Some of the changes associated with health care reform will have a great impact on physicians and their practices.
“I think the most profound way health care reform is affecting the individual physician’s practice of medicine is the administrative cost burdens of the reforms themselves,” said Dr. Terrance Furlow, an internist with Furlow and Associates in Lexington. “It has created a very large burden on the physician’s ability to manage the business part of his practice.”
The paperwork required to keep up with all the mandates of the reform can be overwhelming. “Some of the mandates reflect into insurance filing issues. Some are prior authorizations,” Furlow said. “Many of them are the required filings for quality assurance, and they’re so complicated that an individual physician or small practice cannot develop the administrative framework to comply.”
Furlow said the mandate requiring electronic records seems like a good idea, but its “meaningful use” procedures are complicated and burdensome. “It’s virtually impossible for a small group or a solo physician to go through the process of meaningful use without a consulting firm helping out,” he said. But the federal requirements are so stringent that many electronic medical records companies themselves have gone out of business.
These reforms made it more difficult to maintain solo practices, and Furlow suspects this was one of the law’s goals.
“About two years ago, one of the physicians who helped write the Health Care Reform law made a public statement that their philosophical approach to rewriting health care was they wanted to do away with private practice,” Furlow said. “I think they’re accomplishing their goal.”
Furlow made a personal decision two years ago to leave solo practice because he could foresee difficulties looming.
“I’d been in solo practice for 25 years and enjoyed small business and my patient population, but I could see the administrative burden was going to be too much,” he said. He integrated his practice into the Central Baptist Hospital system. Central Baptist has been very helpful in giving him the administrative support he needed. “I think we complement each well in making the necessary changes,” he said. “It’s been a very good move for me, and now I almost feel like I’m in a second career.”
This was the correct path for Furlow to take. However, other physicians have opted out of medicine entirely.
“There are certain physicians who, based on their practice and where they are in their personal lives and careers, believe the reforms are so difficult and onerous that they feel for their personal beliefs they can’t go on anymore, so they do move on,” Furlow said. “I think the majority of physicians in the middle grudgingly adapt and find some way to survive. Sometimes it’s a painful process to carry on.”
Furlow is wary also about mandated insurance.
“From my perspective, certainly being insured is good for everyone and I would hope all my patients would be insured,” Furlow said. “But the problem with mandated insurance [is it] makes the federal government a ‘big brother.’ As an American, I’m uncomfortable with the concept of mandated insurance controlled by the federal government. But we also have checks and balances from the people themselves, organized medicine and some of the other private groups that can demand the government change and adapt.”
Federal government should not be entirely left out of the equation, Furlow added. “There’s some standardization of the insurance industry that has to happen on a federal level,” he said. “We found you just can’t have the 50 individual states set all the insurance guidelines. The federal government is a good overseer and regulator. But where it becomes too controlling is obviously a problem. The balance has to be struck.”
Furlow is concerned about insurance companies becoming much more proactive about denying benefits for medications that are on the market, including some that are not controlled. “They keep paring down their formulary so it’s kind of one size fits all,” he said. “That’s really hurt a lot of my patients who have complicated illnesses, who need certain medications and for one reason or other it’s not in their formulary anymore.”
The challenges can undermine the doctor-patient relationship, he acknowledged.
“It’s much harder now,” he said. “You can’t put the time and effort in with each patient as was done in the past. I think there will be some unfortunate consequences in patient care and commitment between the physician and the patients as years go on. It’s going to be much more difficult.”
However, to be fair, Furlow pointed out some positive effects of health care reform.
“For instance, last year the wellness visits became available on Medicare,” he said. “They’re something I personally got very involved in early on because I have such a strong interest in preventive care.” Furlow read the regulations and structured a program for wellness visits for his Medicare patients. “It took a lot of time but I think it was worthwhile,” he said. “I’ve been able to offer a much more comprehensive preventative care program to my Medicare patients, and it’s spilled over to my non-Medicare patients as well.”
For Furlow, the issue boils down to being able to take care of his patients to the best of his ability.
“I’ve always had a strong feeling that you take one patient at a time and you do the very best you can for that individual and try to make the system adapt for that patient,” he said. “It may be swimming upstream a little more now than it used to be, but you still have to be an advocate for your patient every day.”
By Tanya J. Tyler, Associate Editor