10 regulatory irritants fueling physician dissatisfaction

The phrase "Don't Tread on Me" may be traditionally associated with Revolutionary War-era America, but it's a good a slogan as any to describe the feelings of many U.S. physicians who are striving to remain in independent practice.

Read through physicians' comments on blogs, Twitter or Facebook and it won't take long to find doctors who profess to be fed up, bewildered and exasperated by what they consider to be excessive government regulation and over-reach into the practice of medicine.

For physicians who share that "Don't-Tread-On-Me" mindset, a recent report from nonprofit group The Physicians Foundation can be seen to represent a laundry list of what's ailing the medical profession.

"Centralized control of medical practice is inefficient, error-prone and an enemy of quality," states the report, called "The Unintended Consequences of Regulation: How Federal Initiatives are Driving Physicians Out of Independent Medical Practice" and written by Fred Hyde, MD, a Columbia University professor.

Below are the "top 10 irritants" that the report claims are acting as regulatory and bureaucratic constraints that distort the professional service of medicine and inflate health costs, as well as a brief explanation of each one from the report.

1. Meaningless work: This refers to federal reporting requirements like meaningful use attestation that add to the physician's work "without any direct benefit to the patient."

2. Box checking: Hyde asserts that reporting requirements such as clinical quality measures have transformed the practice of medicine into the "practice of box checking.

3. Data is replacing information: Central planning initiatives like the federal push to adopt electronic health records or transition to ICD-10 have produced "enormous amounts of data," but that data is sometimes of questionable use to physicians and patients.

4. Quality: The federal government's definition of "quality" has little relationship with things that produce positive clinical outcomes and isn't generally grounded in solid evidence, Hyde says.

5. Site of Service: Why does Medicare sometimes pay more for the same medical services when they're offered in a hospital versus a physician office?

6. Fraud: Hyde worries that a physician can be labeled a "fraud," if she makes an honest mistake. Unlike a hospital, an independent physician may not have the resources to fight an audit from Medicare's Recovery Audit Contractor program.

7. Sustainable growth rate (SGR): The SGR, which determines Medicare physician payment rates, "has no relationship to the cost of medical practice, to physician incomes or to any other factor associated with medical field productivity," Hyde asserts.

8. PCORI and IPAB: These two initiatives, included in the Affordable Care Act, are designed to promote comparative effectiveness research (CER). Hyde objects to CER because it "does nothing for my patients, but will limit what I can do for my patients.

9. Costs: While the federal government is seeking to limit Medicare's cost increases, overhead costs for physicians such as as labor and facilities are constantly rising. That creates a situation, Hyde states, in which, "It costs me to serve government patients."

10. The government is coming between me and my patients: All of the "irritants" Hyde describes drive a wedge between physicians and patients, he says. "The government has to pretend that the doctor is inefficient, fraudulent, delivers poor quality care or all of these to 'justify' the government’s limitations on payment," he writes.

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