Dr. Jeff English the Docs4Patient Care, Georgia Chapter President and the Director of Clinical Research at the MS Center of Atlanta and I have written this piece to alert patients about the rationing of vital services under ObamaCare and warn that the impacts already being seen are in fact, just the beginning.
The future is here. CMS (Center for Medicare and Medicaid Services) is notifying doctors about overutilization of services. My partners and I were among those contacted. Apparently, some of us ordered 40% more radiology tests than our "peers" did last year. (They did not bother to define “peers.”)
Those of us with a heavy concentration of multiple sclerosis (MS) patients were the only ones above the average. MS patients require radiology tests (predominantly MRI’s) for diagnosis and for routine follow-up in order to properly manage their care. The same cost problem exists with drug prescribing because medications used for MS are very expensive, which is obviously out of the control of physicians.
There is no ambiguity about what is going on. There will be rationing of care by bureaucrats in Washington who are looking at statistics instead of patients. We follow the guidelines of our professional societies (the American Academy of Neurology and the Consortium of Multiple Sclerosis Centers) with regard to the frequency of ordering MRI scans. MRI scans are the best way to diagnose and follow the progression of MS disease, but it appears faceless government employees know better than physicians and specialty organizations.
This is just the beginning. It is completely justified to guide physician behavior to improve healthcare, but what the federal government is doing is very different and very dangerous. The statistics which CMS provided to us will soon be posted on their website for public consumption.
We were informed that this was a tool to help us adjust our practice patterns to improve care. This "transparency" is an attempt to drive patients away from "over-utilizers.” There will be no explanation on this website providing details about the type of patients that doctors may be treating. Quite soon, CMS will reduce Medicare reimbursement to those who are in the top 10% of utilization. This will make it economically impossible for physicians and health care organizations to treat people with certain diseases.
How can physicians protect themselves from the iron fist of the Federal government? Quite simply, by taking care of healthy people. Patients who have expensive, chronic conditions will find it increasingly difficult to locate doctors to care for them. These patients will drive doctors and hospitals out of business because they will be penalized for taking care of people who require more testing or expensive medicine. As an alternative, physicians could order fewer tests and avoid expensive medicine, which would in the case of MS, be detrimental to patient care and lead to increasing patient disability.
Under Obamacare, if you are a patient with a "popular" disease, one that has an advocacy group with a huge political organization and lobbyists to champion your problem, you'll probably be fine because of the political pressure that such a group will apply in Washington. If your illness has not made the CMS mandate list, or does not have a Congressman to write an earmark for the care of your condition on their bill, you will be out of luck.
Politics and medicine are very bad bedfellows. Instead of experts in the field of medicine and patients making decisions on appropriate care, politicians will need to convince arbitrary government boards to dictate care. Arbitrary statistics and political influence will control treatment decisions in the future.
Jeffrey B. English, MD is the Docs 4 Patient Care, Georgia Chapter President and the Director of Clinical Research at the MS Center of Atlanta
Hal C. Scherz, MD is the Founder and President of Docs 4 Patient Care, VP of Georgia Urology, and Associate Clinical Professor Urology- Emory University.