Sermo Blog: Highlights from the MD community

From the Founder: Prediction for 2010, Docs Stop Playing the Victim

1.  Turns Out Legislators Want Physicians To Be Employees After All

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Very quietly, the State of Massachusetts has started the process of linking a physician's eligibility for medical license to their participation in the state's public access program (click here for the legislation).  For the national healthcare system, this is a critical development because the current versions of the Senate and House bills have a tremendous amount of similarity to the program that Massachusetts enacted several years back.  Having fallen into the same trap as Massachusetts by not addressing the root causes of health inflation, the rest of the country will no doubt follow the same trajectory and be left with same choice of forcing physicians to participate against their will.  For physicians, it is a vision of things to come (join the discussion here).  For the country it is the perhaps the clearest evidence yet what could be the unintended consequences of this reform effort and an alarming move towards socialism.

2.  Physicians WERE Right About Tort Reform

The timing around the recent Congressional Budget Office "revelation" that tort reform would in fact lead to "at least" $50 Billion in cost savings over 10 years, rather than originally estimated $5 Billion is deeply upsetting to physicians (click here for the CBO report).  Sermo physicians had listed tort-malpractice reform as a number one priority back in May, when the Physician's Appeal was launched.  The fact that the CBO only updated their estimate in mid-December is concerning.

3. Recognition that the AMA's Support was "Purchased"

There is growing discontent among physicians that the AMA's support of the healthcare reform effort was less about physician advocacy and more about the AMA protecting its own financial interests.  The fact that the AMA receives the bulk of their $300MM in revenue, not from its physician members, but from insurance companies and hospitals, through a "special" arrangement with the government to provide CPT billing codes seems to be further eroding the claim that physicians in fact support the current reform efforts, not to mention the AMA's legitimacy.  This was nicely described in a WSJ letter to the editor (click here) and a LA Times-Chicago Tribune Article (click here).

How are physicians responding to this?…..they seem to be taking the lead from the very institution that had been held up of late as the paragon of exceptional, cost-effect healthcare delivery…..Mayo.  So what has Mayo done that has inspired the physicians of this country so much?  Opted out.

By choosing to stop accepting Medicare payments, the Mayo is capturing the imagination (and respect) of physicians across the country (click here for the story).  The response on Sermo has been nothing sort of dramatic.  Discussions around conversion to cash practice and "opting out" are rising dramatically.

In this shifting sentiment, I am starting to see some clear patterns that make me wonder if 2010 might look very, very different for physicians.  I don't think physicians are going to be victims much longer.  Here are my predictions:

1. Physician Interest in Alternative Business Models Continues To Grow

Discussions around alternative business models continue to grow on Sermo.  Perhaps for the first time, physicians are communicating with each other on a large scale about the business of medicine and in doing so, leveling the playing field.  Sermo has supported this effort through our Practice Management Exchange (click here), and now includes a number of CME courses on alternative business models.  This increased awareness will translate into more sophistication and awareness among physicians before signing the increasingly onerous third party payor agreements that have acted to shackle them.  It is also leading to physicians, like Mayo, to opt out of Medicare and Medicaid in larger and larger numbers.  I believe this represents the single biggest shift in physician attitudes in the past 25 years.  Where organizations and associations have largely failed physicians, the doctor's drive to stay in business so they can continue to treat their patients will force them to make some hard decision, and gradually allow market forces to accomplish what advocacy never could.

2.Market Forces Will Be Felt By Patients

Physicians have long sought to protect their patients from the inefficiencies and costs in the healthcare system.  This is beginning to fray.  As physicians start taking the necessary steps to maintain their own financial viability and autonomy, patient access to healthcare resources will be pressured.  Ultimately, this strain will re-unite patients and physicians and start to squeeze out the countless interlocutors who created much of the inefficiencies in our healthcare system.  That being said, it will be a tough couple of years for patients, especially senior citizens and those with lower income, as their access to physicians is increasingly jeopardized.

3.  EMRs Enter the Fray

EMRs are finally gaining momentum.  Their greatest application and the reason for their increasing adoption, however, will not necessarily be in improving patient care or creating efficiencies, EMRs hold tremendous promise for establishing more efficient billing and transaction processing.  EMRs are becoming a financial imperative, not a clinical one.

4. The AMA will Reinvent Itself

With less than 1 in 5 physicians actually AMA members, there is much discussion among physicians about a class action law suit, accusing the AMA of misrepresenting themselves as representing this country's physicians and/or pursuing damages from the AMA.  While I understand the appeal this holds for so many physicians, I do not think it is in the best interest of physicians in this country or patients.  The AMA is well into an effort to re-brand themselves as a public health, rather than physician advocacy organization.  The AMA has already removed most references to physicians in their public face and in fact spent over $40 million dollars in their "Voice for the Uninsured" campaign over the summer.  In 2010, we'll see the AMA achieve a détente with their own physician leadership who still revel in the AMA's perceived prestige, while the commercial side of the AMA accelerates efforts to limit their dependence on physicians by polishing their credentials as a public health organization and ultimately opening AMA membership to non-physician providers, such as nurses, PAs, and administrators.  In 2010, I predict that physicians will evolve past the AMA and the AMA will evolve past physicians.  Both parties will probably be better of without each other.