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Last Word: We're at the breaking point


Rising costs, lower reimbursements, and needless regulations have many doctors feeling overwhelmed.



We're at the breaking point

By Stephen Weinberg, MD

Physicians today are feeling overwhelmed by the problems of our health care system, and helpless to do anything about it. Although many of us are providing more uncompensated care for uninsured and underinsured patients, we're losing the public relations battle for public support. Yet we've been reluctant to counter our critics, for fear of being perceived as self-serving.

Most of us are still trying to provide the prompt, personal, and competent care that patients have come to expect. But our expenses keep increasing—for clerical help, utilities, office supplies, health insurance, and, of course, malpractice premiums—while reimbursement from Medicare and private insurers hasn't kept pace with those rising expenses. In many regions, commercial carriers have consolidated to the point that they can dictate reimbursement schedules that are even lower than Medicare's. We're operating under a de facto price control system that leaves us powerless.

Most of us continue to provide many free services that are taken for granted: taking phone calls from patients at all hours; consulting with other doctors; filling out disability forms; and advocating patients' rights to insurance companies. We should receive payments for such "extras," but there's no incentive for insurers to do so: They know we'll continue to provide those services anyway because of our dedication.

Meanwhile, much of today's health care dollar is wasted on unnecessary utilization review, precertifications, and the inexorable paper chase. Our own practice, for example, has never been denied permission for a procedure because we're careful about proper documentation and appropriate use of services. Nevertheless, we're continually forced to apply for precertifications from the carriers, which costs us and them time and money that could certainly be put to better use.

What does the future hold? Health care costs will continue to rise for several reasons, including the use of more sophisticated and costly treatments and expensive new medications and devices. "Baby boomers" are reaching an age when they'll require significant health care. Chronically ill people will be living longer, and consuming additional health care dollars. More patients will be unable to afford their medications, thereby decreasing compliance and increasing hospitalizations.

As private insurance becomes less affordable, more employers will drop or reduce health coverage for their employees. So more patients will need and receive uncompensated care, further straining hospitals, EDs, outpatient health systems, and doctors in private practice.

Without radical change, the current system is likely to disintegrate as health care premiums double. Unfortunately, there's nothing on the horizon that will alter this progression, given our insatiable demand for health care, combined with rising costs and our aging population.

We need to push for universal health care, including drug coverage. We need increased funding for hospitals, research, and education, higher reimbursements from Medicare and private carriers, and tort reform. We doctors also need increased autonomy in our relationships with our patients, less intrusion from insurers in our practices, less unnecessary regulation and paperwork, and most important, better understanding by society of our role in the health care system.

What can be done to prevent a meltdown? What can be done to assure that we'll get the kind of change we need? We physicians must make our opinions known. I believe that our patients would support us if they understood what the health care industry has done to us. They could become our strongest allies if they understood how much uncompensated time we spend on their behalf, and the amount of free care we provide. They need to realize how dramatically reimbursements have fallen over the past decade. Our national associations need to mount an intensive campaign to educate the public about our situation, because we're reaching a breaking point.


The author is a cardiologist in Cherry Hill, NJ.


Stephen Weinberg. Last Word: We're at the breaking point. Medical Economics Sep. 19, 2003;80:102.

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