Health Care Reform

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• Health Care Reform
• Protecting the Patient-Physician Relationship
• David E. Rogers, MD, MBA
• Assistant Prof. Obstetrics and Gynecology
• University of Texas Southwestern Medical Center
  Dallas, Texas

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• The Patient-Physician Relationship

Much more than what we see in television and
movies.
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The Deterioration of the Patient-Physician
Relationship

• Depersonalization of Practice
• Managed Care and Physician Networks have led to
  physicians being bought and sold like
  commodities.
• Loss of Autonomy and Administrative Hassles
• Institutional and governmental oversight and
  regulation. Practice guidelines.
• Medical Malpractice
• Rise in defensive medicine. Presently at the
  center of many access problems.
• Lower Reimbursement
• Doctors have to be able to keep their doors open.
• Information Technology Computers
• Is it good or bad for patients?

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Physician Problems with Healthcare Reform

• The practice of medicine is enormously COMPLEX!
• The unavoidable Paradox
• COST QUALITY ACCESS
• We can only control TWO at a time.

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• Texas Medical Association
• 2008
• Physician Survey Data

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• Being insured does not necessarily give access
  to care

Insurance ? Health Care
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From 2008 TMA Physician Survey
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From 2008 TMA Physician Survey
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From 2008 TMA Physician Survey
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• Why dont physicians accept all payers?

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From 2008 TMA Physician Survey
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From 2008 TMA Physician Survey
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From 2008 TMA Physician Survey
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Physician Cost/Revenue Comparison
Sources MGMA Cost Survey (medians), Centers for
Medicare Medicaid Services , Medicaid Fee
Schedule
Note Cost and revenue are reported here per
Relative Value Unit a Medicare measure of the
units of service produced. One RVU is
approximately the value of the simplest office
visit for a new patient.
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The Bottom Line with Medicare / Medicaid

• RVUs are measures of services provided.
• MGMA measured practice cost 58 / RVU.
• Medicare pays 36 / RVU.
• The 22 deficit represents a NEGATIVE 38
  OPERATING MARGIN for a practice if it were a
  totally government reimbursed practice!

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Government or insurance programs might
not improve access to care if they

• Increase the administrative cost for physicians
  and patients
• Take too much of the physicians time and
  attention away from patient care
• Pay less than it costs the physician to provide
  care
• Increase demand for physician care more than they
  increase physician supply.
• Increase payment problems, inadequacies and
  inefficiencies which will decrease physician
  supply or decrease the number of patients than
  can be treated by physicians.

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Challenges for the Public and Government

• Understand / Respect the enormous training and
  sacrifice it takes to become a physician.
• Understand the enormous COMPLEXITY of medical
  care.
• Understand the COST QUALITY ACCESS paradox.
• Understand that medical decisions are best left
  in the hands of patients and their physicians.

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Challenges for Physicians and other Providers

• Continue to take care of our patients! JOB 1
• Understand the COST QUALITY ACCESS paradox.
• Be willing to participate in the solution making
  process.
• Understand that when the dust settles on whatever
  type of health care reform we havethe
  Patient-Physician Relationship may be the only
  aspect of healthcare where we still have some
  influence.

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UT Southwestern Medical Center