Regulatory Capture

db makes some good points about the problems in medicine today

My responses:

I would like to find anyone with half a brain in Washington and be able to strip all of this away.

1. Meaningful use – this is just silly now that most people are using EHR. I have been 100% electronic for 7 years but still do not meet “meaningful use” requirements without jumping through hoops. The government spent 40 years developing VISTA/CPRS – they should just say we all have to use that and give it to us. (it is already available in some form for free due to FOI requests)

2. Approval forms – I think I should be paid for everything I fill out. Lawyers bill for all paperwork. We should as well.

3. Prior authorization – You do of course recognize that ‘prior authorization’ is purely devised to save the insurance companies money, right? It is an entirely meaningless hoop to jump through, because the studies prove that adding hoops/regulations means that you get less of that activity. They know that a good percentage of studies will just not be done because it is too much of a hassle.

4. Billing requirements (E&M coding) was put into place to try to compensate appropriately due to complexity but it is a joke. Templates have made the notes meaningless. The only way to do away with this is to have some TRUST in the doctors. How about the old Reagan doctrine of TRUST but VERIFY. Doctors can write whatever they want in their notes to make a meaningful contribution to the care of the patient and to communicate to other doctors, like the old days. Doctors then bill at whatever level they deem fit for their services. Random audits of say 10% of the notes would be performed, and people abusing the system would be drummed out.

5. Performance measures are meaningless. Let good doctors charge more for their services. People will pay if they like their doctor. If you are a crappy doctor, people won’t pay.

6. Admission diagnosis is the dumbest thing that some hospital bean counter ever thought of. I usually admit people to the hospital because I have no idea what their diagnosis is, and I need to do some tests to figure it out.

The bottom line is that doctors have allowed business people to take over medicine. The business people were the C students when we were busting our asses and making As. Why do we let these losers come in and take over the whole show?

We have had pitiful leadership in medicine. People are too busy taking care of patients, or to scared to stick their neck out. Our “leadership” of non-practicing physicians has gotten into bed with the politicians and have gotten fat and happy sucking the teat of the government. The entire system is hopelessly corrupt. The AMA makes its money from the coding system. The ABMS/ABIM make their money making doctors jump through hoops filling out satisfaction surveys and taking tests. And now all of this is being codified by nameless and faceless bureaucrats in Washington under the aegis of MACRA.

The “SGR fix” was a scam and has taken more power away from the doctors.

The doctors have to take back the system if we are to have any hope for American medicine.

We will have to strike or revolt or something – if anyone has ideas of where to start, let me know.

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