In the midst of all the turbulence that characterizes American healthcare in 2008, one thing is certain: health care is changing. Increasing costs and diminishing resources, staggering numbers of uninsured and underinsured citizens, concerns about patient safety and workforce shortages, and the pressure to upgrade healthcare processes with information technology are among a few of the pressing and complex issues with which leaders in the healthcare industry and the government are struggling.
Central to the transformation of the healthcare industry, one would assume, is the physician and yet, increasingly, physicians say that they feel left out of the process and frustrated in the effort to make their voices heard. Broward County Medical Association president Nigel Spier, M.D., says that many of healthcares critics propose solutions that would essentially cut doctors out of the picture, making them nearly irrelevant. “We need to focus our efforts and unify,” Spier says. “We have to present our ideas and influence the future of healthcare. This takes courage, conviction and action. Physicians have rights and responsibilities, and our right to be heard on the issues that affect us, and our patients, only works when we exercise our responsibility to speak out.” For many physicians, professional medical organizations are the best means to speak with a unified voice, and among those organizations, the most effective are often the county medical associations. Grounded in the local community but also linked to national organizations, county medical associations offer substantial leadership, advocacy and support to their members. South Floridas county medical societies are confronting numerous issues, but the most critical issue in 2008 thus far is the pending 10.6% reduction in Medicare reimbursements to physicians. The cuts, which were originally due to take effect in January but were temporarily delayed to July, could have devastating effects, not only on physicians but also on senior citizens, the disabled and even employees of physician practices.
That is the general consensus of several regional medical societies, which have mounted an intensive effort, along with the American Medical Association (AMA), to convince Congress to intervene. According to Dean Traiger, M.D., president of the Lee County Medical Society and a family practice physician, the Medicare cuts represent a crisis for South Florida healthcare. “Florida will feel the impact more than other states because it is a grayer state, with a higher senior population. In South Florida, it is common for 50% of a medical practice to be comprised of Medicare recipients. Physicians may have to restrict the number of Medicare patients they treat, and some are considering early retirement. This means that access to care will be a challenge for even more people. It is also likely that some physicians will have to trim their staffs in order to reduce costs.”
Traiger explains that the Sustainable Growth Rate (SGR), the basis on which the 10% cut is calculated, is flawed and is not tied to economic indicators such as the cost of living. Doctors are being paid at a 2001 rate. Florida physicians stand to lose $1.3 billion for the care of elderly and disabled patients over the next 18 months. On average, says the AMA, each Florida physician faces a Medicare cut of $25,000 in that time period. Over 2 million Medicare patients in Florida will be affected as doctors are forced to limit the volume of Medicare patients they treat or even to opt out of Medicare altogether.
Daniel Higgins, M.D., president of the Palm Beach Medical Society, has traveled to Tallahassee and Washington DC to advocate directly with state and federal legislators regarding the Medicare reimbursement issue. “A cut is not the absence of a raise. No one takes responsibility for the SGR, although no one defends it either. There have been opportunities to get rid of it, but no one had the courage to act. As long as doctors continue to provide the care, at whatever measly rate of reimbursement, no one cares and our rights will continue to be disregarded. There is a crisis coming and it will be the fault of those who did not act, who did not stop a train wreck about to happen.”
Higginss and Trainers concerns are echoed by Bernd Wollschlaeger, M.D., president of the Dade County Medical Association. “In Dade County, we are developing relationships with politicians, working closely with them on issues like Medicare reimbursement. We have to let them know what we need and show them what is happening as a result of public policies. We are advocates on behalf of our physician members.” Wollschlaeger says that involvement in health policy planning is an appropriate role for medical professional organizations and for individual physicians as well. “Medical practices are already struggling, due to the rising cost of living and higher costs associated with staff and supplies. With lower reimbursement, these challenges are compounded.”
Wollschlaeger ties the reimbursement issue to a larger one: the need for physicians to change their mindset about the practice of medicine. He believes that doctors have to think like business persons and take a pro-active stance on the business aspects of healthcare. “In the current environment, a doctor has to be three things: technician, entrepreneur and manager. Doctors must become informed about business practices. We cant afford to delegate the business to the office manager; we need to know ourselves how to fine tune the business of the practice and take corrective actions. Our leaders need to be encouraging this and teaching the business of medicine,” he states. Dade County Medical Associations 1800 members have the opportunity to upgrade their business acumen via seminars, lectures and educational materials available on electronic media.
A related issue for Wollschlaeger, a board certified addiction specialist, is the need for physicians to implement information technology in their practices. He believes that this is a necessity for any doctor who wants to stay in business, but says that many practices are lagging behind, still using paper-based systems. He cites several obstacles to implementation: cost, complexity, concerns about confidentiality and the fact that technology becomes obsolete so quickly. “Dade County Medical Association is trying to empower our members to quantify quality and cost data in their offices and this requires information technology. When you quantify your work, you increase your competitive edge. This helps members see the direct value of membership in the medical association, because it translates into direct value in your practice. Doctors have a responsibility to change the practice of medicine through business practices and information technology.”
Tenna Wiles, Executive Director of the Palm Beach Medical Society, says that “physician viability” keeping physicians in practice is a priority for her organization. “Physician viability is one of four initiatives that comprise our Future of Medicine” program, a long term plan to improve health care in Palm Beach County and establish a roadmap to the future. We created a practice management resource center for our members, offering online resources about health law, coding, reimbursement and other concerns. We have list of consultants they can turn to, and other resources. By supporting them in the management of their practices, we hope to keep them in practice longer.”
Palm Beachs Future of Medicine program is also addressing patient safety and quality of care, access to care and prevention and wellness through a number of specific initiatives. Project Access is will coordinate and locate access to care for those who fall through the cracks, with 300 physician members providing $1.3 million worth of free care.
“We have wonderful resources and a great spirit of collaboration here at the Palm Beach County Medical Society,” Wiles says. “We try to be innovative and empowering to both physicians and patients by making resources available to them.”
For all four county medical associations Broward, Palm Beach, Dade and Lee access to care for the uninsured remains a significant challenge. Drs. Traiger and Wollschlaeger both express deep concern about the high population of indigent residents in South Florida. “The number of uninsured in Dade County is staggering 30% of the population,” says Wollschlaeger. “This impacts the entire area, and even impedes the recruitment of healthcare professionals. To address this and other problems, we are working with community partners. We believe that collaboration is better than confrontation when addressing problems. Ultimately, we all sit in the same boat and we can work for change together.”
That same spirit of unity energizes Spier, who cites the recent battle in the Florida legislature over the Managed Care Bill as evidence of what can be achieved when physicians unify their efforts. “Against seemingly impossible odds, and just about every insurance carrier in the state, we prevailed because the logic and fairness behind the effort was inescapable,” he says. “If there is something that has proven true, it is that when our cause is just, and truly has the best interests of our patients at heart, the message becomes inescapable and rings loud and clear.”
