The title of this blog may seem somewhat preposterous to the uninformed. How could a physician practicing medicine be at risk for personal bankruptcy? The answer is simple. When Obamacare finally is implemented, there will be a number of reimbursement schemes that the government has concocted with insurance carriers such that the American Medical Association (AMA) warned physicians of this possibility in an e-mail sent August 13, 2012. The e-mail contained a reference to a 162 page document entitled, “EVALUATING AND NEGOTIATING PAYMENT OPTIONS, ” which contains guidelines for physicians when negotiating various contracts resulting from the implementation of Obamacare. On page 10 the following statement is found:
“A physician’s failure to assess accurately and manage the risk associated with capitated, shared savings, bundled payment, or risk-based pay-for-performance agreements may threaten the viability of the practice, even to the point of forcing the practice into bankruptcy.”
The AMA document also suggested that physicians hire actuaries and business attorneys to assist them with their efforts. The following is a list of various billing and reimbursement schemes, as outlined by the AMA, that physicians must become familiar with as Obamacare unfolds:
- Fee for Service
- Pay for Performance
- Capitation
- Shared Savings
- Bundled Payments
- Withholds
- Risk Management
- Stop-loss Insurance
- Joint Contracting-Collective Bargaining
- Working Actuaries
After wading through the 162 page document, one could pose the question as to whether younger physicians have been taught the “business of medicine” during medical school and/or in their residency programs? Recently, Merritt Hawkins published the results of a study entitled, “2011 Survey of Final-Year Medical Residents” which was quite disturbing when considering the above question. The following summarizes some of the findings:
- 29% of physicians would choose a career other than medicine
- 56% received no formal instruction regarding the “business of medicine”
- 50% said they were “unprepared to handle the business side of medicine”
In 2014 if Obamacare is not overturned, 30,000,000 people will be added to the healthcare system. In 2015, 62,900 fewer physicians will practice medicine because of retirement. Given these statistics, economic pressure from diverse forms of reimbursement described above could force additional physicians from the practice of medicine. In addition, less than 50% of primary care clinicians were accepting new Medicaid patients as of 2008. Given these statistics, it will be very difficult for those new patients who will be eligible for Medicaid services under Obamacare to find physicians to care for them.
In conclusion, the above reimbursement schemes are so complex and convoluted that healthcare reform begs for simplification of the reimbursement process. The only way to change this is to repeal Obamacare and include physicians in the process as healthcare is streamlined and made more efficient. This would allow the physician to care for more patients without having to have an advanced degree in business management to survive!
