Everyone seems to have their own story about how the Affordable Care Act has affected them. People complain about the increases in the cost of health insurance and that doctors are not providing the care they need.
The Washington Examiner spoke to six active medical practitioners to find out how it’s changing the way they care for patients. Their responses point consistently to the gradual decline in the quality and availability of medical treatment in America.
Government-mandated electronic records: Not safe or useful
All of the doctors pointed out the problems and costs associated with the push to require doctors’ offices and hospitals to use electronic medical records, which began in the 2009 Obama stimulus bill. That legislation spent $30 billion to subsidize creation of EMR systems without including measures to ensure the usefulness or safety of them.
Dr. Richard Armstrong is a board-certified surgeon practicing in Michigan’s Upper Peninsula. For the past 13 years, he has been employed by a critical access hospital.
Armstrong said the most serious problem with Obamacare is the “meaningful use” program, which requires physicians and hospitals to use EMRs to qualify for the subsidies patients receive.
The meaningful use doctrine requires doctors and hospitals to use EMRs to prescribe medicines, exchange healthcare information and meet government-specified clinical quality measures so government and hospital managers can track what each doctor does for each patient. The EMR systems must be government-certified, and results must be reported to the government every 90 days.
However, Armstrong said the government’s “very expensive and clunky” EMR systems aren’t working out as advertised because they are based on 1990s technology and aren’t very useful in tracking or implementing patients’ needs. “There’s no money to maintain, replace or modernize the EMR systems,” he said, adding that when these systems are introduced in a hospital, productivity goes down by about 40 percent. “What it’s done is put our hospital in the red.”
Further, Armstrong said that to comply with Obamacare, his hospital had to join an Obamacare rural “accountable care organization” and implement an EMR system in its clinic. That will cost $250,000-$500,000 — right out of the hospital’s bottom line.
Armstrong lives in a very small town. The hospital employs almost 280 people. The hospital is in trouble, so the whole town is in trouble, he said. He is certain that most critical care hospitals will be forced to close in the next few years.
Dr. Michael Koriwchak is an ear, nose and throat specialist in Atlanta who has taken the EMR problem into his own hands. Instead of just adopting the electronic medical records systems marketed under Obamacare, he makes it work better by adding his self-written software.
“It’s been pretty clear that ‘meaningful use’ adds nothing to quality of care,” he said. “It’s a distraction that has taken the IT healthcare market in a terrible direction in terms of providing products of value.”
Koriwchak said that what’s on the market now is pretty useless, and software companies aren’t trying to improve them. “Nobody wants to talk to experienced providers about making these systems better to actually deliver value to patients and doctors,” he said. “It’s all about compliance, not about innovation.”
Killing drug innovation
Dr. Richard Fuisz, a resident of Florida, is the inventor of various exotic means of getting medicines into patients’ systems, and is the owner of about 150 patents. He consults with other physicians on drug delivery.
Fuisz believes Obamacare has caused apathy in the pharmaceutical industry. He said that before Obamacare, the industry was far more interested in better drugs and better ways to deliver them, even though the costs they incurred, and risked, were high. Fuisz said that, due to Obamacare’s pressure on drug company profits, the industry’s interest in innovation is about 20 percent of what it once was.
He cited the example of his patent pending for a new pill shape. It grew out of studies showing that men given Tylenol for pain during heart procedures were receiving only about 35 percent of the medicine; the rest was obstructed in the esophagus. Fuisz said that before Obamacare, at least five pharmaceutical companies would have been negotiating to license his patent. Now, he’s lucky if one is interested.
Fuisz is convinced that the emphasis on reducing costs in Obamacare, and the political atmosphere that condemns physicians’ earnings and industry profits, is stifling research and development in the pharmaceutical industry.
High deductibles prevent access to care
Dr. Ori Hampel is a urologist in Houston. The city is part of the “stone belt,” he said, due to the unusually high number of people there who suffer from kidney stones.
Hampel is encountering cases in which the deductibles required by patients’ medical insurance are so high that many can’t afford what they need. He cited the example of a 16-year-old boy who was playing high school football. The boy suffered an injury that produced blood in his urine.
The boy’s mother, a single parent and school teacher, had decided to get the boy alternative healthcare coverage because it was too expensive to cover him on her plan. Because Obamacare raised insurance prices, Hampel said, that would have cost her $400-$500 a month.
Hampel wanted to order a CAT scan on the boy’s kidney, but under the Obamacare policy the mother had purchased for him, the deductible was $6,000. Even worse, the insurance prohibited Hampel from negotiating a lower price, which he can do with cash-paying patients.
To help him care for patients like this boy, Hampel is working with hospitals and care credit centers that can lend patients enough money to cover procedures that are unaffordable for them because of high deductibles. An entire population of patients is stuck without care because they can’t afford to pay the deductible, and the hospitals and doctors can’t offer them a discounted rate because of the restrictions in Obamacare.
Dr. Hal Scherz is a pediatric urologist in Atlanta. He sees the same problem that Hampel sees, but from a different angle.
“I have patients who have $6,000-$12,000 deductibles,” he said. “They usually don’t have life-threatening problems, but their problems potentially threaten certain organs. But they can’t afford a necessary operation under the standard of care. I can do that operation for $1,500, but the hospital bill comes in at $12,000-$15,000.”
Scherz said Obamacare drives costs up because “hospitals are the most expensive place to deliver healthcare.”
He said the physician’s cost is not the problem; rather, it’s all the tag-along hospital costs that make it so expensive. Facilities in doctors’ offices can offer the same services for less than half the cost, but to avoid the costs of the Obamacare system, physicians are being driven to sell those facilities to hospitals. The result is a centralization of healthcare.
“Many doctors are even selling their practices to hospitals because they can’t afford to comply with all the government regulations,” Scherz said. Furthermore, physicians are finding that they won’t be paid for their services if they don’t use the electronic medical record systems mandated by the government.
“So what’s happening in a lot of communities like Atlanta, instead of there being 22 hospitals that offer patients a choice on where to go and competitive prices, now there are four healthcare systems competing for the community,” he said.
According to Scherz, the price for selling a doctor’s practice to a hospital is declining. When a typical three-year contract expires, physicians are being squeezed, and not just in what they can earn. Scherz said the “middle manager” hospital administrators are now telling physicians how they can treat patients.
“They’re telling doctors how many patients they need to see in a given day,” he said. “If they’re not seeing the number of patients that a middle manager thinks they should be seeing, they’re being told that the managers aren’t going to pay the guaranteed salary they negotiated because their numbers aren’t high enough.”
In addition, Scherz said doctors are being told “they’re ordering the wrong tests,” which are the tests that don’t reimburse well through insurance, even if they are important for patient care.
Scherz believes this is forcing doctors to concentrate on securing their next contract rather than on the best care for patients. Similarly, hospitals are scaling back on healthcare divisions, he said, reducing the number of nurses as well as people working on patient intake. He said the hospital managers are cutting doctors’ salaries in new contracts if they don’t do what the bureaucrats demand.
“In our children’s hospital, there are more managers than there are members of the surgery department,” he said.
Scherz believes that all of these factors are degrading healthcare in this country. “If you have hospitals in charge of physicians, that means physician behavior is being managed by hospitals that don’t care about the patients as much as they care about their bottom line.”
Dr. Ramin Oskoui is the president of Foxhall Cardiology in Washington, D.C. Oskoui said Obamacare has caused a lot of his patients to lose their insurance. “Maryland used to have a high risk pool for those who wanted private health insurance but weren’t working for a company that provided it,” he said. “Everyone won, but Obamacare destroyed that.”
In addition, Oskoui said drug prices have skyrocketed due to Obamacare. Patients are forgoing certain medications or taking daily medications every other day to “make them last longer.”
The doctors’ solutions to these problems all boil down to this: If healthcare in this country is going to be the best in the world, Obamacare has to be repealed and replaced with a system that puts patients and doctors, not bureaucrats, in charge of healthcare decisions.
Jed Babbin, former U.S. deputy undersecretary of defense in the first Bush administration, is a senior fellow with the London Center for Policy Research.
