Obamacare rate increases in 2015 and 2016 will sweep the GOP into the White House!

Obamacare premiums will cause a firestorm at the polls in 2016! Rate increases will cause so many Americans to drop their Obamacare coverage, and those that have yet to sign-up (There is already low penetration that is well well well lower than the 75% needed) will be priced out of the healthcare market. Many Americans are going to be much worse off than they were prior to Obama breaking the American Healthcare system! Was it perfect? Hell no! But….If the Federal Government would have just bought every uninsured American a solid plan instead of wasting all this money on the Obamacare infrastructure America would not have this huge mess! Just saying!

Forbes/Opinion

JUN 10, 2015 @ 12:57 PM

GUEST POST WRITTEN BY

Robert Laszewski

Mr. Laszewski is the president of Health Policy and Strategy Associates, LLC, a policy consulting firm based in Washington, D.C.

Why Are The 2016 Obamacare Rate Increases So Large?

You might recall that I have said we wouldn’t see the real Obamacare rates until the 2017 prices are published in mid-2016. By then health plans will finally have had a couple of years of credible claim data and two of the three “3 Rs” reinsurance provisions subsidizing the insurance companies will have gone away.

I have also made the argument that after two years the Obamacare enrollment of what it needs for us to be assured that we have a sustainable risk pool—enough healthy people signed up to pay the costs for the sick.

Instead of moderate rate increases for one more year, the big rate increases have begun. They are particularly large among the health insurers with the most enrollment—the carriers with the most data.

Texas Blue Cross stands out. The health plan commented in its federal government rate filings that it covered 730,833 Obamacare individuals in 2014 with premium of $2.1 billion and claims totaling $2.5 billion––for a medical loss ratio of 119%. The plan further commented that, after the “3Rs” reinsurance adjustments, they lost 17% to 20% of premium in 2014–that would be about $400 million. And, they are only asking for a 20% rate increase.

While we won’t see all of the rates in all of the states for a few months, some state regulators have begun to make the 2016 rate actions public:

• CareFirst Blue Cross of Maryland is asking for a 34% rate increase on its PPO plan and a 26.7% rate increase for its HMO. CareFirst has an 80% market share in the Obamacare exchange and only 30% of the eligible Maryland market has signed up on the exchange.

• In Oregon, where less than 35% of the eligible have signed up on the exchange, the biggest insurer with 52% of the market, Moda, has asked for a 25.6% increase. Lifewise, with a 19% market share, has asked for a 38.5% increase.

• Blue Cross Blue Shield of Tennessee, with a 165,000 members making up 70% of the Obamacare exchange is asking for a 36.3% increase. The second biggest player, Humana HUM +1.14%, is asking for a 15.8% increase. Less than 40% of the eligible exchange market signed up in Tennessee.

• Georgia is the second biggest Obamacare market for Humana, having enrolled 254,000 people out of a total market of 479,000, and Georgia “maybe. Its CEO has said about Georgia, “We can’t have one business being subsidized by another business.” Humana is asking for 2016 individual plan rate increases from 14.8% to 19.44%.

• In Iowa, with the lowest enrollment rates in the country, and where its biggest Obamacare insurer went broke last December, Wellmark Blue Cross, which only sells off the exchange, is asking for a 43% increase on its Obamacare compliant policies. Coventry, which has 47,000 Obamacare customers, is asking for an 18% increase for its on-exchange business.

• The Kansas insurance department has not made its rate increases public yet but has said that plans will increase by as much as 38%. Less than 40% of the eligible have so far enrolled.

• Pennsylvania is not encouraging with market leader Highmark asking for increases ranging from 13.5% to 39.65% and the Geisinger HMO asking for increases from 40.6% to 58.4%. Pennsylvania enrolled 50% of the potential exchange market in 2015.

But the rate increases so far are also a mixed bag:

• In Washington State, where only 30% of the market signed up, the biggest player, Primera Blue Cross is asking for a 9.6% increase. But most of the other big plans are withdrawing their old plans and replacing them with new designs: Coordinated Care with 13% share, Lifewise 17% share, and Regence 16% share. When a carrier retools its offerings it is generally a sign of needing to go back to the drawing board. Requested rate changes for other existing plans range from -10.86% to +19.3%.

• In Connecticut, where 45% of the market signed up, the biggest insurer on the exchange, Anthem WLP +% with a 33% share, has asked for a 6.7% increase and the second biggest carrier, Connecticare, has asked for a 2% increase for its on exchange plans. Other increases range from +5.2% to +33%.

• In Michigan, where 45% of the market signed up, the biggest Blue plan with 65% market share is asking for a 9.7% increase on one of its plans and an 11.3% increase on the other. Other increases range from -12.6% to +42.2%.

• In Vermont, the state with the highest market penetration for the Obamacare exchange with 75% signing up, the dominant Blues plan is asking for increases averaging 8.3% and ranging from +4.7% to +14.3%.

There will be lots more big rate increases coming. For two months we’ve been hearing warnings out in the market that this is going to be widespread. It is also important to note that none of these insurers knew what increases their competitors were going to submit when they prepared their rate actions. What would some of these smaller players have done if they had known in advance the big players with the most data and experience were giving such large increases?

Some might argue these increases are not such a big deal because those being subsidized by the government have their out-of-pocket premiums capped as a percentage of their incomes no matter what the insurance costs. That these people apparently think this bigger price will be paid by the health insurance subsidy fairy aside, it will be important to remember that deductibles and co-pays also rise in relation to costs. When the new plans become public expect to see bigger deductibles and co-pays as well for 2016. The average individual baseline Silver Plan deductible was almost $3,000 last year.

Like last year, others will argue that these rate increases still have to be approved in some of the states. But unlike last year, the carriers now have hard data to show the insurance regulators. Some states will bring political pressure to bear on these increases. But a 35% increase is not suddenly going to become a 5% increase. There is obviously an overall claim cost problem here and regulation can sometimes push it off but it can’t make it go away.

Others will point out that people only have to switch plans to keep their costs in line since there are some carriers asking for a lot less. That’s right. But the fact that it is the big market share players that are often asking for the big increases says something important about where these cheaper plans will be next year. The big guys know something.

You just can’t look at this data and come away with a conclusion other than the big cost increases driven by too few people signing up has started. And it has started a year earlier than most of us expected.

Why are rates all over the place? There are a number of reasons.

The number of people signing up for Obamacare has varied considerably by state and is far below the level of penetration the industry typically needs to create a sustainable risk pool

State sign-ups have varied with Vermont signing up 75% of the exchange eligible and Iowa only signing up 20%––insurers typically want to see 75% sign-up. Will the third open enrollment next year turn things around? This year’s results were not encouraging with the states having the best first year enrollment stalling out in 2015––California, Washington and New York.

If this pattern of one good year of state enrollment followed by a flat enrollment continues, it is hard to see how Obamacare can reach a sustainable enrollment level.

Many, but not all, carriers are worried that the Obama administration is not going to follow through on its promises to pay off most of a carrier’s losses through the “3Rs” reinsurance program and decided not to wait another year before hiking the rates

In December’s budget deal, the Congress insisted that the third element of the program—the risk corridors—be revenue neutral after the administration last year promised it would not be capped. S&P recently reported that, “The ACA risk corridor will not receive adequate monies from insurers with profitable exchange business to pay insurers that have unprofitable exchange business.”

And in 2016, the second element of the “3Rs,” the claim reinsurance element, will see the point over which the government helps pay the claim rise from a $45,000 claim to a $90,000 claim.

Then there is the permanent and revenue neutral risk adjustor element of the program. Health insurers with the worst claims experience end up getting subsidized by the ones with the best experience. The problem is that the government won’t do this calculation on the last year’s business until after the health plans have to submit the next year’s rates making next year’s rate calculation dicey at best.

This is not an exact science

Over the years, it has been common to see one insurance company in the same market dramatically price its business differently than another. Some have more data, some are more patient, some are willing to underprice to grab more market share, some have more experience in this market niche, and some just screw it up. Over time, a few years, they all eventually get to about the same place but with lots of variation along the way.

Health plans are still dealing with incomplete data. Really, they are looking at just one year of claims experience (early 2014 to early 2015) for a brand new book of business in which the enrollment has not been stable.

What has concerned many actuaries is how the market penetration for Obamacare slowed considerably in year two in the states with the best first year enrollment results. And, almost all of the states recorded a second year growth rate of 10% to 20%. A 20% growth rate might sound good, but to hit the original Obamacare enrollment targets in this first three-year ramp-up, we needed to see enrollment almost double. Obamacare enrollment just plain looks to be stalling out just about everywhere below satisfactory levels and that is a very bad omen for insurer bottom line results.

These rates assume the King v. Burwell Supreme Court challenge to the premium subsidies in the states using the federally run exchange will be unsuccessful

If the Court eliminates the subsidies in at least 34 states, the health plans will submit new and much higher rates in those states.

Body implants to monitor a patient's health! Lower insurance and health costs!

Wanna lower health insurance rates? Charge unhealthy (Obese, smokers, alcoholics, sedentary, yada yada yada) more than you would charge those that are making the effort (with results) to take care of themselves! That’s all I am gonna say about that!

Will Body Monitoring Implants Be The Future of Healthcare?

Adam Ozimek, CONTRIBUTOR    Forbes Business     MAR 8, 2013 @ 6:00 AM 

A classic problem with insurance markets is that the insurer can’t monitor everyone’s behavior, which creates the moral hazard problem: individuals take on too much risk because they don’t have to pay the full cost. But insurance will only make people behave more risky if the insurer can’t charge them for it. Car insurance companies look to be at long last investigating ways to minimize this information problem by incentivizing drivers to put devices on their cars to partly measure how risky of drivers they are. With health care costs rising and increasingly subsidized by the government, it begs the question of whether such monitoring will become necessary for healthcare in the future?

Future technologies will certainly make this easier. Already we are seeing more and more of the “quantified self”, as new products allow us monitor our bodies and amass data about our behaviors. You can track the number of steps you take in a day, your heart rate, how many calories you’re burning, how you’re sleeping. But future technologies are pointing in an even more exhaustive, and some would say intrusive, self-monitoring direction. Research is being done on biomonitoring implants that will keep track of how your body is doing from the inside. Wired reports on how the U.S. government is funding some of this research:

In a new call for research, Darpa is asking for proposals to devise prototype implantable biosensors. Once inserted under a soldier’s skin, Darpa wants the sensors to provide real-time, accurate measurements of “DoD-relevant biomarkers” including stress hormones, like cortisol, and compounds that signal inflammation, like histamine.

Implantable sensors are only the latest of several Pentagon-backed ventures to track a soldier’s health. Darpa’s already looked into tracking “nutritional biomarkers” to evaluate troops’ diets….

With devices like these a health insurance company could offer you discounts for keeping your stress level low, eating healthy, getting more sleep, and generally engaging in behaviors that make you healthier and thus cheaper to insure. Markets will be providing feedback to us that will put a price on our vices. This not only provides us with incentives but information, as our insurers quantify and remind us of the benefits of healthy behavior in dollar terms. Importantly, unlike many paternalistic prohibitions and regulations people will be free to ignore these price signals. Furthermore, if consumers find the nudges undesirable enough then some health insurance companies won’t require them and consumers will be able to choose to avoid them altogether.

In some sense though, regulations are moving us away from this direction. The adjusted community rating part of Obamacare says that insurance companies can only adjust your insurance premium based on your age, where you live, and whether you smoke. There is an understandable motivation for this too: we want insurance to incentivize healthy behaviors, but a lot of health issues are things we are born with. To many it is clearly unfair that someone should have to pay more for healthcare because of how they did in the genetic lottery. However, the exception for smoking shows that people clearly see unhealthy behaviors as something fair to charge people for.  Yet we have an outright ban on health considerations in part because health outcomes are easier to measure than health behaviors ex post, and so any attempts to punish unhealthy behavior risks punishing unfortunate genetics. But if future technologies make reliably measuring unhealthy behaviors easier than this will be less of a problem.

While Obamacare limits how rates can be set, it does appear that discounts for wellness and prevention programs of some form will be allowed. It’s unclear whether or not this would include discounts for healthy behavior as reported by implantable biosensors. But if healthcare costs continue growing and technological innovation in this area improves the economic pressure will be on lawmakers to allow this, insurance companies to promote it, and individuals to abide by it. Obviously this will strike many today as extremely invasive, but if healthcare costs take up enough of our income then I predict the invasiveness will seem less and less consequential.

Telemedicine....lower caost of Medicine. Making care easier for everyone.

'bout time! Not only does telemedicine help patients, but it also lowers cost. Also...there an increase in the physicians quality of life (Can see patients from home)!

 

Big telehealth firm to go public as remote doctor visits gain traction

Jayne O'Donnell and Benjamin F Mitchell, USA TODAY10:55 p.m. EDT June 30, 2015

One of the largest companies in the telemedicine field is going public Wednesday in a move that signals how important remote doctor visits are becoming to the future of health care and efforts to reduce costs.

Shares in Teladoc, a growing but sometimes controversial player in the field, are priced at $19. Teladoc expects to raise gross proceeds of $180 million by selling 9.5 million shares, which includes 15% made available to the underwriters.

The expected proceeds exceed earlier estimates of about $130 million. Teladoc raised the share price from an estimated $15-17 and added more shares due to the positive reception during the investor road show.

"There was very strong reception by the investment community to the market opportunity, Teladoc's leadership position, our historical performance and our future opportunity," CEO Jason Gorevic told USA TODAY late Tuesday.

Teladoc's 700 board-certified doctors deal directly with consumers on the phone, which sets the company apart from much of the rest of telemedicine, which more often involves a physician with a sick patient who video conferences with another doctor who is often a specialist.

The company won a legal fight recently when a federal judge ruled that a Texas Medical Board regulation that prohibited doctors from diagnosing patients over the phone who they hadn't seen in person or on video was probably anti-competitive. The board was blocked from enforcing it until an antitrust suit Teladoc filed against the board was decided.

Teladoc started in 2002, and Gorevic, a former president of Empire Blue Cross Blue Shield, joined as CEO in 2009.

"I've been looking throughout my career for an opportunity to do something that could really improve quality of care, reduce the cost of care and was a win, win, win for the payers, whether the employers or the health plans, the consumer and the doctor and I finally found one," Gorevic says.

Even the telemedicine industry is conflicted about the best way to do this. Industry experts at an American Telemedicine Association conference in May debated the risks and benefits of over-the-phone consultations, saying that although it is possible to effectively and ethically treat mild conditions this way, some illnesses can't be safely treated over the phone or in a video call. Panelists noted 10% of prescriptions for pediatric sinus infections occur over the phone, and it's up to the industry to keep that number from growing since these children should be seen in person.

A RAND Corp. study commissioned by the California Healthcare Foundation found Teladoc physicians prescribed antibiotics at the same rate as doctors did during office visits.

Several studies show video is "by far preferred as the primary medium in telemedicine," says medical technology analyst Roeen Roashan.

"There is a comfort and level of intimacy that allows both physician and patient to end the session satisfied," he says. But phone consultations have "existed for many years and still play a big role today."

Though some mainstream family care doctors bristle at what they see as a risky practice, companies including PepsiCo, Bank of America and some major insurers use Teladoc as a way to cut soaring health care costs and make doctors more accessible. About 11 million of their employees and clients are Teladoc members.

Another Teladoc client, Rent-a-Center, saves an average of $754 per employee every time they do a phone consultation with a doctor, according to a Teladoc-commissioned study co-authored by Harvard Medical School associate professor and physician Niteesh Choudhry and Stanford School of Medicine professor and physician Arnold Milstein.

The biggest savings reflect what it would have cost if employees went to the emergency room instead. The authors acknowledge something Roashan points out: The savings from telephone consultations are partially offset by the number of times patients need in-office visits after the calls.

Gorevic boasts that his company does more than 500,000 of the 800,000 phone and video consultations a year that involve just one doctor and a patient. That's dwarfed by the 10 million video consultations a year that involve doctors consulting with each other about a patient, which Roashan says could double by 2018.

He's not convinced that's a good thing.

"A 15-minute video call is not the same as good health care," says Roashan, who is with IHS Technology. "There's no patient engagement, it's just a transaction."

Gorevic says his doctors offer patients the option of talking via Facetime or sending pictures or videos for doctors to see. All patients fill out medical histories before they are seen, which is typically within 10 minutes.

Teladoc was sued in early June by competitor American Well, which alleged Teladoc's technology infringed on an American Well patent. The suit seeks an injunction against Teladoc continuing to do business. Teladoc petitioned the U.S. Patent and Trademark Office in March to invalidate some of American Well's patents. Both cases are pending.

"The investment community recognizes Teladoc's opportunity to change the health care landscape," Gorevic says.

Obamacare Premium increases 50% to 30% in many States!

HOLD THE PHONE!!!! I thought Obama said I would receive a $2,500 savings on my premiums? So in a two to three year period Obamacare premium increases would double from those same 2014 premiums! So instead of saving $2,500, my premium will now cost me an extra $5,000. That is a $7,500 swing in the wrong direction!

More Obamacare Insurance Premiums to increase 30% 

by CHRISS W. STREET2 Jun 2015Newport Beach, CA 

Breitbart news

Recently, Breitbart News broke the story last week that major insurers in a number of states were proposing up to 51 percent healthcare premium increases for Obamacare policies. Now Illinois and Pennsylvania are also seeking 2016 rate hikes in the range of 30 percent.

The Obama administration late Monday afternoon disclosed more state Patient Protection and Affordable Care Act health insurance exchanges are also requesting stunningly large average health insurance premium hikes, including Blue Cross and Blue Shield of Illinois asking for an average 29 percent spike and Highmark Health Insurance Co. of Pennsylvania asking for a 30 percent spike, according to the Wall Street Journal.

This grim news follows reporting that New Mexico’s market leader , Health Care Service Corp. is asking for an average premium spike of 51.6 percent. In addition, Tennessee’s top insurer, BlueCross BlueShield of Tennessee wants an average spike of 36.3 percent; Maryland’s market leader, CareFirst BlueCross BlueShield, requested an average spike of 30.4 percent; and Oregon’s top insurer, Moda Health, is seeking a 25 percent spike.

Under Obamacare, insurers must file proposed premium rates with their local state regulator and the federal government by June for the following year beginning January 1. The 2015 rate requests ran to about three times of the 2 percent inflation rate, or 6 percent. At the time, insurance companies had only a little information about the health of the new customers they expected to sign up during the fall Obamacare expansion.

But now insurance companies across the nation are seeing their costs leap due to high utilization costs from people newly enrolled under Obamacare. Insurance companies demanding dramatically higher compensation are causing skyrocketing rates.

The steep rate requests are coming just 60 days after Democrats were ecstatic about a Robert Wood Johnson Foundation study that supposedly “Confirms that Obamacare is Saving States Money.” and a Kaiser Family Foundation study that reported similar findings for Connecticut, New Mexico, and Washington State. Researchers claimed Obamacare “expansion can produce savings in tax dollars and generate new revenue for state budgets.” As an example, Kentucky was expected to save an estimated $820 million, and Arkansas was supposed to save $370 million, according to Think Progress.

But both the Johnson and Kaiser Foundation analysis now look preposterous. Obamacare was sold as reducing the cost of healthcare inflation to below the national inflation rate. But with the current inflation rate slightly negative and the average of the Obamacare state premiums spiking by 30 percent, the exploding cost burden of Obamacare may explain a big part of the recent economic slowdown.

The new requests for huge premium hikes come as the Democrats and Republicans are under both under high stress as they wait to see what the Supreme Court will decide in King v. Burwell, which could decimate the Left’s biggest expansion of entitlements in 50 years. If the Supreme Court strikes down federal money for states that did not establish their own exchanges, 13 million people will lose about $120 billion in federal health insurance subsidies.

In the 2016 elections, the spectacular insurance premium increases should help Republicans that voted unanimously against Obamacare look smart. It may also serve as a dunce cap for Democrats that promised the law would “Cut the cost of a typical family’s health insurance premium by up to $2,500 a year.”

Who makes the decisions on Medicare reimbursements

On problem with outcome based reimbursements, and that is….Many patients do not want to be healed! Let’s face it…People like to complain (so there is no way a treatment will help), Americans have become so fat that the obese do not seek to recover from an illness or injury, and finally there is disability payments that the government will pay out (SSI). And….that’s the bottom line!

GAO: Medicare-Paid Physicians Decide How Much Money They Make

A committee of Medicare physicians controls how much doctors providing services to the government health care program’s patients are reimbursed for their services, but don’t ask to see the reasoning behind their decisions.

Physicians received more than $70 billion in such payments from the government in 2013.

The reimbursement panel withholds information about its members and voting records from taxpayers even though conflicts of interests are all but certain. The panel is comprised of doctors who benefit from its decisions, according to the Government Accountability Office.

The American Medical Association formed the Specialty Society Relative Value Scale Update Committee in 1991 to help the Centers for Medicare and Medicaid determine how much to pay physicians for each service. CMS relies heavily on the committee’s recommendations following nearly seven out of 10 of its recommendations.

“Although the [committee] is currently the only comprehensive source of information regarding physician work, its recommendations may be undermined by … potential conflicts of interest,” GAO said.

Eliminating the conflicts of interest, however, is difficult since Medicare-paid physicians are among the few experts on how much their services are worth.

“This has got to have a lot of subjectivity to it,” said John O’Shea, a senior fellow at the Heritage Foundation and a practicing surgeon. He noted that a cardiologist and a primary care physician would disagree over how much each of their services were worth.

Instead, O’Shea suggested that Medicare switch to a system that pays for a patient’s outcome, rather than a physician’s service. In other words, doctors are paid for the quality and efficiency of their patients’ recovery.

“I think the system is starting to move toward that, but it’s a fairly slow process,” O’Shea said. “The fee-for-service system is going to be around in some shape or form for a while.”

However, O’Shea admitted that a system based on care would also be flawed, since patient outcomes are often beyond a doctor’s control. Two patients could receive the same treatment for the same illness, but could see opposite results.

If a patient-outcome system can’t be developed, there could at least be improvements to the current method.

“This system can be made better, realizing this system has some inherent flaws,” O’Shea said. He agreed with the accountability office’s finding that the relative value committee lacks transparency.

For example, the committee requires certain panels to “include a mix of physician and non-physician experts” to decrease conflicts of interest, but investigators found “detailed information on composition was frequently missing,” GAO said.

The committee argued that it doesn’t disclose voting records “to protect members’ independence through the deliberation process from, for example, outside lobbying and potential negative feedback from colleagues.”

Further, the relative value committee’s votes are usually unanimous, GAO said. “This unanimity typically results from members resolving disagreements about services during deliberation.”

O’Shea believes more transparency is needed. “They say the meetings are open and that the public can go to them, but if you go, you have to sign sort of a nondisclosure form,” he said.

Consequently, CMS can’t be transparent about the panel’s work, since it heavily relies on the opaque committee. A lack of transparency and data sources “may undermine payment rate accuracy,” GAO said.

Inaccurate payment values could incentivize physicians to provide services that would give them a bigger payday from Medicare, “which affects patient care … Mis-valuation can also lead to unwise spending of taxpayers’ and beneficiaries’ money.”

Bean Counters and Office Managers cause Physicians to limit time with patients!

It’s not that Physicians do not want to spend time with Patients…Physicians would like to spend time with those they care for. Problem is the “Bean Counters” have taken control of medicine, and force physicians to treat patients as a source of revenue! That’s just the half of it…the other half are office managers that are assigned (by the Hospital/Health system) to manage the office’s operation. Most (not all…I know several good ones) of these managers are incompetent (and are only taking orders from the Bean Counters & HR)!

Why it’s hell to be a doctor in America today

By Susannah Cahalan

August 23, 2014 | 3:00pm

NY POST

Dr. Sandeep Jauhar is mad as hell.

American health care is in upheaval. On one side, overhead and malpractice insurance costs keep increasing, while salaries stagnate. On the other, patients believe that expensive drugs are better, more people are on government-run insurance that pays less, while private insurance fights every claim.

 

Now doctors spend most of their time trying to game the system, requiring endless paperwork, protracted bureaucratic battles and “treadmill medicine,” seeing as many patients as possible in as little time. This problem will only intensify as millions join the ranks of the insured under the Affordable Care Act.

 

In this self-perpetuating cycle, doctors spend most of their time as businessmen — and care suffers.

 

It’s no wonder then that doctors no longer enjoy their jobs, explains Jauhar, director of the Heart Failure Program at Long Island Jewish Medical Center and author of “Doctored: The Disillusionment of an American Physician” (Farrar, Straus and Giroux), out now.

 

“This book is meant to be like the scene in ‘Network’ when [Howard Beale] opens the window and yells, ‘We’re not going to take it anymore,’ ” Jauhar says in an interview with The Post.

 

“I see an emotional emptiness created by the relentless consideration of money. Most of us went into medicine for intellectual stimulation or the desire to develop relationships with patients, not to maximize income,” he writes.

In a 2008 study of 12,000 physicians, only 6% described their morale as positive. Even insurance claim clerks polled in a different study were happier.

As managed care has grown (by the 2000s, 95% of insured workers were in some kind of managed care plans), so has physicians’ discontent. In 1973, fewer than 15% of physicians reported any doubts about career choices. Today nearly 40% say that they would not choose to enter the medical profession if given the opportunity to do it all over.

 

If things continue as they are, the US can expect a shortage of 150,000 doctors by 2025, according to the American Medical College. Jauhar says that doctors on the online community SERMO are threatening to leave the country or scrap their private practices.

 

The serious downside here is obvious: Unhappy doctors make for unhappier patients.

“The physician-patient relationship is the worst it ever was,” he says.

 

To hammer in this point, Jauhar quotes facts from the Commonwealth Fund: The US ranks 45th in life expectancy (“behind Bosnia and Jordan,” he adds) and compared to other developed countries near last in infant mortality and health-care quality, access and efficiency. We also have fewer physicians and hospital beds than average.

 

This “mid-life crisis in medicine” is reflected in Jauhar’s own writing.

Readers can follow his skepticism in “Intern,” his first book about his internship year at New York Presybterian, harden into disillusionment in “Doctored,” which chronicles his time at LIJ as he enters his middle age (he’s now 44).

 

“Doctored” opens with: “When I look at my career in midlife, I realize that in many ways I have become the kind of doctor I never thought I’d be: impatient, occasionally indifferent, at times dismissive or paternalistic.”

This “kind of doctor,” once so idealistic, now takes morally ambiguous speaking gigs with pharmaceutical companies and side-jobs at “sketchy” cardiologist private practices who push for expensive and often unnecessary tests for the reimbursements.

And this is where the book gets really bleak. Doctors — like his own brother, also a cardiologist — refer to patients as “commodities.” One physician at LIJ admitted that “sometimes you have to drag out” a hospital stay for a patient if you want to get paid.

He writes about one of his patients, a 50-something man who complained of shortness of breath. Fourteen doctors, 12 procedures, and hundreds of thousands of dollars later, he was released with minimal improvement.

 

This is a problem not only of milking income, which of course happens, but because doctors just don’t have the time to do their jobs. Primary care physicians (doctors who Jauhar believes are most unhappy) spend an average of eight to 10 minutes per patient.

It’s a self-fulfilling prophecy. With less time for each patient—studies show (no surprise here) that rushed doctors listen less — relying on expensive tests, which don’t necessarily lead to more accurate diagnoses. Med school advises doctors-in-training that you should be able to diagnose 80% of cases with a health history and an exam alone.

 

No further tests required.

 

But in this exam on-the-run environment, doctors are more likely to practice “defensive medicine,” or “cover your ass” medicine — costing us about $750 billion a year (of the $3.8 trillion we spend a year) in wasteful procedures that lead nowhere.

“After so many years in medicine, I am convinced of one thing: The vast majority of doctors aren’t bad. It is the system that makes us bad, makes us make mistakes,” he writes. “There is a palpable sense of grieving. The job for many has become just that — a job.”

Hospital's and Health Systems cannot afford to pay Physicians....so Phyicians back to private practices!

Just one problem….Many newly trained physicians are being taught to treat patients in an employed model! Let’s just see how it all works out. At any rate…Private Single Specialty practices will be growing in number, and at the end of the day patients will benefit!

Hospitals to reverse trend of employing doctors – consultant

Mar 3, 2015, 1:27pm EST Updated: Mar 30, 2015, 10:04am EDT

 

Carrie Ghose           Staff reporter- Columbus Business First

 

Hospitals and health systems nationwide are losing millions on physicians they've employed by acquiring practices, so a practice-management specialist predicts doctors will soon start spinning out on their own again.

"The pendulum has swung," Tom Ferkovic, managing director of Medic Management Group LLC. "We're starting to see hospitals can no longer afford to own all the practices."

As a result, he expects growth in the 154-person Akron-based firm, including its Columbus office, now with five employees.

The consulting and management outsourcing company renamed itself from SS&G Healthcare Services LLC in December, after BDO USA LLP acquired Cleveland accounting firm SS&G Inc. The health-care consultants were a 15-year-old separate company that co-branded with SS&G, and opted not to go with BDO. Partners in the former SS&G still own shares. The Columbus branch is currently hunting space to leave the BDO office on Spring Street.

Medic Management takes over a practice's back-office functions – billing, insurance reimbursement, payroll – to increase efficiency. As hospitals started acquiring its clients statewide, it formed a hospital division because the health systems didn't have infrastructure or experience running practices.

Nationwide, health systems lost on average $188,000 on each employed physician in 2013, and that increased last year, according to surveys by the Medical Group Management Association, which also is asking if " the tide has ebbed" on acquisitions. In Ohio it's slightly lower, about $187,000, Ferkovic said, and his group has helped hospitals stem such losses.

Physicians have started leaving hospital umbrellas in northern Ohio and out-of-state, he said.

"We're starting to hear discussions of it in (Central and) southern Ohio," he said. "It's coming. We're hearing noise from some of our clients about it."

This has happened before: In the 1990s hospitals started selling off practices acquired in a previous wave. But in 2008, health systems said things were different this time because they would base physician pay on productivity. Hospital employment stretched from primary care to specialties; Central Ohio's last independent cardiology practice group closed in 2014.

But insurance reimbursement still didn't match what hospitals pay doctors. Systems would make that up with lab tests, imaging and procedures – but now Medicare and private insurers are cutting reimbursement rates for those, Ferkovic said.

Doctors who leave aren't going back into untenable solo or two-person offices, he said. They're forming large 30-plus doctor groups, and smaller independent practices are consolidating. Central Ohio Primary Care Physicians Inc. and Orthopedic One – themselves the products of acquisitions and mergers – are among fewer than a dozen independent practices statewide with more than 30 doctors. Expect more, he said.

"Large private groups in the state have done very well over the last few years," he said. "Some are doing really creative things with quality measures and contracting for risk and bundled payments. They're faster, they're more nimble when they have an issue on fixing those, because its their money."