25 May 2012

Restoring the sanctity of the patient-physician relationship. Part 2

Posted by Jody under: Wellness .

Now we’re left with managed care. And managed care is marching forward in most markets throughout America largely unchallenged, largely backed by huge corporate entities with extensive financial resources, and consequently, largely unstoppable. Everyone seems to be buying into managed care, even before we know for sure if it’s good or bad for individual patients or for the health of Americans, collectively considered. No one, except the very rich individual who can afford to pay for medical care out of pocket, is immune from this progression. Even senior citizens, who could long depend on Medicare for their healthcare in their aging years, are now being herded into large HMOs to contain costs.

Some say the relationship between patient and physician has been further compromised, further weakened, under managed care.

“The doctor-patient relationship, once considered the basis of therapy, has been subverted by technology, by the medical education system and, more dramatically, by the intrusive demands of managed care,” said Elizabeth DeVita, associate editor of American Health magazine, in a recent article.

What is managed care? It’s basically a system that attempts to control healthcare costs by carefully managing how, when, where, why and by whom care is provided. To call it “rationing” would be going too far. But its effect is to prevent needless or unnecessary utilization of healthcare services…to keep people away from doctors they don’t need to see, and out of hospitals – – which, when compared to luxury hotels, are pretty expensive places to stay…even for one extra day.

The buzzword in medicine these days is “capitation.” The word is reminiscent of a similar word which brings to mind the swift descent of a guillotine blade, followed by the sound of someone’s head going “plop” into a bucket. Actually, capitation means doctors are paid one set fee per month for each patient. And if they can’t manage their patients’ medical care for this set fee, it’s likely to be the doctors’ heads winding up in the bucket.

“Under capitation at the provider level, the patient becomes a cost center rather than a customer,” said Joseph C. Nichols, Jr., MD, president of the Washington State Orthopaedic Association. “There is a disincentive to provide care, and the sickest patients who need health care the most become pariahs of the system. The focus in this methodology becomes cost containment, and patient illness becomes a burden to cope with.”

“The potential for under-utilizing services is a real concern,” continued Dr. Nichols. “Those who claim that the fee-for-service system causes physicians to inappropriately over-utilize must recognize the potential for those same physicians to inappropriately withhold services when they are given incentives to do just that under capitation.”

Withholding services may become the “default position” under many evolving scenarios of managed care. In cases where a bad legal outcome isn’t anticipated, withholding services

may be easier for doctors to do, considering how time-intensive and aggravating it is for them to argue with managed care companies. It’s also true that doctors who fight managed care companies can be cut from their provider panels. This can hurt doctors’ incomes, sometimes seriously enough to jeopardize their practices.

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