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Evidence-Based Regulation Can Level the Medical Playing Field


More and more physicians are being called on to prove that their healthcare decisions are evidence-based. The irony is, they’re also being forced to comply with regulations that don’t share the same rigorous evidentiary basis.

In healthcare today there is a large push toward practicing evidence-based medicine. This means physicians must deliver care that has been proven successful through widely accepted research. However, that same rigorous approach seems to be absent when it comes to most policies regulating the practice of medicine.

In other words, evidence-based regulation is missing.

And what’s missing as well is physicians seated at the table when policy is determined. Why?

“Other people get paid to spend their time determining policy,” says Joseph Valenti, MD, board member of the Physicians Foundation. “We do not. So, we are volunteering time for these things. And ultimately we’re not always invited to the table.”

Absent that presence, Valenti says the time and care spent on patients is suffering.

Impact on Relationships

Valenti says that physicians’ primary objective each day is their relationship with patients. But the amount of regulatory requirements that must be addressed affects their ability to care for their patients.

“So much time is being spent on things that are not patient care,” he says. “That’s why I call it evidence-based regulation. If we have to practice safe medicine—and we do—then I think whatever we’re doing from here out has to benefit the patient and/or benefit the physician’s ability to take care of the patient. And if it doesn’t do that, then we don’t need it.”

As an example, Valenti points to ICD-10. He says that switching over to ICD-10 provides no tangible benefit to patients. Some electronic medical records, he says, are not programmed with the new codes that must then be downloaded. And if diagnoses and procedures are coded incorrectly, physicians will not be reimbursed.

“ICD-10 sounds like a way to not pay us for the things we do,” Valenti says. “Otherwise, why would we need this? I mean, is calling something a different code changing the way I treat the patient? The answer is no.”

Uneven Playing Field

Valenti says another problem is that the medical playing field is very uneven. Physicians have little power. And the entities that do have power donate so much “soft money” lobbyists whose power far outweighs that of the physician.

“The real thing that is missing here is that the patients need to use their voices in order to be heard,” Valenti says. “Because together, patients and physicians, I think, can change what’s going on.”

Healthcare regulations, Valenti says, that are implemented minus physician voices can increase the cost of a medical practice doing business, as well as decreased reimbursement. For example, he says the American Medical Association pegs the cost of conducting pre-authorizations at between $2,000 and $3,000 annually for medical practices.

“That’s a huge amount of money,” Valenti says. “If someone made a comprehensive list of all the [regulations] a doctor has to meet to see a patient, you would see that the actual relationship with the patient isn’t what we do anymore.”

He believes that, at least in part, is why there’s a physician shortage. Physicians are retiring earlier because they’re fed up.

“We can’t be efficient in the office any more because it takes more people to see the same number of patients.”

All About the Patient

Valenti says that while there’s enormous frustration regarding reimbursement, regulations, and the expectation of physicians working harder, it all comes down to patient care. Because in the end, that’s what physicians do.

“But getting slapped in the face every time you try to do that is not exactly an encouraging motivator,” he says. “And it’s not a motivator for young people to pursue private practice and become a primary care doctor. We’re not creating incentives for smart people to become doctors. We’re creating roadblocks.”

Valenti says he wants to see physicians actively involved at all levels of healthcare regulation where patient care is concerned. But for real change to occur it will take more than involvement. It will require a level playing field that allows physicians to have the same voice as other players.

To that end, the Physicians Foundation is actively involved on many fronts that can have a positive impact on patients, and physicians’ ability to take care of their patients. That includes workforce issues, research and development. But the system, Valenti says, is eroding.

“I don’t have every answer,” he admits. “But I do know that practicing physicians’ voices need to be heard if we’re going to have a system that works for patients. Because ultimately, when it comes to patient care, the buck stops with the physician.”

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