her autotomy. Corporations, private equity firms and mega health insurance companies such as UnitedHealthcare filled a void. Their primary goal is to make money for themselves, their CEOs and investors. The secondary goal is patient care.
What are the qualifications of the people developing guidelines for the procedures that will be reimbursed by insurance? If doctors, are they on the organization’s payroll? Did any of them ever go to a doctor’s office to view firsthand how hectic and demanding it is? How waiting rooms are packed. How it can take weeks to months to make an appointment. How patients are shuffled off to urgent care centers and hospital ERs due to lack of appointment openings or, even more distressing, the lack of qualified physicians.
The physicians, nurses, nurse practitioners and physician assistants are overwhelmed with meaningless administrative tasks, stressed under the unreasonable burdens of seeing more patients yet expected to give excellent care in an efficient manner. Providers are deluged with rules, regulations and guidelines.
They can be hindered in what they feel is the best care for their patients. They are stymied by which drugs they can prescribe and by preauthorization requirements. The latter can lead to a delay in treatment that could be critical. Providers are burdened with the electronic medical record, checking boxes that do not even apply to their patient.
There are 69,000 diagnostic codes that have to be correctly applied to the patient’s particular illness. If incorrectly coded, reimbursement is affected. This now forces the physician to be a gatekeeper, to watch over cost containment.
All of the above issues take time away from being with the patient. To get to know them, their family, their home situation, to gain their trust and confidence, to listen, to give a thorough and complete exam. To discuss the findings and plan of treatment, to support or reassure a patient, to hold their hand in a stressful situation. Most important to be available to them when ill. They do not want to be told to go to the ER or an urgent care center. They want their doctor!
Doctors are angry, demoralized and exhausted leading to early retirement or moving on to a different occupation – the last thing you need today with the shortage of physicians, especially the primary care doctors. Medicine is now industrialized. Doctors are like cogs in a wheel. Being told what they can and cannot do. They have lost their autonomy. They are now employees of profit-making industries. What a shame.
I’m not sure how we can return to kind, compassionate and empathetic patient care. How we can give each patient the time to ask questions and have their concerns addressed. Perhaps doctors can voice “we have had it with corporations dictating how we should practice!” Refuse to follow all their rules and regulations. Will they fire all of us? Highly unlikely.
Or perhaps we should become unionized, demanding what we feel would be the best way to deliver high-quality care to our deserving patients. Put us back in the seat of determining what and how good medical care should be delivered!
Hopefully between doctors and patients protesting the future will bring a better system of medical care delivery that will benefit all.
Dr. John L. Costa is a retired pediatrician who practiced for most of his career in Bedford Hills.
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