I wonder if I will be the last independent practicing ENT doctor in my community. Over the past years I have seen a continuous onslaught of changes all of which are targeted to benefit large corporations but are a burden to my little three man group. I know these changes aren't only impacting me but also any small group of doctors trying to negotiate the web of insanity.
Will we survive the next ten or twenty years?
I hope so because I am certain that the one advantage a small group has is the ability to target our care to the individual patient. When we see a need to slow down and go down a different path we can do it. If a new treatment or algorithm comes out we can make the change right away. No waiting for the corporate office for review and approval. If a patient has a complaint or a compliment it goes right to the top. No hierarchy of people between the patient and the doctor.
So why am I so concerned?
Crippling new regulations are being passed by our state and federal governments every year. For me to really comply I would need a full time attorney and a medical consultant. Obviously, us small guys can't afford that. For example, Medicare decides they want us to switch to sending in your prescriptions electronically. No problem, we spend the money, buy the software, retrain our staff and we're doing the job. But that isn't the end. They want me to prove to them I am doing this. So back in 2009 they ask me to submit a letter to them on every patient I see Medicare or not with a special code. I do this. Then in 2010 they decide to change the code. Now in 2011 I think they are changing again. By the way, do they tell me this? No, they wait until November to send me a letter that I might be doing things wrong but they don't even tell me what it is.
Hmmm, how does the little guy survive?
How about a little bit of ridiculous? The State of California has a law that I need to return a call to you within thirty minutes. Sounds reasonable doesn't it? How about if you're calling about your prescription refill while I am in the emergency room saving someone's life. Which should the priority be? Hmmm.
Even better, they have a law on the books that I have to see patients within fifteen minutes of their appointment time. What if the patient is late, am I still in trouble? Hmmm, how about a penalty if our legislators don't pass a budget within fifteen minutes of deadline? Sounds reasonable to me.
So why is this worse for my little group than the big guys? The big guys can hire people to make sure the i's are dotted and the t's crossed. Meanwhile, they watch us little guys suffer.
What will happen when the last of us closes shop? I guess independent businessmen have been suffering this fate for decades. Maybe a few of us will figure out ways to survive. Maybe we can find a way to team up, but you can imagine trying to have a bunch of independent people agree can be a challenge. Meanwhile, the geniuses in Washington, D.C. and Sacramento are going to paint themselves in to a corner. Because without us little guys to push around the big guys are going to fight hard for their interests. And you can guess who will win that battle. Just look at how the banks have controlled our economy. Well guess what? Health care is 16% of our gross national product. That's a mighty big tail swinging the dog.
What can we do?
I'm open to ideas, tell me!
