By James D. Veltmeyer
When I chose to commit over a decade of my life and incur hundreds of thousands of dollars of medical school debt to achieve my lifelong goal of becoming a doctor, I believed that my training and studies would permit me to heal the sick and save lives. I still want to believe that.
However, as any physician today can confirm, much of my time is now consumed with complying with rules, regulations and red tape imposed by government bureaucrats or begging faceless insurance company operatives for the approval of medically-necessary treatments.
One study in the American Journal of Emergency Medicine found that emergency room doctors spend 43% of their time entering electronic records, but only 28% of their time with patients. Most doctors I know say they spend 70% to 80% of their time entering clinical data and documentation. The Direct Primary Care Coalition estimates that 40% of all primary care revenue goes to claims processing and profit for insurance companies.
The problem has become so serious that thousands of doctors are leaving or considering leaving the profession. This has worsened since the arrival of Obamacare with its mandated Electronic Health Records (EHR) requirement.
With a price tag of $27 billion, the EHR mandate has resulted in many small medical practices (which cannot afford the up to $70,000 cost to purchase and install the EHR system) closing up and physicians either taking early retirements or selling out to corporate medical or hospital groups. Doctors are literally extorted to go “paperless” by having their Medicare payments cut if they do not.
That’s just one example.
Let’s take a look at the coding monstrosity. In the 1980s, Medicare imposed socialist price controls on doctors who treated the elderly. The controls forced us to use complicated coding classifications to submit our claims to the government. The codes were tied to a fee schedule. Hospitals were required to submit to a similar coding system.
This process has not only forced doctors to try to fit round pegs into square holes — consuming vast amounts of time that could be better spent with patients — but it incentivized hospitals to submit as many diagnostic codes as possible to the government in order to increase the “Medicare payday.”
Private insurers soon followed the Medicare example and imposed coding regulations on physicians as well. By making their income dependent on how much they could bill the insurance companies, many doctors began spending more and more time focused on navigating codes to generate revenue for their practice than spending time with their patients.
They also were pushed into seeing far more patients within a workday, reducing the time spent with patients sometimes to just a few minutes. Many medical practices actually employ coding specialists and maximizing profits from codes, which has become something of a cottage industry in some places.
Next, we had the rise of HMOs, PPOs and various sorts of networks which the insurance companies designed to ration care. Physicians, their staff and patients spend endless hours trying to figure out if a certain doctor or hospital is “within the network” or not, often receiving contradictory information from the insurance company and the medical provider.
Often, a patient will be assured that a doctor is “in network” only to find out later that wasn’t the case when a big, unexpected bill arrives in the mail.
Then, we have the “protocols,” certain predetermined treatment standards that often do not apply to the distinct health needs of a specific individual. Think of the notorious COVID-19 “protocols” imposed on hospitals by the CDC: lung-destroying ventilators and kidney-destroying remdesivir.
Again, another example of a government-imposed “one size fits all” approach that treats us all as groups, not individuals with unique needs and requirements. Doctors can face financial retribution if they don’t follow the “protocols,” even if their medical judgment dictates another form of treatment. And, of course, any deviation from the “diktat” must be thoroughly documented to the appropriate health care overlord.
Facing this type of straight-jacket regulatory burden mandated by government and private insurers, is it any wonder that 43% of physicians nationwide are actively looking to retire still in their prime or leave the medical field altogether?
One physician per day is committing suicide, the highest of any profession and two to three times the number in the general population. A recent poll showed that two-thirds of doctors said “government involvement is most to blame for current problems.”
And, once the exodus starts, the physician shortage matched with the increased demand caused by our “someone else pays the bill” insurance system will lead to galloping increases in health care costs which will make today’s levels look tame by comparison.
The current course in American health care is unsustainable. It doesn’t work for patients or doctors. It does work for government medicrats, insurance companies and giant hospital chains who generate the power and the profits.
The real health care reform we need isn’t Obamacare but Direct Primary Care (DPC), the model of health care which frees doctors to treat their patients as their training, judgment and circumstances dictate.
And it gives patients the market power to choose the type of medical care they want and medical provider to see, without the interference of government or insurance companies. It’s really the kind of health care we had in America until the post-World War II period – the days when an office visit was $5 or $10, doctors made house calls and you only relied on your insurance (if you had it at all) for catastrophic health events.
Yes, indeed, those were the days.
Dr. James Veltmeyer is a prominent La Jolla physician and author of “Physician on a Mission: Dr. Veltmeyer’s RX to Save America.” He was voted “Top Doctor” in San Diego County in 2012, 2014, 2016, 2017 and 2019. Veltmeyer can be reached at firstname.lastname@example.org and by visiting his website at drveltmeyer.com.