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Doctors Differ In Diagnosing Supreme Court Ruling

Joe Cantlupe, for HealthLeaders Media, July 5, 2012

For physicians, it's the uncertainty that confuses, frightens, and annoys, he adds.

"Physicians are among the most change-averse humans on the planet," adds Fleming says. "Docs have been burned [in reimbursement issues] and primary care docs have been burned more than most. Cardiologists have been burned, their fees have been slashed. Radiologists have had their fees cut. So basically you are asking physicians, ‘You want to accept something that doesn't have details yet?' How am I supposed to feel about that? That's where the negativity comes in."

But the PPACA decision also has immediate positive impacts in other areas, according to the AMA. It can begin to alleviate administrative burdens on physicians, such as streamlining insurance claims. In addition, the decision ensures that the act carries out important improvements in healthcare, AMA President Jeremy A. Lazarus, MD, said in a statement. Included in that assurance is putting an end to coverage denials for pre-existing conditions, and allowing 2.5 million young people up to age 26 to stay on their parents' health insurance policies.

Regardless of the Supreme Court decision, many physicians are on board for movement from fee-for-service to value-based care, as well as exploring payment options ranging from bundling to those included in accountable care organizations, with an emphasis on patient-centered care. "The devil will be in the details how it all works out," Fleming says.

As part of the crowd that amassed last week outside the Supreme Court, I was told the decision drew some of the loudest and most vociferous crowds in memory outside its marble walls, with many people carrying placards praising the decision or denouncing it, some with megaphones, some with drums, arguing or chanting for whatever position they held.

One physician who stuck out in the crowd was Michael Newman, MD, a Washington D.C.–based internist. He wore a white coat and carried blue binder notebooks. He wasn't part of a group of protesters, but simply a practitioner who works a few blocks away from the Supreme Court building and wanted to see history unfold. He identified himself as a supporter of healthcare reform. Newman acknowledges he may be in the minority of physicians who favor what the Supreme Court has done, but is pleased that it may result in more care for the currently uninsured, for instance.

"There is definitely disagreement about the law, but it's not up to the Supreme Court to fix the problems of healthcare. It's up to the people,." Newman says. "The Affordable Care Act is not the greatest piece of legislation, but the best piece that could be enacted."


Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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4 comments on "Doctors Differ In Diagnosing Supreme Court Ruling"


R Daniel King (7/7/2012 at 11:05 AM)
The Center for Medicare and Medicaid Service has utilized price controls and regulations to control costs and quality respectively. Price controls for centuries have cultivated poor quality, fraud, lost talent, shortages, surpluses, organized crime etc. And federal regulations have extinguished innovation in the delivery system masked by the innovation in industries not subjected to price controls but sell great innovation in medical technology and drugs to the delivery system. Price controls have caused the quality chasm identified in the 1999 Institute of Medicare Report, and to this day, poor quality is still a cash cow as CMS uses savings from price ceilings to reimburse preventable medical errors (minus a few). When Intermountain Health System focused on preventing medical errors, it took a loss on every Medicare patient because CMS price ceilings underpay excellence. Price ceilings have caused a shortage crisis in primary care physicians. Plus, the limits in income contributes to the "less than stellar" medical school applicants in recent decades as the talented students choose price control-free careers. Price floors have resulted in overpayments to cardiologist (recently and painfully corrected) creating years of surpluses and waste. The same for CT scans because CMS's pricing system is slow to respond to technological advances that lowered costs while increasing value. Decades of CMS underpaying excellence has made excellence a cultural misfit in the nation's inefficient, quality challenged healthcare delivery system with few exceptions. And decades of government rewarding failure has filled the quality chasm with a culture of failure that ObamaCare puts on government steroids which makes ObamaCare a dead program spending just like Maine's Dirigo Health, Tennessee's TennCare, and Hawaii's employer mandates.

Tyco Brahe (7/6/2012 at 11:14 AM)
For those who decry government intrusion: The government ONLY has to step in when the private sector has failed. Medicare, SS, Medicaid are ALL programs that the government was forced to [INVALID] because the private sector ignored vulnerable populations. This healthcare reform law is the same. If 1/6th of the country weren't left uninsured because private insurance cost so much, the government would not have to step in. As for expanding Medicaid, just because some doctors don't take medicaid doesn't mean no doctors will. In fact, city hospitals and community health centers ALL take medicaid. If doctors won't take the insurance, watch nurses and PA's suddenly start getting the right to give direct primary care. You cannot leave a large chunk of America without care just because doctors won't take government insurance. The rules will all change. This is all a bump in the road to single-payer medicine. All the other developed countries have figured it out. We will too. Insurance companies and provider greed have forced the hand of the government.

Jay A. Hendrickson, M.D. (7/5/2012 at 5:02 PM)
The reason we are in the current Healthcare predicament is because of governmental intrusion. Where has the government stepped in to a business and made it more efficient, streamlined and overall better? That is correct- NEVER!!!!! As a physician I refuse to work for free, as I did during residency and fellowship. Medicaid pays about 9 cents on the dollar here in California. I can not run a practice without getting pain for the work that I do for the patients. Expanding Medicaid is USELESS. How many physicians, other than University physician, even take Medicaid? None in my area! I also find it amazing how some physicians are happy with this Federal Law. It is equivalent to having a prostitute teach your children abstinence- it makes no sense. As far as the AMA is concerned, I have not been a member for over 10 years now and 80-85% of my colleagues agree with me as only 15-18% of physicians are members. So all of you that think this is a good law, then you can see those patients for free, because your reimbursement will be ZILCH!!!!