South Florida Hospital News
Saturday September 19, 2020

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April 2006 - Volume 2 - Issue 10

Business Muse Ö Reflections on the Business of Healthcare Delivery

The Hassle Factors

I recently attended a meeting where one of the speakers was a representative of the AMA. He spoke at length about a variety of ills plaguing the practice of medicine.

After his presentation I had a chance to discuss with him a number of issues that affect practicing because they affect the business of practice. He informed me that the AMA has now started referring to these conglomerately as the "hassle factors". Factors that occur regularly and eat up your time and guts while you are trying to take care of patients. He believed that the AMA has been trying to adequately enumerate and define these factors. The following is an overview of some of our discussion.

We initially spoke about adequate reimbursement (or perhaps what most view as inadequate fees) for services. Becoming a "provider" requires a long initiation period. Most docs donít start earning a living until they are into their thirties. During the time they are training others are making their way up the ladder and are earning a living. They are buying homes, starting retirement plans, and building a life. By the time a physician begins his practice years he is way behind his peers in earnings, probably in debt, and needs to earn enough to amass the aforementioned basics. If what carriers (and society) are paying for services are not commensurate with the expectations of what the years of training and sacrifice are worth, then disillusion, depression and anger can result.

Carriers, and others, also try to beat up the doctors with their own morality. The insurers wonít pay for a necessary service, but expect you to provide it anyway, especially since believing they are necessary already makes you liable to see they are done. Of course they say you are doing this for your patientís good and as a provider you canít leave your patient without the service. In effect carriers save money as you do it on the cuff.

Malpractice, the dreaded word that makes providers perform tests, services and referrals to cover their butt. The fact that reasonable medical professionals would agree that much of the work or explanations are unnecessary, we have all seen or been the recipient of attacks. The stress associated with guaranteeing complete documentation and excessive explanation gets injected between the doctor and the patient. This potential for an adversarial relationship to occur adds undue pressure to a true desire to help a patient. Even the word malpractice is hurtful. Doctors donít go through all and not care for their patients. It is true accidents happen. That is why docs have been insured. The word malpractice implies that you are a bad practitioner, not that an accident occurred. If you have a traffic accident people do not assume you are a bad driver. The added reality of databases and disclosure of your history further that impression. While it is true that there are some bad apples in every barrel, the vast majority are accidents or just bad outcomes that happen naturally. The pressure to avoid the aggravation or the stigma of being sued adds significantly to the hassles of practice.

Then there are the hassles of maintaining OSHA, HIPAA and other regulations. The constant need to chase carriers to fight denials. Hospital requirements such as committees, record room, taking ER call. Continuing education requirements imposed by states and societies can eat up taking the real vacation and down time everybody needs. Managerial tasks and personnel issues add their own unique hassles to the mix. I am certain you can add to this list.

Taken individually each seems manageable. It is the weight of them all together that creates the stress associated with these "hassle factors". They interfere with the primary goal of caring for fellow human beings. There comes a point when one more straw is all it takes, and it seems they keep adding straws

It is time that organized medicine comes to this realization. It is gratifying to see they have created a term for them. But creating a catchy name is not enough. It is now the time that they attack these factors and try to lighten the load, before the backbone of healthcare delivery (the physician practice), now bending under the weight, breaks.

PHC Practice Development Advisors solicits and appreciates questions of a business nature relating to Practice Development, Managerial Solutions, and the Integration of Technology in healthcare services and delivery to address in future columns. Please address your questions to PHC at
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