Sept. 19--WATERLOO, Iowa -- Monthly insurance premiums and co-pays likely will continue to dominate the business of medicine in Iowa for the foreseeable future, although a changing compensation landscape could see fewer doctors and less one-on-one time between patient and provider, according to some in the profession.
Changes brought on by last year's federal medical-insurance overhaul will lead to lower Medicare payments to doctors, with Medicaid likely to follow suit, doctors say.
The options that will leave are grim, according to Dr. Jay Ginther, an orthopedic surgeon and director of the Cedar Valley Bone Health Institute in Waterloo.
"As of Jan. 1, under Obamacare and under the negotiated settlement on the debt ceiling, physician fees go down 29.5 percent from Medicare, and Medicaid may go down even more," Ginther said.
Doctors, as a result, will have to make some tough choices, Ginther said.
"I have two options, and many other physicians are in my situation," he said. "I can start seeing patients for less time, thereby seeing more per hour, or I can take more time off. If I spend the same amount of time seeing Medicare patients as I'm spending now, I will be paying out of pocket for the privilege of seeing each one."
Another option, which a potentially alarming number of physicians will choose, is to get out of the business, since about 40 percent of them are 60 or older, anyway, Ginther said.
Ginther, 65, said he has "no desire or plan" to retire, but added "there are a number of docs around the country who are getting very frustrated with the number of patients they're expected to see per hour."
He said staffs in some practices spend more than half of their time "dealing with extra documentation and filing" for insurance payment.
"Obamacare regulations, as currently proposed, will substantially increase the amount of documentation required at each visit," he said.
A solution to that dilemma is the cash-only medical practice, said Dr. Mitchell Brooks, a Dallas physician, who is one of a small but growing number of doctors who have opted out of the insurance system.
That means patients pay cash for visits or, if they have insurance, file the necessary paperwork on their own.
"I came to the decision that it was not worth my time and skill set to participate in the system the way it is, because I couldn't practice medicine the way I wanted to in that system," Brooks said. "It forces me to not spend the appropriate amount of time it takes in many instances with the patient."
One-on-one time with a patient is perhaps the most important aspect of the doctor-patient dynamic, and that's difficult when administrative costs alone account for 30 to 60 percent of doctors revenues and force limits on time spent with patients, Brooks said.
"The most important thing you can do in treating a patient is a thorough -- and I mean thorough -- history and examination," Brooks said.
Don't look for the cash-only trend to snowball in Iowa, said Dr. Mark Barnhill, chief medical officer of Iowa Health Physicians, a group that includes doctors affiliated with Iowa Health System across the state.
"I'm sure it has a small number of people who would prefer that, (but) I don't see it has having a big effect on practices," Barnhill said. "It would mean you don't participate in Medicare or Medicaid."
The risk of staying in is a tendency to practice "assembly-line medicine," Ginther said.
"It will get worse," he said. "In the next 10 years, we expect to increase the number of people on Medicare by 50 percent."
Kirk Norris, president and CEO of the Iowa Hospital Association in Des Moines, said the likelihood of doctors opting out of Medicare and Medicaid is nil, since as many as 70 percent of the state's physicians are employed by hospitals and government reimbursements account for as much as half of hospital revenues in the state. He also noted that the number of Iowa residents enrolled in Medicaid (450,000) and Medicaid (600,000) are going to increase.
But Norris also noted that the state's medical profession is responding to changes through more coordination among providers and more efficient managed care strategies.
"You could analogize it to education: You have to provide health care for the masses," he said. "The policy question is the most efficacious way to do that and how to get the highest result."
The trend in combatting the so-called "assembly-line" approach to treating patients is to bring in more of what Norris called "allied professionals," such as physician's assistants and nurse practitioners, to take off some of the pressure.
"That doesn't mean you're going to make non-physicians into physicians, but there's still only 24 hours in a day," he said.
___
(c)2011 Waterloo-Cedar Falls Courier (Waterloo, Iowa)
Visit Waterloo-Cedar Falls Courier (Waterloo, Iowa) at www.wcfcourier.com
Distributed by MCT Information Services