When discussing the Affordable Care Act, politicians and talking heads seem to be exclusively focused on issues of website malfunction, rising premiums and deductibles, loss of consumer choice and debt increase.
But while these crucial issues demand evaluation, it is an unpublicized and unappreciated consequence of health care reform that threatens to fundamentally affect care in ways that will drastically reduce quality while skyrocketing costs — all totally in opposition to the goals of reform as presented by President Barack Obama.
By holding down physician payments to levels far below those required to allow private practices to survive financially, Medicare, private insurers and Obamacare are all forcing providers to see more and more patients per day just to cover their costs of care delivery.
At the same time, physicians are being forced to spend more and more hours complying with costly government regulations, mandates and massive amounts of paperwork, which robs them of the time that should be spent delivering patient care.
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Physicians are spending less and less time with patients at each and every office visit — a trend that began almost 20 years ago and is now officially in overdrive.
For physicians, the roots of this Catch 22 began when insurers and Medicare began their stranglehold on providers by reducing reimbursements to levels far below that required to maintain a functioning office practice, thus creating the option to either compress care or shutter their practices.
Studies confirm that less time spent face-to-face with patients causes reduction in the quality of care. Patients feel shortchanged, rushed and unable to adequately explain their problems and concerns in the few minutes available for them to do so.
As important questions go unanswered and treatment objectives are inadequately explained, patients become more stressed and uneasy about their condition. This in turn prompts requests for additional office visits as patients seek both peace of mind and wellness. In the process, costs are driven up.
For physicians, less time with patients results in less time to gather information and review patient complaints and less time to perform appropriate examination. The risk of making an inaccurate diagnosis goes up. This prompts physicians to rely more on costly testing and requests for consultation from colleagues to aid in making a correct diagnosis and planning effective treatment.
Once again, expenditures go up significantly.
With inadequate time to practice as they were trained, rushed providers suffer increased job stress, reduced job satisfaction and greater risk of illness, which leads to reductions in the physician work force.
Additionally, this has driven down the numbers of young physicians in this country choosing careers in primary care at the very time they are most needed.
All this creates further roadblocks to obtaining treatment and results in care that is neither affordable nor high quality and is far from what America was promised by the architects of reform.
The bottlenecks in the system that result from these issues push more and more patients to the emergency room as physician shortages and longer waits for office visits make this most costly form of care the only available alternative for many.
And thus, under the guise of reform, physicians are left to watch with dismay and frustration as the world's finest health-care system heads into unchartered waters.
The doctor-patient relationship which represents the cornerstone of high-quality health care, is under assault by those who have taken control of the care delivery system away from the caregivers.
Rather than relying on practicing physicians to guide the process of making patient-friendly improvements in our health-care system, Washington has seen fit to gamble with this precious national resource and rely on technology companies, partisan politicians, think-tank-ivory-tower experimental social engineers, insurance actuaries, the legal system and even pharmaceutical companies — all of whom have seen fit to hijack from physicians their most crucial resource for care delivery: time.
As the complaints of hospitals, doctors and all health-care providers continue to fall on deaf ears, one can only believe that it will ultimately take the collective voices of the patients we serve to rise up and try to stem the tide and alter this process before it is too late.
In the meantime, only those doctors and patients who elect to insulate themselves from the negative impact of time constraints by stepping outside the mainstream will be able to turn back the clock to a time in history when conveyor belt medicine would have never been tolerated or considered good for the health of patients or providers.