In the 1990s insurance companies developed managed-care plans that greatly increased their profits at the expense of the physician. With the Affordable Care Act, we are seeing new groups profiting from changes to the health-care system. Entrepreneurs and hospital executives are capitalizing on organizing physicians into groups called Accountable Care Organizations from which they will take a very substantial percentage of collected income. Now that physicians are being required to use electronic medical records, the companies that develop them are harvesting money from physicians’ practices and from hospitals.

The push to use electronic medical records has had more than financial costs. Although it is convenient to have patient records accessible on the Internet, the data processing involved has been extremely time consuming—a sentiment echoed by most of my colleagues. To save time, I was advised by a consultant to enter data into the electronic record during the office visit. When I tried this I found that typing in the data was disruptive to the patient visit. My eyes were focused on the keyboard and the lack of direct contact kept patients from opening up and discussing their medical and personal problems. I soon returned to my old method of dictating notes and pasting a print-out of the dictation into the electronic record.

Yet to avoid future financial penalties from Medicare, I must demonstrate “meaningful use” of the electronic record. This involves documenting that I covered a checklist of items during the office visit, so I spend 90 minutes each day entering mostly meaningless data. This is time better spent calling patients to answer questions or keeping updated with the medical literature.

If electronic records ever allow physicians to obtain data from previous laboratory and imaging testing, it will improve costs and patient care. So far, however, the data in electronic records—like paper charts—can’t be shared unless physicians work in the same health-care system.

My practice quickly adopted the new Medicare requirements for electronically prescribing medications. Yet patients often do not want their prescription sent electronically. They want a physical copy—either because they don’t trust the Internet or because they don’t need to fill the prescription immediately. If I don’t electronically prescribe for a certain number of Medicare patients, I am penalized with a decrease in reimbursement that can rise to a maximum of 5%. Patients should have a choice in how their prescriptions are delivered, and physicians shouldn’t be penalized for how the patients choose. (more…)

The end of government

By Robert J. Samuelson, Published: February 9, 2014

Something strange is happening in Washington. We are slowly dismantling the federal government, even as its spending is growing larger. The paradox is that governmental competence is being systematically degraded while the government’s size, as measured by its budget, is increasing. We are spending more and getting less, and — unless present trends are reversed — this will continue for years. It threatens the end of government as we know it.

The cause is no mystery. An aging population and higher health spending automatically increase budget outlays, which induce the president and Congress to curb spending on almost everything else, from defense to food stamps. Over the next decade, all the government’s projected program growth stems from Social Security and health care, including the Affordable Care Act. By 2024, everything else will represent only 7.4 percent of national income (gross domestic product), the lowest share since at least 1940, says Douglas Elmendorf, head of the Congressional Budget Office.

This is the central budget story, and it’s largely missed — or ignored — by political leaders, the media, political scientists and the public. The welfare state is taking over government. It’s strangling government’s ability to respond to other national problems and priorities, because the constituencies for welfare benefits, led by Social Security’s 57 million, are more numerous and powerful than their competitors for federal support. Politicians of both parties are loath to challenge these large, expectant and generally sympathetic groups.

The United States, of course, is not the only advanced society grappling with aging, but it is extreme in its stubborn denial of the obvious. The Pew Research Center recently polled people in 21 countries about whether aging is a problem. The United States ranked 19th in its unconcern, ahead of only Indonesia and Egypt, whose populations are young. Only 26 percent of Americans thought aging was a problem. The share was 87 percent in Japan, 55 percent in Germany and 45 percent in France. (more…)